Cataract and Implant

Surgery
DOMINIC MCHUGH MD FRCS
LONDON, UK
 Cataract
Causes
Age
Congenital
(genetic, metabolic)
Trauma
Infection
Inflammation
Surgical
Drugs (eg steroids)
 Cataract

May be induced by surgical procedure:

lens touch; gas; oil
 Cataract types

Nuclear sclerosis Posterior subscapsular

Congenital (rubella) Trauma

 Management of Cataract
ECCE (Extracapsular cataract extraction)
But longer wound healing time
 Cataract Surgery

Small incisional Phacoemulsification

surgery (Developed by Kelman, USA)
 Before IOL implantation was
developed
Aphakic spectacles
Contact lenses
Pioneer of intraocular lens
implant

Sir Harold Ridley FRS FRCS

Harold Ridley collaborated with
the Rayner company to develop
the IOL

John Pike, Rayner Company

1949-1950: First IOL implants
 Choice of IOL

Insertion through small incision

High biomcompatilbility
Allows good retinal view
Stable centration
Low PCO (posterior capsular opacification)
rate
 IOL choice
Why foldable/injectable?
Minimise incision size to reduce
healing time and astigmatism
PMMA(rigid) : Non-foldable+large incision

Acrylic: Injectable through 2.2-3.2 mm currently.

Preparation for cataract
surgery
Biometry: The calculation of
required IOL power
Keratometry (K) (corneal
curvature)
Axial length (AL) of eye
(ultrasound)
IOL power= A constant-2.5xAL-
0.9K
Eg: 118-2.5x 24-0.9x45=17.5
dioptres IOL power
Phacoemulsification with IOL
implantation
 Phacoemulsification: surgical
sequence
Corneal tunnel
CCC (continuous curvilinear capsulorrhexis
Hydrodissection
Phacoemulsification
Aspiration of cortical lens matter
IOL insertion
Phaco parameters
Phaco+IOL surgery
Hydrodissection
Phaco+IOL surgery
Phacoemulsification
Phaco+IOL surgery
Aspiration of cortex
Phaco+IOL surgery
Foldable IOL insertion
 Typical injectable IOL

Superflex lens: 6.25mm x 12.50mm

C-Flex lens 5.75mm x 12.00 mm

Cflex/Superflex injector
Loading the Superflex IOL
Superflex insertion
Superflex insertion
Superflex insertion
Insertion of injectable IOL
Endoscope view of Superflex
 Cataract surgery

Postoperative management
Eye pad overnight
Antibiotic+steroid drops for up to one
month
Change glasses at one month
Complications of cataract
surgery (many!)
Posterior capsular rupture and
vitreous loss
Dropped nucleus
IOL dislocation
Endophthalmitis
Retinal detachment
Cataract surgery complications
Cataract surgery: complications
Thank you!