What is the surgical plan for cataract combined with fundus disease?
Nowadays, there are more and more patients with diabetes and age-related macular degeneration. For cataract patients with these combined fundus diseases, not only the treatment of cataract but also the treatment of postoperative fundus disease should be considered before surgery. Therefore, the surgeon must make the diameter of the continuous toric tear capsule larger during cataract surgery, and avoid using multifocal IOLs, which will facilitate further treatment of the patient’s fundus disease after surgery. There is some debate as to whether multifocal IOLs can be used in patients with fundus disease. Some ophthalmologists believe that the use of multifocal IOLs may affect the laser treatment of fundus disease, or affect the observation of the fundus during fundus surgery, thus making it difficult to perform the surgery. IOLs.
What is the surgical plan for cataract combined with glaucoma?
A significant number of cataract patients have different types of glaucoma at the same time. The surgeon must first determine whether the patient has open-angle or closed-angle glaucoma, because the surgical plan is very different for different types of glaucoma. For closed-angle glaucoma, the patient’s atrial angle and intraocular pressure should be evaluated before surgery, and the patient should be asked if he or she has had any previous episodes of glaucoma. For patients with closed-angle glaucoma combined with cataract, surgery is usually performed by combining lens removal with atrial angle separation, which can resolve both cataract and closed-angle glaucoma at the same time. However, for patients with open-angle glaucoma combined with cataract, cataract extraction combined with trabeculectomy is required to treat glaucoma at the same time as cataract surgery. Of course, cataract extraction and trabeculectomy can be performed separately. If the cataract surgery is performed separately, the surgeon will pay special attention to gentle handling during the surgery and careful aspiration of the viscoelastic from the patient’s eye at the end of the surgery to avoid the residual viscoelastic from causing the patient’s postoperative intraocular pressure to rise. Even so, more patients with open-angle glaucoma have elevated intraocular pressure after cataract surgery than those without glaucoma.
What are the differences in treatment options for cataracts combined with uveitis?
Cataracts combined with uveitis are complex cataracts, and the surgeon has to consider three aspects when treating them: ① timing of surgery ② delicate operation during surgery ③ preoperative and postoperative medication.
Timing of surgery: The surgical plan must pay attention to the control of inflammation of uveitis. Generally, cataract surgery will be performed only after the inflammation is controlled and stable for more than three months. Of course, it is possible to perform surgery during the inflammatory phase in very special cases, but the surgery must be very necessary to do so, such as uncontrolled elevated intraocular pressure due to crystalloid causes.
Delicate operation during surgery: Patients with combined uveitis have very complex eye conditions, usually with pupillary adhesions, atrial angle abnormalities, corneal abnormalities, etc., in addition to cataracts. Therefore, it is necessary for the surgeon to operate very carefully during the surgery to avoid damaging the iris and cornea of the patient in order to minimize the impact on the eye and reduce the appearance of postoperative inflammatory reactions.
Pre- and post-operative medications: Pre- and post-operative medications for uveitis also need to be very individualized and must be very carefully designed by the surgeon based on the patient’s medical history, and the medications used before and after surgery vary from patient to patient. For patients with more active inflammation, oral hormonal medications or even some oral immunosuppressants are given before surgery to control inflammation; hormonal eye drops are used prophylactically before surgery. Postoperatively, anti-inflammatory drugs are required, and the intensity of their use should be higher than that of conventional patients. At the same time, the evolution of postoperative inflammation in patients needs to be closely observed and given timely treatment.