Improve The Odds Of Successful Cataract Surgery In Uveitic Eyes In a Few Steps
Many people have cataract formation because it is a typical eye complication. Problems occur because of extended corticosteroid or intraocular inflammation. Usually, this medical condition affects people when they are young.
In some cases, typical complications can occur with other complications, such as an anterior capsule or papillary membranes. This is why cataract surgery in the uveitic eyes can cause postoperative and intraoperative problems. However, there are a number of ways to improve the visual and anatomic outcomes.
Although a cataract tray and phacoemulsification equipment are helpful, you must still plan ahead to prepare yourself for any possible difficulties that could occur during surgery. Give the operating room staff a list of everything that you may need in the room in case a risky situation occurs. According to medical experts, the best tools are capsular tension tings, iris hooks, retinal scissors, and a lens loop.
Procedures Before Surgery
Remission should be your ultimate goal. This can be achieved by using a systemic or local treatment. Usually, about three months of quiescence is the best solution. However, in severe situations, the preferred method is a longer duration without any flare-ups. The patient should be monitored regularly during this period because there may be issues with the retinitis, cystoid macular edema, and anterior chamber cell.
Drastic changes should not be made to the patient’s treatment regimen shortly after surgery. When a patient has a well-controlled rheumatologic disorder and is on a proper dose of an immuno-suppressant, the individual should continue to take the drug prior to surgery.
Patients who have ocular autoimmune disease should be treated with a dose of oral corticosteroids several days after the surgery is over. On the day of the surgery, an individual who takes chronic systemic corticosteroids will also need an extra dose of corticosteroids.
Never Use A Topical Anesthesia Alone
Certain eye problems can have intraoperative complications in many cases. This is a problem because iris manipulation causes discomfort. Usually, using a retro bulbar block is an efficient solution. Though, general anesthesia is required for extended cases and for pediatric patients who are reasonably young.
Viscoelastic Cannula During Synechiolysis
Viscoelastic cannula should be introduced below the non-adherent portion near the pupillary border. By sweeping laterally, you can easily apply the adhesion on the pupillary margin. If the lens capsule is adherent to the margin, this technique can help you achieve synechiolysis easily.
Pupillary Membrane Affecting The Pupil
In most cases, during the posterior synechiolysis, the pupillary membrane is simple to remove. However, when a patient has prolonged intraocular inflammation, the membrane can become fibrotic and thick. As a result, disrupting the membrane without using a sharp instrument will be impossible or extremely difficult. Because forceful manipulation can cause bleeding, all procedures should be implemented with caution. After the membrane is opened, use retinal scissors to minimize tension on the iris.
Prepare For A Floppy Iris
There are two common issues that make pupillary dilation challenging in unveitic eyes. Typically, the pharmacologic dilation will only have a little response or no response. Viscomydriasis can be done following a Pupillary membrane excision.
However, the iris may behave like a severe case of intracameral floppy iris syndrome. In this situation, iris hooks can be quite helpful. Consider using a 27-gauge needle to make paracentesis wounds for the hooks. By engaging every hook using gentle tension before totally retracting them, you can make the procedure much easier.
Fibrotic Anterior Capsule Issues
Trypan blue can be very useful because the lens of the anterior capsule has a certain density. Pupillary membranes happen in many layers; some people often confuse the layers with the anterior capsule. Whenever the hydrodissection cannula cannot be inserted, additional procedures must be implemented. To open the capsule, you must use a variety of techniques and the proper tools, such as retinal scissors.
Thanks to new technological advancements, many uveitis patients can get IOLs. However, Aphakia is a better option for young children and patients who have inflammation that is chronic.
The End Of The Surgery
Uveitis patients must receive postoperative medical management. They must be monitored more often than traditional cataract patients. If postoperative inflammation cannot be controlled, a regional steroid injection must be used.
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