DOMINIC MCHUGH MD DOMINIC MCHUGH MD FRCSFRCS

LONDON, UKLONDON, UK

Cataract and Implant Cataract and Implant SurgerySurgery

CataractCataractCausesCauses

• AgeAge

• Congenital Congenital

(genetic, metabolic)(genetic, metabolic)

• TraumaTrauma

• InfectionInfection

• InflammationInflammation

• SurgicalSurgical

• Drugs (eg steroids)Drugs (eg steroids)

CataractCataract

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

Cataract typesCataract types

Nuclear sclerosis Posterior subscapsular

Congenital (rubella) Trauma

Management of CataractManagement of Cataract

• ECCE (Extracapsular cataract ECCE (Extracapsular cataract extraction)extraction)

But longer wound healing timeBut longer wound healing time

Cataract SurgeryCataract Surgery

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

Before IOL implantation was Before IOL implantation was developeddeveloped

• Aphakic spectaclesAphakic spectacles

• Contact lensesContact lenses

Pioneer of intraocular lens Pioneer of intraocular lens implantimplant

Sir Harold Ridley FRS FRCS

Harold Ridley collaborated Harold Ridley collaborated with the Rayner company to with the Rayner company to

develop the IOLdevelop the IOL

John Pike, Rayner Company

1949-1950: First IOL 1949-1950: First IOL implantsimplants

Choice of IOLChoice of IOL

• Insertion through small incisionInsertion through small incision

• High biomcompatilbilityHigh biomcompatilbility

• Allows good retinal viewAllows good retinal view

• Stable centrationStable centration

• Low PCO (posterior capsular Low PCO (posterior capsular opacification) rateopacification) rate

IOL choiceIOL choiceWhy foldable/injectable?Why foldable/injectable?Minimise incision size to Minimise incision size to reduce healing time and reduce healing time and

astigmatismastigmatism×PMMA(rigid) : Non-foldable+large incisionPMMA(rigid) : Non-foldable+large incision

Acrylic: Injectable through 2.2-3.2 mm Acrylic: Injectable through 2.2-3.2 mm currently.currently.

Preparation for cataract Preparation for cataract surgerysurgery

Biometry: The calculation of Biometry: The calculation of required IOL power required IOL power

Keratometry (Keratometry (KK) (corneal ) (corneal curvature)curvature)

Axial length (Axial length (ALAL) of eye ) of eye (ultrasound)(ultrasound)

IOL power= IOL power= A constantA constant--2.5x2.5xALAL-0.9-0.9KK

Eg: Eg: 118118-2.5x -2.5x 24-24-0.9x0.9x4545=17.5=17.5 dioptres dioptres

IOL powerIOL power

Phacoemulsification with IOL Phacoemulsification with IOL implantationimplantation

Phacoemulsification: Phacoemulsification: surgical sequencesurgical sequence

• Corneal tunnelCorneal tunnel

• CCC (continuous curvilinear CCC (continuous curvilinear capsulorrhexiscapsulorrhexis

• HydrodissectionHydrodissection

• PhacoemulsificationPhacoemulsification

• Aspiration of cortical lens matterAspiration of cortical lens matter

• IOL insertionIOL insertion

Phaco parametersPhaco parameters

Phaco+IOLPhaco+IOL surgery surgeryHydrodissectionHydrodissection

Phaco+IOLPhaco+IOL surgery surgeryPhacoemulsificationPhacoemulsification

Phaco+IOLPhaco+IOL surgery surgeryAspiration of cortexAspiration of cortex

Phaco+IOLPhaco+IOL surgery surgeryFoldable IOL insertionFoldable IOL insertion

Typical injectable IOLTypical injectable IOL

Superflex lens: 6.25mm x 12.50mm

C-Flex lens 5.75mm x 12.00 mm

Cflex/Superflex injector

Loading the Superflex IOLLoading the Superflex IOL

Superflex insertionSuperflex insertion

Superflex insertionSuperflex insertion

Superflex insertionSuperflex insertion

Insertion of injectable IOLInsertion of injectable IOL

Endoscope view of SuperflexEndoscope view of Superflex

Cataract surgeryCataract surgery

Postoperative managementPostoperative management

Eye pad overnightEye pad overnight

Antibiotic+steroid drops for up to one Antibiotic+steroid drops for up to one monthmonth

Change glasses at one monthChange glasses at one month

Complications of cataract Complications of cataract surgery (many!)surgery (many!)

• Posterior capsular rupture Posterior capsular rupture and vitreous lossand vitreous loss

• Dropped nucleusDropped nucleus

• IOL dislocationIOL dislocation

• EndophthalmitisEndophthalmitis

• Retinal detachmentRetinal detachment

Cataract surgery Cataract surgery complicationscomplications

Cataract surgery: Cataract surgery: complicationscomplications

Thank you! Thank you!