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However, this procedure is expensive and sometimes may be difficult to perform in certain
types of cataracts.

In all these types of surgeries, there are chances of intraoperative complications. The most
common causes are posterior capsular rupture and zonular dialysis. If this happens, the
management of vitreous loss is crucial and should be managed by automated vitrectomy.

Intraocular Lenses
Posterior chamber IOLs (PC IOL) are the best choice unless contra-indicated. Other less
commonly used lenses are Anterior Chamber and Scleral Fixated IOLs.

There is a wide range of PC IOLs with various value added optical and non optical
characteristics. The most common materials used are polymethyl methacrylate (PMMA)
and acrylic lenses. Even though they have comparable visual acuity outcomes, the rates of
posterior capsular opacification (PCO) is lower in acrylic than PMMA. In patients, where
there is more chance of posterior capsular opacification,as in children or diabetics or
others, acrylic lenses may be preferred. Acrylic lenses can be hydrophobic or hydrophilic.

Another parameter which has been thought to influence PCO occurrence is the design of
the intraocular lenses. Square edged lenses are known to cause a lower incidence of PCO.
The ophthalmologist can choose any of these PCIOLs according to clinical indications,
patient’s visual need and affordability.

Anterior chamber lenses if used at all, should preferably be single-piece flexible open-loop.
Effective and safe use of an anterior chamber lens depends on appropriate sizing. Anterior
chamber IOLs are used most often when there is inadequate capsule support for a
posterior chamber IOL. Placement of an anterior chamber lens requires a peripheral
iridectomy and proper anterior vitrectomy.

The surgeon should have access to a variety of lens styles to select an appropriate IOL for
an individual patient. Variations in the preoperative state of the eye, the surgical
technique, patient expectation, and surgeon experience and preference affect the decision.

Post Operative Medication:
i) Topical corticosteroid in a tapered fashion for 4 to 6 weeks.

ii) Topical broad spectrum antibiotics for two weeks.
iii) Cycloplegic drops, NSAID and anti glaucoma medications according to
ophthalmologist’s clinical decision.
Outcomes of cataract surgeries should be carefully monitored and results used for
improvement of service. Presenting visual acuity, rather than best corrected visual
acuity should be taken as the standard for assessing visual success.
Complications of Cataract Surgery should be carefully documented clearly explained to
the patient in their own language and appropriate care given.

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