Preparing For Cataract Surgery in Special Situations Part 1 NUR

Preparing for Cataract
Surgery in Special Situations

Systemic Considerations
Medical Status
• Medical evaluation by the patient’s primary care physician may
be part of the preoperative planning process.
• Conditions such as hypertension and diabetes mellitus should

be stabilized. Because patients are required to fast prior to
surgery, insulin or oral hypoglycemic medication often requires
adjustment in diabetic patients.
• Procedures on these patients should be performed as early in

the day as possible to minimize large fluctuations in blood
glucose levels.
American Academy of Ophthalmology. Lens and Cataract – Basic and Clinical Science Course, Section 11. 2020 - 2021. San Fransisco: American Academy of Ophthalmology. Pg. 216
• In patients with lung disease, pulmonary function should be optimized
prior to and during surgery; patients may be permitted to bring their
inhalers into the operating room.
• Patients with lung disease may be prone to coughing, which can damage
ocular structures during surgery and threaten wound security.
• Coughing should be controlled judiciously with medication and the
patient instructed to warn the surgeon of any need to cough.
• With small-incision surgery, the risk of such
intraoperative complications can be reduced and
wound security enhanced. Patients with chronic
obstructive pulmonary disease (COPD), bronchitis,
congestive heart failure, or obesity benefit from
being placed in the reverse
• Trendelenburg position to reduce venous

congestion in the head and neck and lessen the
risk of vitreous loss and choroidal hemorrhage.,
the surgeon should consider general anesthesia.
Medical Status
• Ocular inflammation such as scleritis and
uveitis associated with connective tissue or
inflammatory diseases should be controlled
preoperatively to minimize the risk of scleral
or corneal necrosis.
• The ophthalmologist can work in conjunction

with the other physicians involved in the
patient’s care to gauge therapy with systemic
corticosteroid and immunosuppressive agents.
• For patients with severe arthritis, it can be difficult to lie comfortably during surgery.
• Usually, the surgical table can be adjusted and pillows added to provide sufficient
comfort without interfering with surgical access to the eye.
• A patient who has ankylosing spondylitis with cervical immobility presents an

extreme challenge in surgical positioning (Fig 9-1).
• If no systemic medical contraindications exist and if adequate access cannot be attained

otherwise, the surgeon should consider general anesthesia.
Anticoagulation Therapy or Bleeding
Disorders
• Clear corneal cataract surgery performed with topical
anesthesia in patients receiving anticoagulation therapy
is not associated with an increased incidence of vision-
threatening hemorrhagic complications.
• Minor bleeding problems, such as eyelid ecchymosis,

hyphema, and subconjunctival hemorrhage, are more
common with anticoagulant use, but these are transient
and self-limited. If a retrobulbar block is used, the risk of
retrobulbar hemorrhage is 3 times higher when the
patient has been taking anticoagulants.
Disorders
• The surgeon should weigh the systemic risks of discontinuing therapy with the surgical risks of
continuing anticoagulation or antiplatelet therapy. When warfarin is continued, the international
normalized ratio (INR) should be maintained within the therapeutic range.
• If anticoagulation therapy is to be discontinued or adjusted for surgery, coordination with the

prescribing physician is recommended.
Disorders
• Discontinuation of anticoagulation is recommended in patients
who have previously experienced a suprachoroidal hemorrhage
because these patients are predisposed to recurrent bleeding.
• Restoring normal coagulation usually requires 3–5 days after

stopping warfarin, and restoring platelet function requires 10–21
days after stopping antiplatelet therapy.
• The clinician should ask the patient about the use of all
medications, including nonprescription items that may contain
aspirin, vitamin E, or vitamin K, which could affect coagulation
status. Table 9-1 presents a list of anticoagulant and antiplatelet
agents approved by the US Food and Drug Administration.
Anticoagulation Therapy or Bleeding Disorders
• IN THE ABSENCE OF HYPOTONY OR HEMORRHAGIC COMPLICATIONS, ANTICOAGULATION
THERAPY MAY BE SAFELY RESUMED FOLLOWING THE FIRST POSTOPERATIVE VISIT. ASSESSMENT
OF THE PATIENT’S COAGULATION PROFILE PRIOR TO SURGERY SHOULD BE CONSIDERED FOR
SYSTEMIC CONDITIONS THAT MIGHT ALTER CLOTTING ABILITY.
TERIMA KASIH

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Preparing for Cataract

Surgery in Special Situations

• Conditions such as hypertension and diabetes mellitus should

• Procedures on these patients should be performed as early in

• Trendelenburg position to reduce venous

• The ophthalmologist can work in conjunction

• A patient who has ankylosing spondylitis with cervical immobility presents an

• If no systemic medical contraindications exist and if adequate access cannot be attained

• Minor bleeding problems, such as eyelid ecchymosis,

• If anticoagulation therapy is to be discontinued or adjusted for surgery, coordination with the

• Restoring normal coagulation usually requires 3–5 days after

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