Ophthalmology Book

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Cataract Extraction

Aka: Cataract Extraction
  1. See Also
    1. Cataract
    2. Floppy Iris Syndrome
  2. Definition
    1. Surgical removal of lens
  3. Indication: Visual Impairment secondary to Cataract
    1. Prevents Activities of Daily Living (ADL)
    2. Significantly interferes with patient's life-style
  4. Efficacy
    1. Patients achieving vision 20/40 or better: 90%
    2. Patients with significantly improved vision: 95%
    3. Preoperative exam can predict poorer outcome
  5. Preparation
    1. Preoperative exam
      1. Medical conditions stable
      2. No current infectious disease
      3. No current Skin Infections
      4. Medication history of any Alpha Adrenergic Antagonists
        1. See Floppy Iris Syndrome
    2. Topical antibiotic used preoperatively
      1. Cleanses the lids
  6. Technique: General
    1. Outpatient 1 hour procedure under Local Anesthesia
    2. Techniques
      1. Extracapsular (95%)
        1. Lens nucleus removed through anterior lens capsule
          1. Phacoemulsification used on younger patients
            1. Soft lens fragmented with Ultrasound
            2. Lens components aspirated
        2. Posterior lens capsule polished and left intact
        3. Causes less derangement of surrounding tissue
        4. Provides chassis for new lens implant
      2. Intracapsular
        1. Older technique, used up until the mid 1980's
        2. Entire lens and capsule removed
        3. Lens frozen to cryoextractor tip and removed
  7. Technique: Lens Replacement
    1. Background
      1. Surgical Aphakia (absent lens)
      2. With Cataract removed, vision blurred without lens
    2. Types
      1. Intraocular lens Implant (95%)
        1. Implanted at time of Cataract surgery
        2. Lens implant can be delayed years after surgery
      2. Contact Lenses
        1. Difficult to handle for many elderly
        2. Requires sufficient eye tearing
      3. Aphakic Spectacles (least desirable)
        1. Magnify Vision 33%
        2. Distort images
        3. Limits peripheral vision
        4. Not tolerable for single eye correction
          1. Due to magnification difference
  8. Precautions: Floppy Iris Syndrome
    1. See Floppy Iris Syndrome
    2. Current or prior use of Alpha Adrenergic Antagonists can have a significantly increased risk of intraoperative complications
  9. Management: Postoperative follow-up
    1. Ophthalmology follow-up:
      1. 24 hours after surgery
      2. 2-4 days after surgery
      3. Periodic exams until lens prescribed at 2-3 months
      4. Urgently for change in eye appearance or sensation
    2. Precautions
      1. Avoid Eye Trauma
      2. Avoid Increased Intraocular Pressure
        1. Strenuous Physical Activity
        2. Bending
      3. Use eye-shields or glasses all the time
    3. Management
      1. Eye patch
        1. Worn continuously for first week after surgery
        2. Worn only at night After first week
      2. Activities
        1. After first week, normal activities performed
        2. Patient may drive after first week if vision ok
      3. Medications
        1. Topical antibiotic and steroid for first 3-4 weeks
      4. Suture
        1. Small enough (10-0 nylon) to not require removal
        2. Suture removed at 6-8 weeks if necessary
      5. Healing
        1. Completely healed by 3 months after surgery
        2. May obtain final Refraction at that time
  10. Complications (5% Incidence of major complication)
    1. See Floppy Iris Syndrome
    2. Fulminant Endophthalmitis (0.1% Incidence)
      1. Infection inside eye occurs within first week
      2. Caused by Staphylococcus and Streptococcus
      3. Vision Loss can occur in 24 hours (0.02% Incidence)
    3. Glaucoma
      1. Occurs in first 4 days
    4. Hemorrhage
    5. Suture breakage
    6. Intraocular lens displacement
    7. Iritis
    8. Clouding of Posterior Capsule
      1. Occurs in up to 50% of patients
      2. Follows extracapsular extraction within several years
      3. Treated by Neodymium YAG laser
        1. Causes breakdown of posterior capsule

Cataract Extraction (C0007389)

Definition (MSH) The removal of a cataractous CRYSTALLINE LENS from the eye.
Concepts Therapeutic or Preventive Procedure (T061)
MSH D002387
SnomedCT 54885007, 265822000, 274013007, 148886005, 148879002
English Cataract Extractions, Extractions, Cataract, Extraction, Cataract, CE - Cataract extraction, Cataract extractions, cataract extraction (treatment), cataract extraction, cataract extractions, cataract surgery, cataracts surgery, cataract surgeries, cataract excision, cataract removal surgery, Cataract extractions (procedure), Cataract extraction, Excision of cataract, Extraction of cataract (procedure), Extraction of cataract, Extraction of cataract, NOS, Excision of cataract, NOS, Cataract extraction, NOS, Cataract extraction NOS, Cataract Extraction
Spanish resección de catarata, Extracción de catarata, escisión de una catarata, extracción de una catarata (procedimiento), extracción de una catarata, Extracción de Catarata
Dutch cataractextractie, Cataractextractie, Extractie, cataract-
French Extraction du cristallin, Extraction de cataracte
Italian Estrazione di cataratta, Estrazione della cataratta
Portuguese Extracção de catarata, Extração de Catarata
Japanese 白内障による水晶体摘出, ハクナイショウニヨルスイショウタイテキシュツ, 毛様小体離断法-酵素性, 酵素的毛様小体離断法, 毛様小体離断法-酵素的, 白内障摘出, 酵素的小帯融解術, 白内障摘出術
Swedish Starroperation
Finnish Kaihenpoisto
Russian FERMENTNYI ZONULOLIZ, KATARAKTY EKSTRAKTSIIA, КАТАРАКТЫ ЭКСТРАКЦИЯ, ФЕРМЕНТНЫЙ ЗОНУЛОЛИЗ
Czech Extrakce katarakty, extrakce katarakty, čočka oční - extrakce, extrakce oční čočky, katarakta - extrakce
Croatian KATARAKTA, EKSTRAKCIJA
Polish Usunięcie zaćmy, Zonuloliza enzymatyczna
Hungarian Cataracta extractio
Norwegian Grå stær-kirurgi, Grå stær-operasjon, Kataraktkirurgi
German Kataraktextraktion
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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