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cataract surgery

Classification: 1) extracapsular cataract extraction surgery 2) intracapsular cataract surgery 3) phacoemulsification cataract surgery. Indications: - cataracts - may reduce risk of hip fracture (RR=0.84) [3] - associated with 60% mortality reduction in women, including all-cause mortality, & reduced mortality due to accidents, infections, neurologic disease, cancer, pulmonary disease, & vascular disease [15] - small reduction in automobile accidents, 0.22 per 1000 patient years [16] - unrestricted monitoring required for other eye diseases - improves ability to monitor macular degeneration [1] - cataract extraction associated with reduced risk of dementia (RR=0.71) [18] Contraindications: - no data supports cataract surgery improving activities of daily living [1] - visual outcomes in people with macular degeneration do improve with cataract surgery but not to the extent seen in patients without retinal disease - thus cataract surgery is not expected to correct visual loss in patients with macular degeneration Procedure: - preoperative testing not indicated [4,25] - removal of an opacified lens (cataract) from the eye to restore sight - low risk of hemorrhage - continue clopidogrel & aspirin in patients with drug-eluting stent - continue warfarin or direct oral anticoagulant - use of intraocular vancomycin* during cataract surgery to prevent endophthalmitis generally not recommended [14] * no FDA-approved formulation of vancomycin for intraocular injection [14[ Laboratory: - preoperative laboratory testing not recommended [4,11,12] Complications: - opacification of the posterior capsule (most common) [6] - posterior capsular rupture - retinal detachment - chronic postoperative uveitis - vitreous hemorrhage - cystoid macular edema - cataract surgery does not increase neovascular activity in wet macular degeneration [1] - endophthalmitis - alpha-1 adrenergic receptor antagonists can lead to floppy iris syndrome during cataract surgery [2] - do not initiate alpha-1 adrenergic receptor antagonist therapy prior to scheduled cataract surgery [1] - increased risk of falls in the elderly after 1st & 2nd cataract surgery [7,10] - no association of cataract surgery with macular degeneration [13] - cataract surgery permits better visualization of the retina & macula - cataract surgery improves visual acuity in patients with macular degeneration [19,20,21,22,23,24] - surgery is not expected to correct visual loss in a patient visual loss corresponding in time with worsening sclerotic cataracts (GRS12, SOE= BS) - intraocular injections of a compounded formulation of triamcinolone, moxifloxacin, & vancomycin in each eye at the end of cataract surgery associated with case of hemorrhagic occlusive retinal vasculitis [14] Management: - ketorolac plus prednisolone ophthalmic is not superior to ketorolac monotherapy for postoperative central macular thickening after uncomplicated cataract surgery [17] Notes: - preoperative consultation [5] - value unclear - reimbursed by Medicare - no guidelines [5] - contrast sensitivity & stereopsis are factors in vision-related quality of life after 1st eye cataract surgery - visual acuity is not [8] - contrast sensitivity affects driving difficulty after 1st cataract surgery for bilateral patients - visual acuity is not affected [9]

Specific

extracapsular cataract extraction (ECCE) surgery intracapsular cataract extraction surgery phacoemulsification (PE) cataract surgery

