Retinal consideration in cataract surgery

Retinal consideration in cataract surgery
ARMD
DR
VO
SCLERAL BUCKLE
RD
VITRECTOMY
LATTICE DEGENERATION

1. Retinal Consideration in Cataract Surgery Dr . Mohamed ELShafie , MD Prepared and presented by Free, focused mini-lessons

2. Cataract surgery is safe… No complications in 95%, 91% achieving vision ≥6/12, 50% ≥6/6…

3. …but some patients still fail to achieve a satisfactory vision

4. Don’t lose sight of retinal disease ‎ when visualizing outcomes

5. provide a good visual outcome without exacerbating underlying retinal disease or creating any new problems ‎with the retina . “ “

6. Start Here Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 01 g ARMD Creation Process Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 03 s

7. 01 02 03 03 Reports on the effect of cataract surgery on AMD progression but not proving causation AREDS2 report #27 clearly states cataract surgery did not increase risk of developing advanced AMD up to 10 years of follow-up average ‎gain in VA persisting for at least 18 months

8. Eyes with mild AMD, significant cataract ARMD .

9. 01 02 assessment of visual function objectively 03 snellen acuity amsler grid testing dark adaptation

10. post-injections pre-cataract surgery 1. patient response to injections 2. Date of most recent injection‎

11. eight weeks post-cataract surgery with recurrent activity.‎

12. 01 Setting realistic expectations . 02 MF-IOLs ‎ EDOF IOLs reduced contrast sensitivity . 03 pseudophakic monovision binocular vision will be compromised Treatment considerations

13. Tech Analyzing Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 02 g DME Test Process Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 04 d

14. 1 4 5 3 2 compromise retinal monitoring and treatment Capsular opacification and contraction ‎ posterior subcapsular cataracts ‎ develop cataracts earlier ‎ need good glycaemic and blood pressure control before surgery compromised blood-aqueous barrier increases postoperative inflammation Diabetic patients ‎

15. 01 02 reports increased rates of new onset retinopathy and worsening of DME and existing ‎retinopathy after cataract surgery double in the first postoperative year PREMED 2 , 2018 diabetic patients who received postoperative subconjunctival injection with triamcinolone acetonide had a ‎lower macular thickness and macular volume at 6 and 12 weeks postoperatively than patients who did not.

16. 1 2 3 4 5 larger rhexis complete cortical clean-up larger optic IOLs aggressive control of postoperative inflammation early retinal ‎therapy within one to two weeks after cataract surgery

17. Start Here Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 01 g RVO Creation Process Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 03 s

18. significant improvement in postoperative vision has been found following cataract surgery ‎ reports increased risk of CME ‎30 times higher‎

19. 01 02 When considering cataract surgery ‎ completely free of retinal ischemia ‎ macular oedema resolved and remains stable for 2 to 3 months without intervention 03 04 unless the cataract precludes visualization of the posterior pole NSAID drops one week prior to surgery and to continue Anti- VEGF ‎ intraoperative minimise the risk.‎ 05

20. Once IVI Phaco IVI 3 times Phaco with subtenon kenakort

21. What do you think ???

22. Start Here Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 01 g ERM Creation Process Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 03 s

23. 1 2 3 Grading of ERM. 4

24. Cataract proceed with cataract surgery alone. ‎ increased risk of post-operative CMO ERMs may progress more ‎quickly following cataract surgery ERM Treatment considerations vision is affected primarily by careful inspection of peripheral retina Vitrectomy, ERM peeling cataract 3-12 m. later. Cataract vitrectomy, ERM peeling 3-12 m. later. phacovitrectomy , ERM peeling.

25. Surprise after phaco surgery: Discrepancy BCVA to lens opacity

26. High myopia Tech Analyzing Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 02 g

27. 01 02 When considering cataract surgery ‎ major risk factors for RD‎ PCO after cataract surgery 03 IOL calculations are less reliable ‎ esp AL > 30mm 04 no benefit in implanting zero power IOL !!! cataracts and chronic symptomatic floaters .‎ 05

28. Peripheral Retinal Degenerations Tech Analyzing Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 02 g

29. Lattice degeneration is associated with an increased risk of a retinal detachment “ “

30. 1 2 3 4 Atrophic holes ‎ symptoms of vitreous traction (flashing lights)‎ fellow eye has a history of RD‎ positive family history of RD.‎

31. Start Here Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 01 g After Scleral Buckle Creation Process Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 03 s

32. 01 02 When considering cataract surgery ‎ Long axial length affecting IOL power‎ Conjunctival scaring 03 Risk of scleral perforation during anaesthesia injection

33. Start Here Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 01 g After vitrectomy Creation Process Donec ornare rutrum neque sit amet pellentesque. Nulla eget dictum tortor. 03 s

34. 01 02 When considering cataract surgery ‎ Soft globe than normal‎ Unstable zonules 03 Deep anterior chamber 04 Intraoperative miosis, fluctuation of AC depth Posterior capsule instability.‎ 05 Cataract progression ?! 06

35. Pseudophakic CME .

36. 01 02 Preoperative risk for CME‎ Diabetic retinopathy‎ Uveitis 03 Retinal vein occlusion 04 Use of prostglandines Epiretinal membrane .‎ 05 Postoperative CME-development partner eye .‎ 06

37. Vision loss due to AMD?

38. 01 02 Preoperative considerations for OCT of fundus‎ Discrepancy lens opacity-vision (age!)‎ Pre-existingretinal diseases: AMD, RVO, uveitis, diabetes 03 Vitreoretinal diseases: epiretinal membranes, macular holes 04 Use of prostglandines Postoperative complications fellow eye .‎ 05

39. Legal issues The police are often involved therefore, accurate record keeping is essential. Photographs can be of additional use.

40. Informed Consent

41. PATIENT COUNSELING Although the final visual outcome often remains in doubt for weeks or even months, encourage the patient not to give up hope unless the eye has permanent loss of vision. The emotions run from depression to exhilaration. Compassion, competence, and commitment are appreciated by the patient. Be realistic but not overly pessimistic about potential outcomes

42. patient selection is key

43. 1 2 3 Cataract surgery improve vision in patients with retinal diseases Notes possible impact of surgery on progression of underlying retinal pathology monitor and treat underlying retinal pathology in peri -operative period‎.

44. THANK YOU