Indications of surgery: 1) Visual loss 2)Surveillance of
retinopathy 3)Laser therapy
Slide 5
PREOPERATIVE CONSIDERATIONS : VA Slitlamp Exam Fundoscopy
Sonography
Slide 6
SURGICAL TECHNIQUE: Phaco. Large Capsulorrhexis Large Optic
Diameter Lenses Acrylic Lenses
Slide 7
POST OPERATIVE MANAGEMENT: 1.Steroids 2.NSAID 3.Close Post
Operative Fundocopy
Slide 8
Decreased vision after surgery by: - Severe fibrinous uveitis -
Capsular opacity - NVI - Macular edema - Deterioration of
retinopathy
Slide 9
Cataract surgery and progression of diabetic retinal disease
Jaffe et al (1992): Nonproliferative diabetic retinopathy
progressed following ECCE
Slide 10
Romero-Aroca et al.(2006): no significant differences in the
rates of diabetic retinopathy progression with and without cataract
surgery
Slide 11
cataract surgery causes progression of diabetic macular edema
Biro and Balla (2009): Increased macular thickening in the first 2
months after surgery, with no significant difference between
diabetics and normal controls
Slide 12
As a whole, there is no clear evidence that phacoemulsification
surgery causes progression of diabetic retinopathy or diabetic
macular edema, particularly in patients with low-risk or absent
diabetic retinopathy
Slide 13
PERI-OPERATIVE TRIAMCINOLONE Kim et al. (2008): They found no
significant difference in diabetic retinopathy progression, visual
acuities, or central macular thickness at 6 months
postoperatively
Slide 14
INTRAVITREAL TRIAMCINOLONE No long-term benefit of in
comparison with focal/grid photocoagulation in eyes with diabetic
macular edema
Slide 15
INTRAVITREAL BEVACIZUMAB AFTER CATARACT SURGERY The study makes
no comment on any differences in acuity improvement between the
treated and untreated groups
Slide 16
PANRETINAL PHOTOCOAGULATION AND CATARACT SURGERY TIMING The
PRP-first group had significantly higher levels of aqueous flare
intensity that persisted until 3 months post phacoemu-
lsification
Slide 17
PRP-first with higher aqueous flare intensities,worse visual
outcomes and macular edema progression
Slide 18
CONCLUSION: adjuvant anti-inflammatory or anti-VEGF agents at
the time of cataract surgery show improved outcomes of acuity and
macular edema primarily in patients with preexisting macular edema
at the time of surgery
Slide 19
CATARACT SURGERY AND GLAUCOMA
Slide 20
CATARACT SURGERY IN ANGLE CLOSURE GLAUCOMA UBM and anterior
segment OCT have recently confirmed that a thickened and anteriorly
positioned lens may be involved in the pathogenesis of PACG
Slide 21
Plateau iris mechanisms can comprise up to 62% of eyes with
anatomically narrow angles in some populations
Slide 22
These findings suggest that lens extraction may be advantageous
in eyes with PACG and may lead to a significant IOP reduction
Slide 23
CATARACT SURGERY IN OPEN ANGLE GLAUCOMA Cataract surgery
Trabeculectomy Cataract extraction and trabeculectomy Alternative
surgical technique to lower IOP
Slide 24
severity of glaucoma visual needs Experience and skill of the
surgeon
Slide 25
CATARACT SURGERY ALONE Glaucomatous damage is mild IOP is
within the target range well tolerated medications
Slide 26
TRABECULECTOMY ALONE Patients with uncontrolled severe glaucoma
despite maximum tolerable medical therapy should benefit from
trabeculectomy alone
Slide 27
COMBINED CATARACT SURGERY AND TRABECULECTOMY In the presence of
a visually significant cataract and uncontrolled glaucoma
Slide 28
CONCLUSION: important factors 1.Age 2. Disease Severity
3.Ability To Tolerate Medications 4.Desired IOP