Cataract Surgery. Pearls and Techniques

Description

Foreword Preface Contents About the Editors What Do Cataract Patients Want? Anxiety and Surgical Fear Supporting Information on Cataract Surgery Disclosure of Cataract Surgery Training Recovery Time and Return to Work Refractive Outcome and Presbyopia Management Second Eye Surgery Syndrome Alteration in Appearance Following Cataract Surgery Double Vision After Cataract Surgery Floaters and Retinal Detachment Following Cataract Surgery References Timing of Cataract Surgery When Should Patients Be Offered Cataract Surgery? Stage of Cataract Development Patient Reported Outcome Measures (PROMs) Age and Unilateral Versus Bilateral Surgery Timing of Surgery in the Presence of AMD Narrow Angles and Angle Closure Glaucoma Fuchs Corneal Endothelial Dystrophy Previous Corneal Transplantation References Risk Stratification Risk of Posterior Capsule Rupture or Vitreous Loss or Both Risk Stratification Tools Shortcomings of the Current Risk Stratification Tools Recommendations References Choice of Anaesthesia Brief Description of Techniques What Anaesthetic Drugs Can Be Used? Complications of LA Techniques and Reducing the Risk Preparing the Patient Consent Which Anaesthetic to Use, When? Which Technique is Best for Cataract Surgery? How Can I Find Out More About Eye Anaesthesia? References Novel Methods of Delivery Introduction Bilateral Surgery in Ophthalmology Suggested Protocol for ISBCS Health Economy and ISBCS Patient Quality of Life After ISBCS Barriers and Concerns About ISBCS Ethics Tariff and Reimbursement Rate Presumed Risk of Bilateral Complications Postoperative Refractive Error Toxic Anterior Segment Syndrome (TASS) Cystoid Macular Oedema Endophthalmitis Retinal Detachment Road Toward ISBCS Other Aspects of Cataract Surgery Delivery Other Strategies for More Cost-Efficient Cataract Surgery Delivery Referral System Task Delegation to Health Care Professionals Presence of Anaesthetist Number of Staff and Cataract Cases Per List References Refractive Aim and Choice of Intraocular Lens Introduction IOL Biomaterials PMMA Silicone Hydrophobic Acrylic Hydrophilic Acrylic IOL Optical Design Three Piece or One Piece? Square Edged or Round Edged? Planar Haptics or Angulated Haptics? Loop Haptic or Plate Haptic? Ultraviolet Light Filtered or with Blue Light Filtered? IOL Optical Properties IOL Selection Spherical Correction Monofocal IOL Presbyopia Presbyopia-Correcting IOLs Multifocal IOL Supplementary IOL Accommodative IOL Extended Depth of Focus IOL Refractive Rotational Asymmetry IOL Monovision and Mini-Monovision Astigmatism Toric IOL Aniridic IOLs Adjustable IOLs Special IOL Techniques Piggyback IOL Anterior Chamber IOLs Scleral Fixating IOLs Rare IOL Related Complication IOL Opacification Conclusion References Calculating the Human Eye—Basics on Biometry Introduction Devices and Measurement Principles History Parameters Needed for IOL Calculation Devices Ultrasound Optical Biometry Influence of Biometric Data for IOL Calculation Potential Sources of IOL Calculation Errors Practical Advice on Biometry Measurements Calculation of IOLs Evolution of Formulae Current IOL Formulae Simplifications/Assumptions Applied to IOL Formulae Ray Tracing IOL Calculation in Special Cases “Long” and “Short” Eyes Eyes After Refractive Surgery Eyes Post Cross-linking Children Aphakic Eyes Pseudophakic Eyes Posterior Segment Surgery Need for (Optimised) IOL Constants Tools Summary and Advice Teaching Phacoemulsification Cataract Surgery Introduction Educational Theory Adult Learning Constructivism Experiential Learning Reflection Zone of Proximal Development Communities of Practice Sustained Deliberate Practice Preparation Before Commencing Surgery Simulation Based Training Virtual-Reality Simulators Model Eyes Assessment Tools in Ophthalmic Surgical Training Preparation for Live Surgery How to Get the Most Out of Eyesi Training Live Surgery The Steep Part of the Learning Curve—Cases 1–20 Getting in the Groove—Cases 20–100 Increasing Case Complexity—Cases 100+ Management of Posterior Capsule Rupture and Vitreous Loss References Challenging Cases Objectives of This Chapter Introduction Pre-Operative Challenges Immunosuppressed Hypertension Diabetes and Hyperglycaemia Anticoagulants Periocular Disease Orthoptic Challenges/Orthoptic Imbalance Challenging Situations in Cataract Surgery Patients with Difficult Positioning and Back Problems Patients with Severe Anxiety and Special Needs (E.g. Learning Difficulties, Cognitive Impairment) Enophthalmos, Deep Set Eyes and Highbrow Head Tremor Dense (Brunescent) Cataract White (Mature Cortical) Cataract (Fig. ) Cataract in Presence of Corneal Pathology Glaucoma Extremes of Axial Length Prior Pars Plana Vitrectomy Patients Who May Require Subsequent Vitreo-Retinal Surgery Patients Who Have or at Risk of Developing Age-Related Macular Degeneration (AMD) Small Pupil Zonulopathy Uveitis and Pre-existing Posterior Synechiae Posterior Polar Cataract (Fig. ) Prior Scleral Buckling Surgery Management of Vitreous Loss References Pseudophakic Cystoid Macular Oedema Introduction Pathogenesis Diagnosis Funduscopy Fundus Fluorescein Angiography Optical Coherence Tomography Risk Factors Diabetes Uveitis Glaucoma Medications Differential Diagnosis Pseudophakic Cystoid Macular Oedema (PCMO) Versus Diabetic Macular Oedema (DMO) Prophylaxis and Treatment Corticosteroids Nonsteroidal Anti-inflammatory Drugs (NSAIDs) Anti-VEGF Agents Surgery Miscellaneous Carbonic Anhydrase Inhibitor (Acetazolamide) Immunomodulatory Therapy Management Summary References Prophylaxis and Treatment of Endophthalmitis Epidemiology of Endophthalmitis Prophylaxis Diagnosis and Treatment References Posterior Capsule Opacification Introduction Biological Processes Behind PCO Cell Survival, Proliferation, and Growth Factor Signalling Epithelial to Mesenchymal Transition Elschnig Pearls Prevention of PCO IOL Material IOL Design Capsular Tension Rings and Endocapsular Equator Rings Inhibition of Cell Growth Using Chemical Agents Closed Capsular Bag Irrigation Treatment of PCO Neodymium : Yttrium-Aluminium-Garnet (Nd:YAG) Laser References Market Forces, Premium Cataract Surgery and Managing the Unhappy Patient Funding and Size of the Market Patient Expectations and Consent for Premium Cataract Surgery Managing the Unhappy Patient After Cataract Surgery References Carbon and Cataracts: How to Make Your Service Sustainable Introduction The Triple Bottom Line What We Do Know? The Case for Change Patients’ Safety and Population Health Inter-generational and Inter-national Justice Opportunities for Change Case Study of Aravind Eye Care System The Need for Context Specific Benchmarking Common Approaches for More Sustainable Cataract Care A Culture of Sustainability Process Improvements Procurement Reduction Reduce Needless Waste Productivity and Sustainability Recycling, the Last Resort but a Big Engager What Don’t We Know? Variation in Care Acceptability of Significant Changes to Care Models Regulatory Barriers and Infection Control Summary References Afterword Index