cataract surgery
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Classification
- extracapsular cataract extraction surgery
- intracapsular cataract surgery
- phacoemulsification cataract surgery.
Indications
- cataracts
- may reduce risk of hip fracture (RR=0.84)[3]
- associated with 60% mortality reduction in women, including all-cause mortality, & reduced mortality due to accidents, infections, neurologic disease, cancer, pulmonary disease, & vascular disease[15]
- small reduction in automobile accidents, 0.22 per 1000 patient years[16]
- unrestricted monitoring required for other eye diseases
- improves ability to monitor macular degeneration[1]
- cataract extraction associated with reduced risk of dementia (RR=0.71)[18]
Laboratory
- preoperative laboratory testing not recommended[4][11][12]
Procedure
- preoperative testing not indicated[4][25]
- removal of an opacified lens (cataract) from the eye to restore sight
- low risk of hemorrhage
- continue clopidogrel & aspirin in patients with drug-eluting stent
- use of intraocular vancomycin* during cataract surgery to prevent endophthalmitis generally not recommended[14]
* no FDA-approved formulation of vancomycin for intraocular injection [14[
Complications
- opacification of the posterior capsule (most common)[6]
- posterior capsular rupture
- retinal detachment
- chronic postoperative uveitis
- vitreous hemorrhage
- cystoid macular edema
- endophthalmitis
- alpha-1 adrenergic receptor antagonists can lead to floppy iris syndrome during cataract surgery[2]
- do not initiate alpha-1 adrenergic receptor antagonist therapy prior to scheduled cataract surgery[1]
- increased risk of falls in the elderly after 1st & 2nd cataract surgery[7][10]
- no association of cataract surgery with macular degeneration[13]
- cataract surgery permits better visualization of the retina & macula
- cataract surgery improves visual acuity in patients with macular degeneration[19][20][21][22][23][24]
- surgery is not expected to correct visual loss in a patient visual loss corresponding in time with worsening sclerotic cataracts (GRS12, SOE= BS)
- intraocular injections of a compounded formulation of triamcinolone, moxifloxacin, & vancomycin in each eye at the end of cataract surgery associated with case of hemorrhagic occlusive retinal vasculitis[14]
Management
- ketorolac plus prednisolone ophthalmic is not superior to ketorolac monotherapy for postoperative central macular thickening after uncomplicated cataract surgery[17]
Notes
- preoperative consultation[5]
- contrast sensitivity & stereopsis are factors in vision-related quality of life after 1st eye cataract surgery
- visual acuity is not[8]
- contrast sensitivity affects driving difficulty after 1st cataract surgery for bilateral patients
- visual acuity is not[9]
More general terms
More specific terms
- extracapsular cataract extraction (ECCE) surgery
- intracapsular cataract extraction surgery
- phacoemulsification (PE) cataract surgery
References
- ↑ 1.0 1.1 1.2 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ 2.0 2.1 Prescriber's Letter 19(5): 2012 Drug-Induced Adverse Eye Effects Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=280508&pb=PRL (subscription needed) http://www.prescribersletter.com
Chang DF. Floppy iris syndrome: why BPH treatment can complicate cataract surgery. Am Fam Physician. 2009 Jun 15;79(12):1051, 1055-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19530635 - ↑ 3.0 3.1 Tseng VL et al Risk of Fractures Following Cataract Surgery in Medicare Beneficiaries JAMA. 2012;308(5):493-501 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22851116 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1273017
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19. 20 American College of Physicians, Philadelphia 2012, 2015, 2021, 2025
Whinney C. Perioperative medication management: general principles and practical applications. Cleve Clin J Med. 2009 Nov;76 Suppl 4:S126-32 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19880829 - ↑ 5.0 5.1 5.2 Thilen SR et al. Preoperative consultations for Medicare patients undergoing cataract surgery. JAMA Intern Med 2013 Dec 23 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24366269 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1790996
- ↑ 6.0 6.1 Knobbe CA Cataract Surgery Complications http://www.allaboutvision.com/conditions/cataract-complications.htm
- ↑ 7.0 7.1 Meuleners LB, Fraser ML, Ng J, Morlet N. The impact of first- and second-eye cataract surgery on injurious falls that require hospitalization: a whole- population study. Age and Ageing. 2014;43:341-34 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24192250
- ↑ 8.0 8.1 Fraser ML, Meuleners LB, Lee AH, Ng JQ, Morlet N. Vision, quality of life and depressive symptoms after first eye cataract surgery. Psychogeriatrics. 2013 Dec;13(4):237-43. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24118634 [PubMed - indexed for MEDLINE]
