cataract post op care - ncascade.com · routine cataract surgery • risks • dry eye •...

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