Published on 08/03/2015 by admin
Filed under Opthalmology
Last modified 08/03/2015
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CHAPTER 8 Fundamental principles, goals of and indications for surgery
John Brazier
Chapter outline
Cataract surgery has the potential to transform the visual lives of patients. Modern phacoemulsification has brought reduced incision size, earlier stabilization of refraction, and more predictable astigmatic effects of surgery. In the small number of cases where surgery is associated with significant complications, it may produce a negative impact on the lives of patients, often during the later years of their lives. The ophthalmologist has to tread the line between restoring sight and risk of complications by using knowledge and skill to optimize surgical choices and outcomes. Some major challenges in cataract surgery persist including peroperative posterior capsule rupture, inadvertent loss of the crystalline lens into the vitreous, postoperative endophthalmitis, and late sight-threatening complications of retinal detachment and corneal decompensation.
Surgeons are likely to perform at the highest level when they feel relaxed in their working environment. Experience shows that surgeons working in a good team, providing complementary skills (ophthalmologists, anesthetists, nurses, optometrists, orthoptists, technicians, operating department assistants), will be able to acquire the information they need for informed decision making with patients and high quality surgery. Indeed, successful cataract surgery requires much more than the surgical act of a cataract procedure. It involves matters as far reaching as the construction of medical facilities to make care delivery streamlined, mastery of technologies both established and innovative, the building of efficient teams with workers who function in harmony, and an evolved level of interpersonal skills from members of the team. With these and other building blocks can an efficient service providing cataract treatment be established.
So the fundamental principles in cataract surgery are like those for medicine as a whole. Assessment of a patient is reliant on history and clinical examination with additional technical examination including parameters such as refraction, keratometry, corneal topography, and biometry. The patient’s visual symptoms and needs form a crucial part of this interchange. Coexisting eye disease such as diabetic eye disease, age-related macular degeneration (AMD), glaucoma, and amblyopia must be taken into account. The intraocular lens technologies now available need to be selected to give patients the best chance to achieve their visual goals. This will involve consideration of the target refractive outcome after cataract surgery with use of monofocal, toric or multifocal lens implants and possibly incisional corneal astigmatic modification where appropriate. The method of anesthesia for cataract surgery will depend on surgeon/patient preference based on the patient’s age, general health, level of anxiety, and ability of patients to cooperate. It is desirable to offer written or video information for patients about their diagnosis and treatment. The internet now offers an extensive if unfiltered information resource for patients.
Duke-Elder1
Ophthalmic Surgery Principles and Practice
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