Retinal consideration in cataract surgery ARMD DR VO SCLERAL BUCKLE RD VITRECTOMY LATTICE DEGENERATION

1. Dr . Mohamed ELShafie, MD
Prepared and presented by
Free, focused mini-lessons

3. Cataract surgery is safe…
•No complications in 95%,
•91% achieving vision ≥6/12, 50% ≥6/6…

4. …but some patients
still fail to achieve a
satisfactory vision

5. Don’t lose sight
of retinal disease
when visualizing
outcomes

6. 6
KSU Hospital
provide a good visual outcome without exacerbating
underlying retinal disease or creating any new
problems with the retina.
“ “

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presentation
to
DesignBall
team
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ARMD

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Reports on the effect of
cataract surgery on AMD
progression
but not proving causation
clearly states cataract surgery
did not increase risk of
developing advanced AMD up
to 10 years of follow-up
average gain in VA persisting
for at least 18 months

9. 9 COVID19 IN CHILDREN
Eyes with
mild AMD, significant
cataract
ARMD.

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assessment of visual function
objectively
03
snellen acuity
amsler grid testing
dark adaptation

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HOSPITAL
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post-injections
pre-cataract surgery
1. patient response to injections
2. Date of most recent injection

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HOSPITAL
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eight weeks post-
cataract surgery with
recurrent activity.

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Setting realistic
expectations.
02
MF-IOLs
EDOF IOLs
reduced contrast
sensitivity.
03
pseudophakic monovision
binocular vision will be
compromised
Treatment considerations

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compromise retinal
monitoring and treatment
Capsular opacification
and contraction
posterior subcapsular
cataracts
develop cataracts
earlier
need good glycaemic
and blood pressure
control before surgery
compromised blood-
aqueous barrier
increases
postoperative
inflammation
Diabetic
patients

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reports increased rates of new
onset retinopathy and worsening
of DME and existing retinopathy
after cataract surgery
double in the first postoperative year
diabetic patients who received
postoperative subconjunctival
injection with triamcinolone
acetonide had a lower macular
thickness and macular volume
at 6 and 12 weeks
postoperatively than patients
who did not.

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larger rhexis
complete cortical
clean-up
larger optic
IOLs
aggressive control
of postoperative
inflammation
early retinal therapy
within one to two
weeks after cataract
surgery

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presentation
to
DesignBall
team
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RVO

19. significant improvement in
postoperative vision has
been found following
cataract surgery
increased risk of CME
30 times higher

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When considering cataract
surgery
completely free of retinal ischemia
macular oedema resolved and remains stable
for 2 to 3 months without intervention
03
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unless the cataract precludes
visualization of the posterior pole
NSAID drops one week prior to surgery
and to continue
Anti- VEGF intraoperative minimise the risk.
05

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KSU HOSPITAL
Once IVI
Phaco
IVI 3 times
Phaco with subtenon kenakort

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HOSPITAL
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What do you think ???

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ERM

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Grading of ERM.
4

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 proceed with cataract surgery alone.
 increased risk of post-operative CMO
 ERMs may progress more quickly
following cataract surgery
Treatment considerations
vision is affected primarily
by
 Vitrectomy, ERM peeling cataract 3-12 m. later.
 Cataract vitrectomy, ERM peeling 3-12 m. later.
 phacovitrectomy, ERM peeling.

26. Surprise after phaco
surgery: Discrepancy
BCVA to lens opacity

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presentation
to
DesignBall
team
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High myopia

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When considering
cataract surgery major risk factors for RD
PCO after cataract surgery
03
IOL calculations are less reliable
esp AL > 30mm
04 no benefit in implanting zero power IOL !!!
cataracts and chronic symptomatic floaters.
05

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presentation
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team
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Peripheral
Retinal
Degenerations

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KSU Hospital
Lattice degeneration is associated with an increased risk of a
retinal detachment
“ “

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IN
CHILDREN
KSU
HOSPITAL
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Atrophic holes
symptoms of vitreous
traction (flashing lights)
fellow eye has a history of RD
positive family history of RD.

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After
Scleral Buckle

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When considering
cataract surgery Long axial length affecting IOL power
Conjunctival scaring
03
Risk of scleral perforation during
anaesthesia injection

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presentation
to
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team
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After
vitrectomy

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When considering
cataract surgery Soft globe than normal
Unstable zonules
03 Deep anterior chamber
04 Intraoperative miosis, fluctuation of AC depth
Posterior capsule instability.
05
Cataract progression ?!
06

36. Pseudophakic CME.

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Preoperative risk for CME
Diabetic retinopathy
Uveitis
03 Retinal vein occlusion
04 Use of prostglandines
Epiretinal membrane.
05
Postoperative CME-development partner eye.
06

38. •Vision loss due to AMD?

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Preoperative considerations for
OCT of fundus Discrepancy lens opacity-vision (age!)
Pre-existingretinal diseases:
AMD, RVO, uveitis, diabetes
03
Vitreoretinal diseases:
epiretinal membranes, macular holes
04 Use of prostglandines
Postoperative complications fellow eye.
05

44. Legal issues
The police are often involved therefore,
accurate record keeping is essential.
Photographs can be of additional use.

45. Informed
Consent

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KSU Hospital
patient selection is key

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1
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Cataract surgery
Notes
possible impact of
surgery on
monitor and treat underlying
retinal pathology

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KSU HOSPITAL
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THANK YOU