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Modern Cataract Surgery

Modern Cataract Surgery. Professor Ejaz Ansari, FRCOphth MD. Modern cataract surgery- benefits to your patients. Cataract- what is it, its symptoms and signs Indications for cataract surgery The procedure and results Recent innovations for your patients Video (if time!). The Healthy Eye.

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Modern Cataract Surgery

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  1. Modern Cataract Surgery Professor Ejaz Ansari, FRCOphth MD

  2. Modern cataract surgery- benefits to your patients • Cataract- what is it, its symptoms and signs • Indications for cataract surgery • The procedure and results • Recent innovations for your patients • Video (if time!)

  3. The Healthy Eye • Light rays enter the eye through the cornea, pupil and lens. • These light rays are focused directly onto the retina, the light-sensitive tissue lining the back of the eye. • The retina converts light rays into impulses; sent through the optic nerve to your brain, where they are recognized as images.

  4. What is a cataract? • Clouding of the normally clear lens of the eye. Healthy lens Lens with a cataract • Can be compared to a window that is frosted or yellowed.

  5. What is a cataract? • A clear lens refracts light onto the retina and fine-tunes our focusing ability. • A cloudy lens prevents light from focusing sharply on the retina.

  6. Symptoms of cataracts • Painless blurring of vision. • Glare or light sensitivity. • Poor night vision and/or difficulty driving at night. • Double vision in one eye. • Needing brighter light to read. • Fading or yellowing of colors. Yellowing of colors

  7. When should cataract surgery be performed? • When cataracts cause enough vision loss to interfere with your daily activities: • Performing your job • Driving safely • Reading and watching TV in comfort • Taking medication • You and your ophthalmologist should decide together when surgery is appropriate.

  8. How is cataract surgery performed? • Ambulatory day case procedure (usually) • Local or topical anesthesia • Phacoemulsification (ultrasound) • Shield, no patch

  9. How is cataract surgery performed? • A small incision is made close to the edge of the cornea. • A tiny, high-frequency ultrasound instrument is inserted that breaks up center of the lens. • Broken-up cloudy lens material is removed through the incision.

  10. Advantages of Phaco(emulsification) • For the surgeon • For the patient- quicker visual rehabilitation, less astigmatism, fewer visits post-op, fewer post-op complications (closed system surgery) • For the health economy

  11. What can I expect from cataract surgery? • Most cataract surgical procedures are performed without complications and result in immediate improvement in vision (0.1% chance of reduced vision). • You will apply eye drops for 4-6 weeks following surgery to reduce the possibility of infection and/or inflammation in the eye- enough dispensed! • You may need an eyeglass prescription to obtain your clearest vision following surgery.

  12. What can I expect from cataract surgery? • Drive after 1 week (use one’s discretion) • Care with washing hair and face for 4 weeks • No gardening for 4 weeks • Continue those glaucoma drops! • See consultant after 2-3 weeks • See optician after 6 weeks • Not everyone is the same- glaucoma, ARMD, diabetes

  13. Posterior capsulotomy • In a small number of cases, the natural capsule supporting IOL can become cloudy after cataract surgery. • Posterior Capsulotomy: laser surgery to open cloudy capsule and restore clear vision. Posterior Capsulotomy

  14. Phaco steps • Incision • Capsulorrhexis • Hydrodissection • Phaco • Irrigation and aspiration (for cortex) • IOL insertion • AC reformation and wound closure • Cataract PHOTO: M&Ms Chocolate UK Ltd.

  15. Steps- incision and capsule

  16. Hydrodissection and phaco

  17. Irrigation and aspiration; IOL insertion

  18. MICS v Standard

  19. Micro-incision cataract surgery • MICS • 1.8- 2.2mm incision (ct. 3mm) • Even quicker visual rehabilitation • Fewer post-op meds • Fewer post-op visits • Less astigmatism: @ 2 weeks post-op -0.33D; @6 weeks with 3mm incision -0.67D; (n=60)

  20. New intraocular lenses

  21. Is it laser? • NO! It’s ultrasound, but.............. • Laser cataract surgery (femto) is being used in some centres • Even with laser at the moment, phaco is required

  22. Conclusions • Surgery is the only treatment for cataract • Modern day case micro-incision cataract surgery under topical anaesthesia- gold standard • Post-operative drops for 4-6 weeks • Range of innovative IOLs available • Femtosecond cataract surgery being improved

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