General

eye surgery; opthalmologic surgery; ocular surgery

References

  1. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  2. Prescriber's Letter 19(5): 2012 Drug-Induced Adverse Eye Effects Detail-Document#: 280508 (subscription needed) http://www.prescribersletter.com - Chang DF. Floppy iris syndrome: why BPH treatment can complicate cataract surgery. Am Fam Physician. 2009 Jun 15;79(12):1051, 1055-6. PMID: 19530635
  3. Tseng VL et al Risk of Fractures Following Cataract Surgery in Medicare Beneficiaries JAMA. 2012;308(5):493-501 PMID: 22851116 http://jama.jamanetwork.com/article.aspx?articleid=1273017
  4. Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 19. 20 American College of Physicians, Philadelphia 2012, 2015, 2021, 2025 - Whinney C. Perioperative medication management: general principles and practical applications. Cleve Clin J Med. 2009 Nov;76 Suppl 4:S126-32 PMID: 19880829
  5. Thilen SR et al. Preoperative consultations for Medicare patients undergoing cataract surgery. JAMA Intern Med 2013 Dec 23 PMID: 24366269 http://archinte.jamanetwork.com/article.aspx?articleid=1790996
  6. Knobbe CA Cataract Surgery Complications http://www.allaboutvision.com/conditions/cataract-complications.htm
  7. Meuleners LB, Fraser ML, Ng J, Morlet N. The impact of first- and second-eye cataract surgery on injurious falls that require hospitalization: a whole- population study. Age and Ageing. 2014;43:341-34 PMID: 24192250
  8. Fraser ML, Meuleners LB, Lee AH, Ng JQ, Morlet N. Vision, quality of life and depressive symptoms after first eye cataract surgery. Psychogeriatrics. 2013 Dec;13(4):237-43. PMID: 24118634 [PubMed - indexed for MEDLINE]
  9. Fraser ML, Meuleners LB, Lee AH, Ng JQ, Morlet N. Which visual measures affect change in driving difficulty after first eye cataract surgery? Accid Anal Prev. 2013 Sep;58:10-4 PMID: 23689201
  10. Meuleners LB, Lee AH, Ng JQ, Morlet N, Fraser ML. First eye cataract surgery and hospitalization from injuries due to a fall: a population-based study. J Am Geriatr Soc. 2012 Sep;60(9):1730-3. PMID: 22882171
  11. Chen CL et al Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery. N Engl J Med 2015; 372:1530-1538. April 16, 2015. PMID: 25875258 http://www.nejm.org/doi/full/10.1056/NEJMsa1410846
  12. Keay L, Lindsley K, Tielsch J, Katz J, Schein O. Routine preoperative medical testing for cataract surgery. Cochrane Database Syst Rev. 2012 Mar 14;3:CD007293. Review. PMID: 22419323 Free PMC Article
  13. Marra KV, Wagley S, Kuperwaser MC et al Care of Older Adults: Role of Primary Care Physicians in the Treatment of Cataracts and Macular Degeneration. J Am Geriatr Soc. 2016;64(2):369-377. PMID: 26825587 http://www.medscape.com/viewarticle/859809
  14. FDA Safety Alert. Oct 3, 2017 Intraocular Injections of a Compounded Triamcinolone, Moxifloxacin, and Vancomycin (TMV) Formulation: FDA Statement - Case of Hemorrhagic Occlusive Retinal Vasculitis. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm578743.htm
  15. Tseng VL, Chlebowski RT, Yu F et al Association of Cataract Surgery With Mortality in Older Women. Findings from the Women's Health Initiative. JAMA Ophthalmol. Published online October 26, 2017. PMID: 29075781 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2657478 - Smith JR. Association of Cataract Surgery With Decreased Mortality Among US Women. JAMA Ophthalmol. Published online October 26, 2017. PMID: 29075741 https://jamanetwork.com/journals/jamaophthalmology/article-abstract/2657474
  16. Schlenker MB, Thiruchelvam D, Redelmeier DA. Association of Cataract Surgery With Traffic Crashes. JAMA Ophthalmol. Published online June 28, 2018. PMID: 29955857 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2686118
  17. Erichsen JH, Holm LM, Jacobsen MF et al Prednisolone and Ketorolac vs Ketorolac Monotherapy or Sub-Tenon Prophylaxis for Macular Thickening in Cataract Surgery. A Randomized Clinical Trial. JAMA Ophthalmol. Published online August 12, 2021 PMID: 34383010 https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2782731
  18. Lee CS, Gibbons LE, Lee AY et al Association Between Cataract Extraction and Development of Dementia. JAMA Intern Med. Published online December 6, 2021 PMID: 34870676 PMCID: PMC8649913 Free PMC article https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2786583 - Slomski A Cataract Surgery May Stave Off Dementia Among Older Patients. JAMA. 2022;327(5):416 https://jamanetwork.com/journals/jama/fullarticle/2788544
  19. Chen AX, Haueisen A, Rasendran C et O Visual outcomes following cataract surgery in age-related macular degeneration patients. Can J Ophthalmol. 2021 Dec;56(6):348-354. PMID: 33609442
  20. Karesvuo P, Elbaz U, Achiron A et al Effect of cataract surgery on wet age-related macular degeneration activity. Acta Ophthalmol. 2022 Feb;100(1):e262-e269. PMID: 33838002 Free article. https://onlinelibrary.wiley.com/doi/10.1111/aos.14864
  21. Starr MR, Mahr MA, Barkmeier AJ et al Outcomes of Cataract Surgery in Patients With Exudative Age-related Macular Degeneration and Macular Fluid. Am J Ophthalmol. 2018 Aug;192:91-97. PMID: 2980281
  22. Choi EY, Kim TY, Lee CS. Predictive Factors for Long-Term Outcomes of Cataract Surgery in Patients Receiving Active Treatment for Neovascular Age-Related Macular Degeneration. J Clin Med. 2021 Jul 15;10(14):3124. PMID: 34300289 PMCID: PMC8306055 Free PMC article. https://pmc.ncbi.nlm.nih.gov/articles/PMC8306055/
  23. Saraf SS, Ryu CL, Ober MD. The effects of cataract surgery on patients with wet macular degeneration. Am J Ophthalmol. 2015 Sep;160(3):487-492.e1. PMID: 26095263 Clinical Trial.
  24. Daien V, Nguyen V, Morlet N et al Outcomes and Predictive Factors After Cataract Surgery in Patients With Neovascular Age-related Macular Degeneration. The Fight Retinal Blindness! Project. Am J Ophthalmol. 2018 Jun;190:50-57. PMID: 29550186
  25. Macias AA, Goldfarb J. Preoperative Evaluation of Patients Undergoing Eye Surgery. Anesthesiol Clin. 2024 Mar;42(1):159-168. PMID: 38278587 Review.
  26. Day AC, Wormald R, Coronini-Cronberg S et al The Royal College of Ophthalmologists' Cataract Surgery Commissioning Guidance: executive summary. Eye (Lond). 2016 Mar;30(3):498-502. . PMID: 26795408 PMCID: PMC4791709 Free PMC article.