3cataract surgery

Sir Harold Ridley
The Ridley IOL
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History of Cataract surgery
• The earliest records come from Hindu medicine. • This is the couching of Cataract Surgery in India in 2000 BC.
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Examination method of cataract
• slit lamp
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Preparation for operation
• elective surgery
• Systemic diseases control well, which is stable and the patients can tolerate operation , no active inflammation in the eye
Preoperative
2 days postoperative
Case 2 --Complicated cataract after glaucoma surgery
Numerous formulae have been developed which utilize keratometry and axial length to calculate the IOL power.
IOL master
• the IOL power • Depth of the anterior chamber Diameter of the cornea
Topical anesthesia - 1993
• Dr. Freeman popularized the use of topical anesthesia in 1993. • Surgery can be performed without injection.
A story
1974, Chairmen Mao was diagnosed with a cataract , almost got blind for 1 year. 1975, Chairmen Mao took a cataract surgery.
Surgical management of unusual cataract
二、Case 1 --Cataract with obsolete uveitis
Female，67-year-old，Cataract，Obsolete Uveitis PE：VA 0.1(Left), Less circular pupil, Most posterior synechia, Brown lens opacity, Corneal endothelia cells 1036/mm2. Management：Phaco + IOL implantation + Pupil angioplasty, Postoperative VA 0.5, IOP 8mmHg
History of cataract surgery
• During World War II, Harold Ridley observed that aviators could tolerate shards of PMMA(polymethyl methacrylate)plastic from the aircraft canopies in their eyes. • He used this knowledge to create and to implant the first intraocular lens between 1949 and 1950.
The IOL is inserted into a cartridge for injection which is loaded into an injector handset
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Sutureless Cataract Surgery 1991
• Dr. McFarland discovered that if he were to construct the incision as a valve, the incision would be self sealing. • Thus he started the “no stitch” cataract surgery.
History of cataract surgery.
• 1867 Henry Williams of England first described the use of sutures in cataract surgery.
History of cataract surgery
• In 1914, Van Lint of Brussels, described the use of anesthesia. • We are still using his technique – the Van Lint technique, to numb the eye.
Corneal endothelium count
Eyes with decreased endothelial cell counts have increased vulnerability to postoperative decompensation secondary to operative trauma.
Viscoelastic is injected into the anterior chamber
A-scan ultrasonography
A-scan ultrasonography
a generally slightly less accurate method of determining the axial dimension and can be acquired either by direct contact
History of Cataract Surgery
This is the couching of Cataract in Europe between 2000BC to 1000 AD.
History of Cataract Surgery
• Jacques Daviel’s first scientific description of cataract extraction in 1752. • No anesthesia • No sutures • Sand bags to prevent movement of the head.
injection of viscoelastic into the capsular bag ; (C) incision is enlarged; (D) cartridge nozzle with IOL is introduced through the incision; (E) IOL is slowly injected into the eye; (F) IOL is dialled into position if necessary
surgery of cataract
田甜
Treatment of cataract
• There isn’t any effective drug to the senile cataract. • It is major to operation.
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Operative time
• At the immature or mature stage • The lens is extracted when the vision is affected or the complications occurred.
(C) drapes isolate the eyelids from the operating field with insertion of a speculum.
• (A) Cortical lens matter is pulled centrally and aspirated: (B)
Original Ridley Implant
Foldable implant - 1991
• In 1991, FDA approved the use of Silicone foldable implant. • With foldable implant inserted a 6 mm implant through a 3.2 mm incision opening. • One stitch surgery.
Optical Coherence tomography
several ultrasonic emulsifying machines • 蠕动泵 文丘里泵
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IOL Monofocal Technology Advances
1949 PMMA 1983 SILICONE 1994 HYDROPHOBIC ACRYLIC Single-Piece Design 2005 + Aspheric Optic UV only UV and Blue Light Filtering
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Preparation for operation
A detailed eye examination to predict postoperative vision - visual function -Introcular pressure, mydriasis, etc -A/B ultrasonic exam -IOL master -Corneal curvature -Corneal endothelium count
Before 1975, preimplant era, patients have to wear this thick glasses to focus. These glasses are heavy and clumsy, and causes 25% magnification of what they see.
History of cataract surgery
• Phacoemulsification of Cataract 1974 to now
Phaco = Lens Emulsify = make into liquid.
Intracapsular cataract extraction without Implant – before 1975
• Too hard lens nucleus may not adopt this method
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Small incision manual cataract surgery
• (A)
Anterior chamber is entered; (B) capsulorhexis; (C) prolapse of nucleus into anterior chamber; (D) expression of nucleus; (E) cortical cleanup;Baidu Nhomakorabea(F) IOL in place
cataract abaissement Acupuncture of traditional chinese medicine
Phacoemulsification
(A) Povidone-iodine 5% is instilled;
(B) disinfect the skin around eye;
– strongpoint:
• Self-healing wound • The corneal astigmatism after operation is fine • Visual restoration is soon
– Shortcoming:
• The apparatus is expensive