This PPt is about pre operative assessment of cataract surgery.

1. DR. SOUMI KANJI

2. GOALS OF PREOPERATIVE ASSESSMENT OF
CATARACT SURGERY
 Ensure symptoms are consistent with cataract.
 Preoperatively identify and avoid potential sources of intraoperative
complications.
 Surgeon should clarify the patient about goals regarding the course
and outcome of surgery.
 Match proper surgical procedure to patient .

3. HISTORY
 History of present illness:
1.Visual decline(blurred/clouded)over weeks to years.
2.No further improvement of eye sight with glasses.
3.Decreased near vision/distant vision/both.
4.Decreased colour preception(harder to distinguish blues and blacks)
5.Disabling glare.
6.Coloured halos.
7.Worse during different periods of day.
8.Monocular diplopia or polyopia.
9.Myopic shift/ Hypermetropic shift
10.Altered contrast sensitivity.

4.  Ocular history:
1.Preexisting ocular conditions
a) Any history of spectacle use.
b) Any history of corneal abnormality.
c) Any history of hereditary ocular disease.

5. 2.Conditions with implications for cataract surgery
a. Glaucoma-optimal control of IOP should be achieved prior cataract surgery.
b. Uveitis- ideally eye should be quiet without use of corticosteriods atleast for 3
months before surgery.
c. High myopia-higher risk of retinal detachment after cataract surgery .
d. Prior retinal surgery-cataract surgery is often difficult d/t loose zonules and
posterior capsular instability in patients who had vitrectomy previously.
e. Prior ocular trauma- there can be zonular instability.
f. Pseudoexfoliation –can cause zonular instability, poor pupillary dilation.
g. Prior refractive surgery
h. Contact lens wear

6.  History of systemic illness:
CONDITIONS FURTHER
QUESTIONS
ACTIONS
DIABETES MELLITUS Well controlled? If poor control ,defer surgery and need physician’s
suggestion.
SYSTEMIC
HYPERTENSION
If systolic >170mmHg or
diastolic >100mmHg
Contact physician .
ACUTE MYOCARDIAL
INFRACTION
Date of MI? Defer surgery for 3-6 months from date of MI.
Contact physician/anaes thetist for current
cardiovascular status.
ANGINA Stable/well controlled? Bring glyceryl trinitrate spray on day of surgery.
Contact physician if patient is unstable
RESPIRATOPRY
DISEASE
Is chest function optimal?
Can patient lie flat?
Chest function Yt to bring inhaler to hospital.
Trial of lying flat atleast for half an h
STROKE Date of stroke?
Any residual difficulties?
Defer surgery for 6 months from date of stroke.
HUMAN
IMMUNODEFICIENCY
VIRUS INFECTION
Any high risk factors? Special precautions to avoid needlestick injury.
JAUNDICE OR KNOWN
VIRAL HEPATITIS
Underlying diagnosis? Special precautions to avoid needlestick injury.
EPILEPSY/PARKINSON
DISEASE/TREMOR
Is condition well
controlled?
General anaesthesia may be prefered.

7.  Drug history:
1. Drugs known to cause cataract-
a)corticosterods
b)phenothiazines
c)amiodarone
d)statins
e)anticholinesterases
2. Drugs that compromise cataract surgery itself-
a) Intraoperative floppy iris syndrome causing drugs such as alpha-1 blockers
(prazosin,terazosin,doxazosin,tamsulosin),antipsychotic agents
(chlorpromazine),antihypertensive (labetolol)
b)Anticoagulants do not increase incidence of bleeding but if bleeding
occurs it tends to be larger ,can complicate visualisation.
 Allergy/Adverse reactions:
Patient should question about allergy to-
a)NSAIDS
b)fluroquinolones
c)latex
d)iodine

8.  Social history:
1.Alcohol or sedative use or abuse.
2.Smoking.
3.Occupational history.
 Family history:
1.Some patients have strong family history of cataract that can explain early onset
of cataract formation.
2.It is important to know whether the patient will be able to perform
postoperative instructions.

9. MEASUREMENT OF VISUAL FUNCTION
 Visual acuity testing:
Snellen acuity is measured under lightened and darkendend condition. Distance
and near visual acuity must be tested for BCVA.
 Refraction:
Refraction is useful for calculating the IOL power necessary to obtain desired
postoperative refraction and for determinig myopic shift/hypermetropic shift.

10. EXTERNAL EXAMINATION
 Body habitus
 Ocular adnexa
 Motility
 Pupil

11. SLIT LAMP EXAMINATION
 Conjunctiva:
Whether there is any abnormality.
 Cornea:
a) Specular Reflection can be done to assess corneal endothelium.
b) Pre corneal tear film assessment.
c) We have to look for any abnormality in the cornea.
 Anterior chamber and Iris:
1.Depth of AC
2.Gonioscopy-
3.Iris –a)iridodonesis
b)exfoliation at margin of undilated pupil
c)iris coloboma.

12. • Crystalline lens:
1 Determination of type of cataract-acquired or congenital
2.Morphology and grading of cataract
a)Nuclear cataract.
b)Cortical cataract.
c)Posterior subcapsular cataract.
Nuclear cataract grading:
GRADE COLOUR
1 WHITE
2 YELLOW
3 AMBER
4 BROWN
5 BLACK

13. 2.Maturity of cataract

14. Other features of lens to be noted
1.Position of lens
2.Lens coloboma
3.Pseudoexfoliation syndrome
4.Phacodonesis

15. FUNDUS EXAMINATION
 Opthalmoscopy:
 Full fundus examination can be done by-
1.Direct ophthalmoscopy
2.Slit lamp biomicroscopy using +90D lens
3.Indirect ophthalmoscopy
 Attention to be paid to –
1.Optic nerve (thorough evaluation for cupping and pallor)
2.Macular pathology
3. Peripheral retina
4 Retinal vessels
 Fundus evaluation with opaque media:
B scan ultrasonography

16. PREOPERATIVE MEASUREMENTS
 Biometry:
Calculation of lens power.
 Ocular parameters –
1. Curvature of anterior corneal surface determined by Keratometry.
2.Axial length measurement by Optical coherence biometry or A-scan
 IOL power calculation-SRK formula (for long axial length)
P=A-2.5L-0.9K
P-lens implant power
A-constant specific to lens implant
L-axial length(mm)
K-average keratometric reading

17. In modified SRK formula on basis of axial length(L)
if L <20mm;A +1.5
if L 20-21mm;A +1.0
if L 21-22mm;A +0.5
if L 22-24.5mm; A
if L 24.5-26mm;A-1.0
if L >26mm;A-1.5
other formulas -1.Hoffer Q
2 Haigis L
3 Barret universal 2
4 Hill-RBF
A.Optical coherencie bometry
B.Contact ultrasonic biometry
C.Ultrasonographic monitor display

18. OTHER TESTS
 Measurement of BP
 Blood sugar
 Syringing /ROPLAS
 Tonometry

19. THANK YOU