A thorough preoperative exam is crucial in

Cataract and systemic disease

A thorough preoperative exam is essential to find any disease outside of the eyes. Roibeard Ó hÉineacháin reports

Looking beyond the eye during preoperative assessment can optimise the outcomes of cataract surgery in patients with systemic disease with ocular manifestations, said Betty Lorente Bulnes MD, FEBO, Spain, at the 25th ESCRS Winter Meeting.

“Sometimes we are too focused on the eyes of our patients and we forget that they might have diseases outside of their eyes,” Dr Lorente Bulnes said.

She noted that a thorough preoperative exam is crucial in determining systemic diseases that might affect the patient’s ability to cooperate and collaborate with the surgeon. This would include Down syndrome, Alzheimer’s, Parkinson’s disease and musculoskeletal disorders. As an example, she described a recent case where due to an arthritis condition the patient could not bring the back of his head on to the operating table and she had to perform the operation while standing up.

Also important is careful questioning as iris retractors and capsular tension rings of the patient regarding the medical should be ready to hand in such cases in history. For example, in patients with a order to stabilise the bag, she said. history of prostatic disease, even a brief She added that eyes with a history regimen of alpha blockers such as of uveitis, whether it is caused by tamsulosin can leave its imprint infection or autoimmunity, also on the iris many years later. In require special consideration. such cases, the surgeon will For example, patients at her need to be prepared to deal centre currently receiving with intraoperative floppy corticosteroids require an iris syndrome. Research adjustment of their regimen conducted 10 years ago in the week prior to surgery. now shows that intracameral In addition, those receiving phenylephrine is very effective biologic treatments undergo inducing pupil dilation in these Betty Lorente Bulnes MD, FEBO surgery between treatments and eyes, Dr Lorente Bulnes noted. those with herpetic uveitis or

“Another aspect that is really frequent in a history of herpetic eye disease receive our patients is antithrombotic agents. We prophylactic treatment should take all of this into account before Dr Lorente Bulnes also noted that in bringing our patients into the OR, studying patients with ocular surface disease one the risks and benefits of stopping these should be careful not to rule out pemphigoid, drugs in these major diseases,” she added. a very aggressive and underdiagnosed

Marfan’s syndrome is another condition disease that can masquerade as less serious that requires modifications in cataract conditions such as chronic blepharitis or procedures. Special instrumentation such chronic conjunctivitis.

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