• Check list
• axial length measurement
• consent
• multifocals
• Tinted implants
• Fuchs corneal dystrophy
• in angle closure
• pseudoexfoliation
• Cataract surgery & uveitis
• Cataract surgery & diabetic maculopthy/retinopathy
• Cataract surgery & post-op cystoid macular oedema
• Cataract surgery and AMD

Check list/consent   ...use this to help you remember to look for all conditions that increase the risk of surgery. Many of the risks can be reduced if the issues are addressed.

pstechnical check list/consent

NICE. Not recommended at Good Hope, and are NOT recommenced (College meeting, 2009)

Mainster (college 2009)

• UV blocking lenses will be helpful at preventing macular degeneration (AMD).
• Other tints are NOT recomeneded and will not help prevent AMD. Yellow tints etc will NOT help...they reduce contrast snsitivity and illumination
• aspheric lenses may help (especially if patients have large pupils)

This condition is explained starting here. Cataract surgery is more risky in this condition, as Fuchs dystrophy and the surgery can combine to damage the cornea permanently. New research suggests what surgery with care and the latest techniques and viscoelastics on eyes with corneal thickness <640um is safe, without a corneal transplant. See hypermetropia risk.

College 2009: with viscoelastics, many patients may have safe surgery. Consider scleral tunnels.

Spalton (College, 2009, my memory!) recommends:

• surgery should be delayed until uveitis is controlled
• intravitreal triamcinolone in patients on systemic immunosuppression (this produces less glaucoma than if given for retinal vein occlusion patients, for instance, presumably because of ciliary body damage and less aqueous formation). This helps tremendously.
• microsnips to dilate pupil during surgery. Lots of different viscoelastics.

Monique Hope-Ross (College, 2009, my memory!) recommends:

• control blood pressure, glucose, and cholesterol
• retinopathy does get worse after cataract surgery
• laser first to reduce macular oedema
• preoperative steroid and acular (start 1 week before)
• consider antigrowth factors (lucentis/Avastin)...use these if macular odema preent
• consider intravitreal steroid (my comments: this helps retinopathy but has the risk of secondary glaucoma)
• chronic macular oedema with epiretinal fibrosis may not respond to treatment

For post-operative cystoid macular oedema, Monique Hope-Ross (College, 2009, my memory!) recommends:

• usually this is found at first postoperative visit at 4 weeks
• at 4 weeks, maxidex/acular three times/day for 4 weeks
• at 8 weeks, if no better, subtenons triamcinolone
• at 12 weeks, if no better, repeat subtenons tiramcinolone
• at 16 weeks, intravitreal triamcinolone

But more recent research Antivegf Arevelo 09. 26 eyes halved macular thickness from 500 microns. Number of injections average 2.7, 26 eyes.

Luff (College, 2009, my memory!):

• macular degeneration maybe become active after cataract surgery (the evidence is not conclusive either way)
• cataract surgery often improves sight in AMD patients
• the VIP telescope lens system may help a few patients...those  with scotomas not too big but not too small. 10 degrees loss of peripheral sight with 33% extra magnification