Cataract Post Op Care C. Dan Siapco, MD April 16, 2015
Routine Cataract Surgery
• Risks
• Dry eye
• Endophthalmitis
• Toxic Anterior Segment Syndrome (TASS)
• Cystoid Macular Edema
• Retinal tear/detachment
• Pseudophakic bullous keratopathy
• Refractive surprise
• Negative dysphotopsia
• Choroidal hemorrhage
• etc
IOL Types and Configurations
• Conventional
• Toric
• Monovision
• Multifocal
• Accomodative
Post Op Day #1
• Exam:
• Conjunctiva
• Approximation
• Injection
• Subconjunctival hemorrhage
• Cornea
• Abrasions
• Edema - focal vs diffuse
• Incision - Seidel testing
Post Op Day #1
• Anterior chamber
• Cell usually around 2+ (suspect TASS if 3+ or greater)
• Flare - usually not much
• Endophthalmitis - may not be seen on POD#1 - may present POD#2
• Flat chamber - watch IOP
• Wound leak (low)
• Aqueous misdirection (high)
• Choroidal hemorrhage (normal to high)
Post Op Day #1
• Iris
• Peaked - vitreous?
• Irregular - surgical trauma
• Transillumination defects
Post Op Day#1
• IOL
• Position
• Toric rotation
• Viscoelastic
• High myopes - large capsular bag
Post Op Day #1
• Patient Instructions:
• Avoid swimming 2 weeks
• Avoid lifting over a gallon of milk for 2 weeks
• Avoid rubbing eye
• Wear eye shield when sleeping
• Negative dysphotopsia
Post Op Week #1
• Exam:
• Cornea - usually edema gone
• AC - trace to 1+ cell
• IOP - steroid response usually at week 2
• Refraction
• Adjust for 2nd eye
• ELP/K’s/AL
Post Op Week #1
• Patient instructions:
• Stop eyeshield
• Stop antibiotic
• Taper drops (3-4 weeks)
• Steroid TID
• NSAID TID
Post Op Month #1
• Exam:
• Cornea - clear
• AC - quiet to trace cell
• TASS - prolonged cell
• Consider steroid taper over 4 weeks
• IOP - steroid response
• Refraction - new spectacles
Post Op Month #1
• IOL - watch for early PCO especially in younger patients.
• Retina
• OCT if 20/25 or worse
• Dilated exam for retinal tears
Post Op Month #1
• Patient Instructions:
• Stop drops if quiet but if any cell continue until drops are gone.
• Warn about PCO
• Warn about PVD
Other Considerations
• 20/happy
• Multifocal IOL’s:
• Residual refractive error
• Dry Eyes - treat aggressively
• Glare and halos
• Glasses for intermediate vision - push out near image
• PCO - treat aggressively
Thank you very much! Cascadia Eye