Management
Cataract Surgery Following Refractive Surgery
Î Patients should be informed of the potential inaccuracies of IOL-power
calculation and that further surgery may be necessary to achieve the
desired target refraction. (III, G, S)
Cataract Surgery and Uveitis
Î The medical regimen should be individualized based on the severity
and sequelae of past episodes of uveitis and the ease with which
inflammation has been previously controlled. (III, G, S)
Î Surgical planning should take into account the possible need for other
procedures, which are often required because of associated uveitic
complications, such as secondary glaucoma. (III, G, S)
• Surgical procedures may need to be modified to manage pre-existing posterior
synechiae, pupillary membranes, zonular compromise, and fibrotic scarring of the
pupillary margin.
Î Adjunctive corticosteroids at the time of surgery (intravenous,
periocular, or intraocular) should be considered. (III, G, S)
Î Postoperatively, eyes with uveitis generally require greater
frequency and duration of topical anti-inflammatory treatment
and should be monitored closely for complications such as severe
iridocyclitis, secondary glaucoma, posterior synechiae, secondary
membranes, and CME. (III, G, S)
Cataract in the Functionally Monocular Patient
Î When cataract surgery is contemplated in a functionally monocular
patient, the ophthalmologist has an obligation to inform the patient that
blindness is one of the risks of cataract surgery and that it can also
result from worsening ocular comorbidity following surgery. (III, G, S)
Î The ophthalmologist and patient should consider that delaying surgery
until the cataract is very advanced may increase surgical risk and slow
visual recovery. (III, G, S)
Second-Eye Surgery
Î Cataract surgery for both eyes is an appropriate treatment for patients
with bilateral cataract-induced visual impairment. (I-, G, S)
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