- ↑ 9.0 9.1 Fraser ML, Meuleners LB, Lee AH, Ng JQ, Morlet N. Which visual measures affect change in driving difficulty after first eye cataract surgery? Accid Anal Prev. 2013 Sep;58:10-4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23689201
- ↑ 10.0 10.1 Meuleners LB, Lee AH, Ng JQ, Morlet N, Fraser ML. First eye cataract surgery and hospitalization from injuries due to a fall: a population-based study. J Am Geriatr Soc. 2012 Sep;60(9):1730-3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22882171
- ↑ 11.0 11.1 Chen CL et al Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery. N Engl J Med 2015; 372:1530-1538. April 16, 2015. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25875258 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMsa1410846
- ↑ 12.0 12.1 Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev. 2012 Mar 14;3:CD007293. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22419323 Free PMC Article
- ↑ 13.0 13.1 Marra KV, Wagley S, Kuperwaser MC et al Care of Older Adults: Role of Primary Care Physicians in the Treatment of Cataracts and Macular Degeneration. J Am Geriatr Soc. 2016;64(2):369-377. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26825587 <Internet> http://www.medscape.com/viewarticle/859809
- ↑ 14.0 14.1 14.2 FDA Safety Alert. Oct 3, 2017 Intraocular Injections of a Compounded Triamcinolone, Moxifloxacin, and Vancomycin (TMV) Formulation: FDA Statement
Case of Hemorrhagic Occlusive Retinal Vasculitis. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm578743.htm - ↑ 15.0 15.1 Tseng VL, Chlebowski RT, Yu F et al Association of Cataract Surgery With Mortality in Older Women. Findings from the Women's Health Initiative. JAMA Ophthalmol. Published online October 26, 2017. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29075781 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2657478
Smith JR. Association of Cataract Surgery With Decreased Mortality Among US Women. JAMA Ophthalmol. Published online October 26, 2017. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29075741 https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2657474 - ↑ 16.0 16.1 Schlenker MB, Thiruchelvam D, Redelmeier DA. Association of Cataract Surgery With Traffic Crashes. JAMA Ophthalmol. Published online June 28, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29955857 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2686118
- ↑ 17.0 17.1 Erichsen JH, Holm LM, Jacobsen MF et al Prednisolone and Ketorolac vs Ketorolac Monotherapy or Sub-Tenon Prophylaxis for Macular Thickening in Cataract Surgery. A Randomized Clinical Trial. JAMA Ophthalmol. Published online August 12, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34383010 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2782731
- ↑ 18.0 18.1 Lee CS, Gibbons LE, Lee AY et al Association Between Cataract Extraction and Development of Dementia. JAMA Intern Med. Published online December 6, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34870676 PMCID: PMC8649913 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2786583
Slomski A Cataract Surgery May Stave Off Dementia Among Older Patients. JAMA. 2022;327(5):416 https://jamanetwork.com/journals/jama/fullarticle/2788544 - ↑ 19.0 19.1 Chen AX, Haueisen A, Rasendran C et O Visual outcomes following cataract surgery in age-related macular degeneration patients. Can J Ophthalmol. 2021 Dec;56(6):348-354. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33609442
- ↑ 20.0 20.1 Karesvuo P, Elbaz U, Achiron A et al Effect of cataract surgery on wet age-related macular degeneration activity. Acta Ophthalmol. 2022 Feb;100(1):e262-e269. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33838002 Free article. https://onlinelibrary.wiley.com/doi/10.1111/aos.14864
- ↑ 21.0 21.1 Starr MR, Mahr MA, Barkmeier AJ et al Outcomes of Cataract Surgery in Patients With Exudative Age-related Macular Degeneration and Macular Fluid. Am J Ophthalmol. 2018 Aug;192:91-97. PMID: https://www.ncbi.nlm.nih.gov/pubmed/2980281
- ↑ 22.0 22.1 Choi EY, Kim TY, Lee CS. Predictive Factors for Long-Term Outcomes of Cataract Surgery in Patients Receiving Active Treatment for Neovascular Age-Related Macular Degeneration. J Clin Med. 2021 Jul 15;10(14):3124. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34300289 PMCID: PMC8306055 Free PMC article. https://pmc.ncbi.nlm.nih.gov/articles/PMC8306055/
- ↑ 23.0 23.1 Saraf SS, Ryu CL, Ober MD. The effects of cataract surgery on patients with wet macular degeneration. Am J Ophthalmol. 2015 Sep;160(3):487-492.e1. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26095263 Clinical Trial.
- ↑ 24.0 24.1 Daien V, Nguyen V, Morlet N et al Outcomes and Predictive Factors After Cataract Surgery in Patients With Neovascular Age-related Macular Degeneration. The Fight Retinal Blindness! Project. Am J Ophthalmol. 2018 Jun;190:50-57. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29550186
- ↑ 25.0 25.1 Macias AA, Goldfarb J. Preoperative Evaluation of Patients Undergoing Eye Surgery. Anesthesiol Clin. 2024 Mar;42(1):159-168. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38278587 Review.