Cataract and Implant Surgery DOMINIC MCHUGH MD FRCS

Cataract and Implant Surgery DOMINIC MCHUGH MD FRCS LONDON, UK

Cataract Causes • Age • Congenital (genetic, metabolic) • Trauma • Infection • Inflammation • Surgical • Drugs (eg steroids)

Cataract • May be induced by surgical procedure: lens touch; gas; oil

Cataract types Nuclear sclerosis Congenital (rubella) Posterior subscapsular Trauma

Management of Cataract • ECCE (Extracapsular cataract extraction) But longer wound healing time

Cataract Surgery • Small incisional Phacoemulsification surgery (Developed by Kelman, USA)

Before IOL implantation was developed • Aphakic spectacles • Contact lenses

Pioneer of intraocular lens implant Sir Harold Ridley FRS FRCS

Harold Ridley collaborated with the Rayner company to develop the IOL John Pike, Rayner Company

1949 -1950: First IOL implants

Choice of IOL • Insertion through small incision • High biomcompatilbility • Allows good retinal view • Stable centration • Low PCO (posterior capsular opacification) rate

IOL choice Why foldable/injectable? Minimise incision size to reduce healing time and astigmatism × PMMA(rigid) : Non-foldable+large incision Ö Acrylic: Injectable through 2. 2 -3. 2 mm currently.

Preparation for cataract surgery Biometry: The calculation of required IOL power Keratometry (K) (corneal curvature) Axial length (AL) of eye (ultrasound) IOL power= A constant-2. 5 x. AL 0. 9 K Eg: 118 -2. 5 x 24 -0. 9 x 45=17. 5 dioptres IOL power

Phacoemulsification with IOL implantation

Phacoemulsification: surgical sequence • Corneal tunnel • CCC (continuous curvilinear capsulorrhexis • Hydrodissection • Phacoemulsification • Aspiration of cortical lens matter • IOL insertion

Phaco parameters

Phaco+IOL surgery Hydrodissection

Phaco+IOL surgery Phacoemulsification

Phaco+IOL surgery Aspiration of cortex

Phaco+IOL surgery Foldable IOL insertion

Typical injectable IOL Superflex lens: 6. 25 mm x 12. 50 mm C-Flex lens 5. 75 mm x 12. 00 mm

Cflex/Superflex injector

Loading the Superflex IOL

Superflex insertion

Superflex insertion

Superflex insertion

Insertion of injectable IOL

Endoscope view of Superflex

Cataract surgery Postoperative management Eye pad overnight Antibiotic+steroid drops for up to one month Change glasses at one month

Complications of cataract surgery (many!) • Posterior capsular rupture and vitreous loss • Dropped nucleus • IOL dislocation • Endophthalmitis • Retinal detachment

Cataract surgery complications

Cataract surgery: complications

Thank you!