Non-surgical management of early cataract consist of optimizing spectacle or contact lens prescriptions.
Cataracts may cause the eye to become more nearsighted and new eyeglasses may improve vision.
The use of magnification and increased illumination in low contrast environments are helpful.
Cataract extraction with intraocular lens implantation is the only treatment and definitive cure.
Therapies to arrest or reverse cataract formation consist of oxidative stress or crystalline protein aggregation targets.
Cataract surgeries indicated when visual impairment interferes with activities of daily living.
Additional indications for surgery include correcting refractory imbalances between eyes and improving visualization of potential retinal pathology.
Cataracts often reduces contrast sensitivity and/or cause glare by scattering light instead of focusing light sharply on the retina.
This effect produces halos around light sources and heightened sensitivity to bright lights.
The presence of unsafe driving due to severe glare is an indication for surgery, even if the patients visual acuity is normal.
Routine preoperative medical evaluations, and testing before cataract surgery are not recommended: selective medical testing may be considered for higher risk patients.
Most outpatient cataract surgery is performed with topical anesthesia and intralocular lidocaine with patients positioned supine.
Periocular injections are helpful in more complex cases, providing akinesia of extraocular muscles and longer acting as anesthesia.
General anesthesia during cataract surgery is reserved for pediatric patients and adults who cannot follow instructions, or unable to lie immobile.
There is no evidence to withhold antiplatelet or anticoagulant therapy before cataract surgery.
Cataract surgery is typically performed through small, self sealing corneal incisions that eliminate the need for sutures.
Cataract surgery uses phacoemulsification where ultrasonic waves delivered through a handheld probe fractures the clouded lens into small fragments through a circular anterior capsulotomy.
These fragments are then aspirated out of the eye while the capsular bags preserved and supports zonules.
A malleable ocular lens is injected into the eye and unfolds in the capsular bag.
The malleable IOL is fixated to the same location as the natural lens, the avascular capsule bag sequesters the prosthetic IOL and minimizes foreign body reaction.
With extremely advanced cataracts, the lens nucleus may become too solid to emulsify with ultrasound and is then manually extracted through a larger incision that is sutured closed.
To prevent a rare postoperative endophthmitis, a potentially blinding intraocular infection, prophylactic intraocular antibiotics with moxifloxacin or cefuroxime are used.
IFIS is defined by progressive pupillary, constriction, and iris prolapse during cataract surgery.
There is a propensity for this floppy iris to prolapse towards the area of cataract extraction during surgery, and lead to progressive intraoperative pupil constriction.
The loss of iris dilatator muscle tone, which does not affect a person’s vision, but is associated with a higher risk of cataract surgical complications such as iris, trauma and lens capsule tears.
The incidence of IFIS is currently approximately 1% among cataract operations.
Asssociated with tamsulosin, a medication prescribed for urinary symptoms associated with benign prostatic hyperplasia.
Severe IFIS is most commonly seen with selective alpha-one antagonists such as tamsulosin and silodosin.
Patients with cataracts should be educated about adverse effects of alpha antagonist medications on cataract surgery.
Tadalafil a phosphodiesterase-5 inhibitor is not associated with IFIS.
There are comparable postoperative event rates in patients whether they have cataract surgery separately or simultaneously: the benefit of staged surgery is that the patient can assess the refractory outcome of the first die that may lead to selecting a different intraocular design or refractive target in the second eye.
Patients are typically given a topical steroid alone or in combination with a non-steroid anti-inflammatory eyedrop for 2 to 4 weeks following surgery.
Some surgeons use periocular or intraocular steroid injections at the time of surgery to reduce the need or frequency of postoperative drops.
The use of topical antibiotic prophylaxis is declining with wide adoption of interocular antibiotics.
Minimal restrictions on physical activities in exercise following a small incision, cataract surgery or recommended.
Visual improvement typically occurs within the first week of surgery and new eyeglasses are typically delayed until their refraction stabilizes after several weeks.
Overall satisfaction with cataract surgery management is greater than 98%.