This document provides a thorough pre-operative assessment for cataract surgery. It summarizes the patient's ocular and systemic history, examines the eye, performs investigations including visual acuity tests and biometry to determine IOL power. Key areas assessed include lens density, corneal thickness, endothelial cell count, intraocular pressure, and checking for other ocular pathology. Informed consent discusses potential complications. Relevant lab tests and pre-op measures are also outlined. The goal is to fully evaluate the patient and eye pre-operatively to plan the surgery, guide IOL selection, and maximize the visual outcome.

1. DR RAKHI.P.DCRUZ

2. PRE-OPERATIVE ASSESSMENT
 OCULAR HISTORY
 SYSTEMIC HISTORY
 OCULAR EXAMINATION
 OCULAR INVESTIGATIONS
 LABOROTARY INVESTIGATIONS

3. OCULAR HISTORY
 Ocular Symptoms Like Blurring Of Vision,coloured
Halos,diplopia,glare
 Nuclear Cataract-distant> Near
 Posterior Subcapsular-near>distant
 Duration And Progression
 H/O Of Previous Intraocular Disease
 H/O Previous Cataract Surgery
 H/O Intraocular Injuries

4. SYSTEMIC HISTORY
 H/o of all systemic diseases,current medications
patient is on..
 Medications relevant to eye surgery
 Systemic alpha blockers(tamsulosin)-floppy iris
syndrome
 Antiplatelets and anticoagulants
 Antihypertensives like diuretics-electrolyte imbalances
 Long term steroids-delayed healing
 Drug allergy to sulfonamides and other antibiotics

7. OCULAR EXAMINATION
 Visual acuity-distant and near vision
 Head posture & ocular posture-cover-uncover test
 Ocular movements
 Ocular adnexa-
blepharitis,ectropion,entropion,lagophthalmos
 Lacrimal sac syrininging to r/o dacrocystitis
 Conjuctiva-congestion,scarring,symblepharon

8.  CORNEA-stromal opacity and prominent arcus senilis
 Decreased endothelial count as in corneal guttata-post
op decompensation
 Specular microscopy and pachymetry to assess the risk
and to take precaution
If abnormal or C- thickness > 600 µm is poor prognosis
for corneal clarity.
 Endothelial deposits and keratic precipitates-uveitis or
glaucoma
 First treat the intraocular diseases..symptm free period
of 4-6 months for uvietis,steroids to prevent relapse

9. ANTERIOR CHAMBER-Shallow (intumescent of lens or
forward displacement by posterior pathology)
. Gonioscopy to rule out the angle abnormalities
(synechia, neovascularization).
 PUPIL-
 Reacting promptly to light-both direst and consensual
 Presence of RAPD-Implies substantial additional
pathology
 Readily dilating with mydriatics

10. lens
 Size of lens nucleus and grading of nuclear sclerosis-
for planning size of incision and type of surgery
 Nuclear cataract are harder and need more power with
phaco
 Black nuclear opacity-extremely dense-ECCE
 Postr polar cataract-prevent posterior capsular
dehiscence and subsequent vitreous disturbances-
avoid HYDRODISSECTION

11.  ZONULAR APPARATUS –examine under mydriasis.
 Pseudoexfoliation weak zonule, fragile capsule
& poor mydriasis
 SCLERA-prominent explant/encircling band for prior
RD
 OR
 Eye is particularly large/sclera is thin-peri an
retrobulbar local anesthesia should be avoided

12. FUNDUS EXAMINATION
A thorough fundus examination is important.
Retinal and optic nerve function must be assessed pre-
op,Because if it is defective operation becomes
valueless.
Pathology such as ARMD,RETINAL DETACHMENT Can
adversely affect visual outcome..hence a thorough
fundus evaluation is important.
In eyes with very dense opacity,when fundus cannot be
seen 5 tests are of value

13.  1.PROJECTION OF LIGHT
 2.2 POINT LIGHT DISCRIMINATION
 3.MADDOX ROD
 4.ENTOPIC VIEW OF RETINA
 5.USG B SCAN-r/o vitreous haemorrage,retinal
detachment,intraocular tumour & posterior
staphyloma.
 Foveal ERG

14. INTRAOCULAR PRESSURE
 Can be raised due to swellin of lens in INCIPIENT
STAGE/due to phacolytic glaucomain which case
extraction is indicated.
 Primary glaucoma can be pre-excistent
 If galucoma glaucome medically controlled-lens
extraction
 If NOT,perform a trabeculectomy followed by cataract
extracion/combined procedure.

15. REFRACTIVE ERROR
 Its critical to obtain patients pre-operative refractive
status in order to guide IOL implant selection.
 BIOMETRY facilitate calculation of lens power likely to
result in desired post op refractory outcome.
 It involves 1.Keratometry 2.A SCAN
 AXIAL LENGTH-curvature of anterior corneal surface
calculation by interferometry apparatus.

16. Use SRK formula (Sanders, Retlaff & Kraff)
P = A – 2.5L – 0.9K
P : Lens implant power for emmetropia (D)
L : Axial length (mm)
K : Average keratometric reading (D)
A : Constant specific to the lens implant to be used
That A = 113 for AC lenses & 119 for PC lenses.
many other formulas like
HAIGIS,HOFFER,HOLLADAY etc are also
used.

17.  CORNEAL PACHYMETRY
* Ultrasonic pachymeters can accurately & reliably
measure endothelial cell function.
* If thickness > 600 µm maybe consistent with corneal
edema & endothelium dysfunction that increase the
likelihood postoperative clinical corneal edema.

18.  SPECULAR MICROSCOPY: (endothelium cells)
* A normal cell count > 2400 cells/mm2
* If a cell count fewer than 1000 cells/mm2 is risk of
postoperative corneal decompensation.

19.  After examination,we need to assess potential visual
function after cataract removal.
 1.GUYTON MINKOUSKI POTENTIAL ACUITY
METER
 LOTMAR, RODENSTOCK TYPE LASER
INTERFEROMETER(uses coherent white
light/helium/neon laser generated interface stripes
/fringes)

21. GLARE DISABILITY TESTING
 Brightness acuity tester
 or
 Miller nadler glare testing device
 Simple alternative is snellens chart kept indoor and
outdoor in sunlight or a penlight shining obliquely
towards pupil.

24. Contrast sensitivity
 Contrast sensitivity drops with cataract
 Wallmount charts for testing (PELLI ROBSON ,TERRY
CHARTS)
 VEP(VISUALY EVOKED POTENTIAL) is more specific
and it require intact macula and optic nerve besides
cortical centre.

26. INFORMED WRITTEN CONSENT
 Patient should give full informed written consent
before catarcat surgery.
 1 in 1000-achieves very little or no sight
 1 in 10000-lose eye completely
 Mild complications-periocular echymosis,raised
IOP,mild iridocyclitis,wound leak.
 Moderate-posterior capsular rupture,zonular
dehiscence,corneal decompensation,CME,RD(1%)
 SEVERE-
ENDOPTHALMITIS(0.1%)SUPRACHOROIDAL HGE

27. LAB INVESTIGATIONS
 NORMAL-RBS,ECG,SCREENING,BP,XTD
 XRAY,URINE R/E,BRE,RFT,APTT,PT INR-in patients
with individual risk factors or planned for general
aneasthesia,
 Preop-antibiotic eye drops QID-3 DAYS PRIOR TO SX.
 ANTIANXIETY DRUGS if pt apprehensive
 Preparing eye-cutting lashes
 Asked to take a normal meal,normal sleep,normal
bath,continue systemic medications .

28. Thank you...