Page 60 - NAME OF CONDITION: REFRACTIVE ERRORS

iv. Lens induced glaucoma
Prognosis of surgery should be clearly explained to the patient in an understandable

language.
Contra-indications for surgery:
i) Patient not convinced about surgery
ii) Patient has satisfactory functional vision either with or without visual aids
iii) Cataract surgery is unlikely to improve vision
iv) Patient is medically unfit

Anesthesia
Cataract surgery may be performed using a variety of anesthesia techniques that include
general and local (regional) anesthesia (e.g., retrobulbar, peribulbar, periocular, sub-
Tenons injection, topical, and intracameral). Local (regional) anesthesia is generally used,
with or without sedation/analgesia. Traditionally, a retrobulbar or peribulbar anesthesia is
used for most of the extracapsualr cataract surgeries. Topical anesthesia can be used for

patients undergoing clear corneal phacoemulsification. General anesthesia may be utilized
if needed for children and patients with medical, psychosocial, or surgical indications. The
planned mode of anesthesia should be decided after interaction between patient and the
doctor. The process should be discussed with the patient so that he/she will know what to
expect in terms of pain, discomfort, consciousness level, visual experiences, and
complications.

Infection Prophylaxis
Greatest concern of an ophthalmologist after successful surgery is the endophthalmitis
because of its serious consequences. Prevention remains the best measure to avoid it. Risk

for endophthalmitis can be lessened by reducing the number of microorganisms on the
ocular surface.

Prophylactic strategies that are commonly practiced include using topical antibiotic eye
drops before surgery, applying 5% povidone iodine to the conjunctival cul de sac, preparing
the periocular skin with 10% povidone iodine, careful sterile draping of the eyelid margins
and eyelashes, and applying topical antibiotic eye drops after surgery.
Taking care of personal hygiene of the patient is very important. A thorough face washes
before surgery is recommended. A surgeon should stick to strict aseptic techniques of

surgeries.
Wound construction and closure should be meticulous. The surgery should end with a
water tight incision and the surgeon should not hesitate to put sutures for security.

Surgical Techniques
The preferred method to remove a cataract is extracapsular extraction by either of the
following techniques:
a. Manual small incision cataract surgery
b. Conventional extracapsular cataract extraction.

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