Senile Cataract Follow-up

  • Author: Vicente Victor D Ocampo Jr, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Nov 18, 2011
 

Further Inpatient Care

  • Most cataract surgeries are performed on an outpatient basis, especially with the onset of phacoemulsification performed under topical anesthesia. Often, patients are discharged from the clinic as soon as they have recovered from the emotional stress of the procedure. Patients are sent home on topical steroids and antibiotics either separately or in combination. An eye shield is placed on the newly operated eye and removed a few hours later.
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Further Outpatient Care

  • On the first postoperative day, visual acuity should be consistent with the refractive state of the eye, the clarity of the cornea and media, and the visual potential of the retina and optic nerve. Mild edema of the eyelid may be evident, as well as some conjunctival injection. The cornea is normally clear with minimal edema and striae. The anterior chamber should be deep with mild cellular reaction. It is important to check whether the posterior capsule is intact and whether the IOL is positioned properly. The red reflex must be strong and clear and the intraocular pressures should be within normal limits. Transient intraocular pressure elevations may be observed and attributed to retained viscoelastic.
  • Significant improvement of these initial findings is to be expected in subsequent postoperative evaluation as the ocular inflammation subsides typically within 2 weeks. Topical steroids and antibiotics are tapered accordingly. Refraction is believed to be stable at the sixth to eighth postoperative week, at which time corrective lenses can be prescribed. Significant postoperative astigmatism can be addressed by suture removal by the sixth week as guided by keratometry or corneal topography.
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Inpatient & Outpatient Medications

  • During the postoperative period, the patient is prescribed topical 1% prednisolone acetate, which is applied every hour for the first day, then tapered depending on the inflammatory state of the eye. Studies have shown that topical ketorolac tromethamine provides adequate postoperative control of intraocular inflammation without the risk of increased intraocular pressure, which may be associated with steroid use. A broad-spectrum topical antibiotic also is given 4-6 times a day for 1-2 weeks.
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Deterrence/Prevention

  • Age is believed to be the most significant risk factor for senile cataract and, as such, it is almost inevitable to develop some degree of lens opacity as one becomes older. No study has established firmly whether avoidance of some of the risk factors for senile cataract (eg, UV exposure, hypercholesterolemia, diabetes mellitus) will lessen the chance of developing a senile cataract.
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Complications

The following are the major intraoperative complications encountered during cataract surgery:

  • Shallow or flat anterior chamber
  • Capsular rupture
  • Corneal edema
  • Suprachoroidal hemorrhage or effusion
  • Expulsive choroidal hemorrhage
  • Retained lens material
  • Vitreous disruption and incarceration into wound
  • Iridodialysis
  • Retinal light toxicity

The following are the major immediate postoperative complications encountered during cataract surgery often seen within a few days or weeks after the operation:

  • Flat or shallow anterior chamber due to wound leak
  • Choroidal detachment
  • Pupillary block
  • Ciliary block
  • Suprachoroidal hemorrhage
  • Stromal and epithelial edema
  • Hypotony
  • Brown-McLean syndrome (peripheral corneal edema with a clear central cornea most frequently seen following ICCE)
  • Vitreocorneal adherence and persistent corneal edema
  • Delayed choroidal hemorrhage
  • Hyphema
  • Elevated intraocular pressure (often due to retained viscoelastic)
  • Cystoid macular edema - Studies have shown that diclofenac was more effective than topical steroids in preventing CME.[22]
  • Retinal detachment - Significant risk factors include axial length greater than 25 mm, age younger than 65 years, and intraoperative complications.[23]
  • Acute endophthalmitis
  • Uveitis-glaucoma-hyphema (UGH) syndrome

The following are the major late postoperative complications seen weeks or months after cataract surgery:

  • Suture-induced astigmatism
  • Pupillary capture
  • Decentration and dislocation of the IOL
  • Corneal edema and pseudophakic bullous keratopathy
  • Chronic uveitis
  • Chronic endophthalmitis
  • Wrong power of IOL used

At any stage of the postoperative recovery of the eye, a risk of noninfectious endophthalmitis and infectious endophthalmitis exists. Noninfectious endophthalmitis is believed to be a multifactorial process or an interindividual variable response to a common factor as a hypersensitivity reaction. Treatment may range from the use of topical, transseptal, or oral steroids to the explantation of the intraocular lens.

Although of low incidence, infectious endophthalmitis may lead to severe vision loss and blindness.[24] Staphylococcus epidermidis is the most common isolated organism, and rupture of the posterior capsule is one of the most common risk factors.[24] Of late, a significant increase in the incidence of gram-positive bacteria in bacterial isolates from postoperative eyes suspected of having endophthalmitis has been observed. Furthermore, a significant increase in resistance to ciprofloxacin has occurred. Seemingly, the spectrum of bacteria causing postcataract endophthalmitis is changing partly because of an increased resistance to mainstay antibiotics in the treatment of endophthalmitis.

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Prognosis

  • In the absence of any other accompanying ocular disease prior to surgery, which would affect significantly the visual outcome, such as macular degeneration or optic nerve atrophy, a successful uncomplicated standard ECCE or phacoemulsification carries a very promising visual prognosis of gaining at least 2 lines in the Snellen distance vision chart. The main cause of visual morbidity postoperatively is CME. A major risk factor affecting visual prognosis is the presence of diabetes mellitus and diabetic retinopathy.
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Patient Education

  • To date, no established guidelines are available for the prevention of senile cataracts. Education programs are geared toward early detection and surgical intervention when vision is impaired functionally. With the advent of phacoemulsification, patients are advised against delaying lens extraction to the point when the cataract is hard and mature and the likelihood of postoperative complications increases.
  • For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Cataracts.
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Contributor Information and Disclosures
Author

Vicente Victor D Ocampo Jr, MD  Head, Uveitis and Ocular Immunology Service, Veterans Memorial Medical Center, Philippines; Head, Uveitis and Ocular Immunology Service, Ospital ng Makati Medical Center, Philippines; Consulting Staff, Department of Ophthalmology, Asian Hospital and Medical Center, Philippines

Vicente Victor D Ocampo Jr, MD is a member of the following medical societies: American Academy of Ophthalmology, Philippine Academy of Ophthalmology, and Philippine Ocular Inflammation Society

Disclosure: Nothing to disclose.

Coauthor(s)

C Stephen Foster, MD, FACS, FACR, FAAO  Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary; Founder and President, Ocular Immunology and Uveitis Foundation, Massachusetts Eye Research and Surgery Institution

C Stephen Foster, MD, FACS, FACR, FAAO is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American Association of Immunologists, American College of Rheumatology, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, American Uveitis Society, Association for Research in Vision and Ophthalmology, Massachusetts Medical Society, Royal Society of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard W Allinson, MD  Associate Professor, Department of Ophthalmology, Texas A&M University Health Science Center; Senior Staff Ophthalmologist, Scott and White Clinic

Richard W Allinson, MD, is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

J James Rowsey, MD  Former Director of Corneal Services, St Luke's Cataract and Laser Institute

J James Rowsey, MD is a member of the following medical societies: American Academy of Ophthalmology, American Association for the Advancement of Science, American Medical Association, Association for Research in Vision and Ophthalmology, Florida Medical Association, Pan-American Association of Ophthalmology, Sigma Xi, and Southern Medical Association

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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