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 Posterior subscapsular Congenital (rubella) 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  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 -2.5x

AL 0.9

K Eg: 118 -2.5x 24 0.9x

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: 6.25mm x 12.50mm

C-Flex lens 5.75mm 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!