CECILIA KOETTING, OD: Hi. Cecilia Koetting coming to you from Denver, Colorado, again. I’m here with Optometry Advisor and today we’re going to talk about something that I think is very important: comanagement. With optometry and ophthalmology, it is a really important and helpful tool for our patients, as well as our clinics, to be comfortable to comanage patients having cataract surgery. So, what we’re going to go through today are some videos and photos to talk about what we’re looking for at day one, week one, and month one at our postoperative appointments for our patients having cataract surgery.
The first part of this series will be focusing on the actual surgery itself.
It’s important to be able to understand what the patient is going through so that we can better identify what problems they might have and what’s important to see on day one. Many surgeons perform laser-assisted cataract surgery, utilizing laser to help create the capsulorhexis as well as the main incision and the port incision. Here we see the circle of the capsulorhexis being formed and then a cruciate x to help create areas to open up the flap and help break up the cataract. Next, the limbal relaxing incisions (LRI) is formed, then the main incision. Then, we see the port incision being formed.
Here we will watch a full cataract extraction surgery with an intraocular lens (IOL) implantation provided by Dr Elizabeth Yeu, implanting the Apthera IOL (AcuFocus). The surgery begins by creating the incision sites, both the main incision site and the port incision site which the instruments will go in through. A balanced salt solution (BSS) is placed inside the eye to protect both the endothelial cells of the cornea as well as to make it easier to work within the eye. Capsulorhexis was made by creating a circular tear of the anterior portion of the capsule. This allows access to the lens within.
More BSS is being placed in and the phacoemulsification wand is placed inside the eye through the main port to begin to sonically break up the lens while also aspirating to remove the lens at the same time. It is typically broken up into quadrants to be aspirated because this makes it easier to access each part without missing any and leaving remnants within the eye, which can cause persistent inflammation in these patients.
Once the main portion of the lens is removed, the phaco tip is changed for a smaller one, which is then placed back inside the eye to remove the posterior portion of the lens. This also allows the posterior portion of the capsule to be, essentially, buffed and removes all the small cells and any kind of posterior subcapsular cataract. More BSS is placed in and then the lens itself is implanted into the eye through a small instrument, delivering it folded up. After it’s delivered into the eye, it’s opened up, as you saw, it rolled open on its own — but then, using that same phaco tip, we are moving it into place with the haptics out toward the periphery. And centering the lens so that it’s in the appropriate place. Continued lubrication throughout the entire procedure to the external portion of the eye is important to make sure that the front surface does not dry out and the patient does not have more irritation the day after. Once the lens is centered, an antibiotic is placed within the eye to decrease any risk of infection.
Some surgeons may also elect to place a steroid solution within the eye to decrease inflammation as well.
Join me next time when we’ll follow a patient through their day 1 postop journey and discuss what’s important to be looking for to make sure the patient is healing well.