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Cataract in the Adult Eye

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Management 6 Infection Prophylaxis Î Careful watertight incision construction and closure (with or without sutures) is obligatory, irrespective of surgical style, because the incidence of infection increases with wound leak. (II-, M, S) Î Several studies support the safety of intracameral moxifloxacin injection for endophthalmitis prophylaxis, and three retrospective studies suggest efficacy. (I-, G, S) Î Compared with an intracameral bolus, antibiotic in the infusate has the theoretical disadvantage of achieving less predictable intraocular antibiotic concentration and duration, and the practice should be discouraged. (III, M, S) Î There is good evidence for the use of a 5% solution of povidone iodine in the conjunctival cul de sac to prevent infection. (II-, M, S) Î The surgeon must ensure that antisepsis of the periocular surface, typically with povidone iodine, is achieved and that all incisions are closed in a watertight fashion at the end of the procedure. (II-, M, S) Surgical Technique Î Only an ophthalmologist has the medical and microsurgical training as part of a comprehensive resident experience needed to perform cataract surgery. (III, G, S) Î When feasible, small-incision surgery is generally preferred for several reasons. (I+, G, S) Smaller incisions: • require fewer sutures for secure closure • are safer in the event of sudden patient movement or a superchoroidal hemorrhage during surgery • are associated with less postoperative inflammation • induce less unwanted astigmatic change than larger incisions • result in greater long-term stability of the refraction Femtosecond Laser Î There may be certain types of cataracts, such as posterior polar or phacomorphic, for which the femtosecond laser should not be used due to higher complication rates, such as posterior capsular rupture. (II-, M, S)

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