Systemic Comorbidities
Î For patients with complex medical conditions, it may be beneficial to
coordinate care with the patient's primary care physician. Depending
on the planned anesthesia and sedation, appropriate measures should
be taken to stabilize and monitor the condition. (III, G, S)
Î Evidence-based guidelines recommend continuation of anticoagulants
in patients undergoing cataract surgery provided that the international
normalized ratio is in the therapeutic range (I+, G, S) and that aspirin
be discontinued perioperatively only if the risk of bleeding outweighs
its potential benefit. (I-, G, S)
Combined Surgery and Special Circumstances
Cataract Surgery and Glaucoma
Î When a candidate for cataract surgery also has glaucoma, surgical
treatment options include cataract and IOL surgery alone, combined
cataract and glaucoma surgery, glaucoma surgery after cataract
surgery, or cataract surgery after glaucoma surgery.
Î Glaucoma surgical options include trabeculectomy, aqueous shunts,
nonpenetrating glaucoma surgery, minimally invasive glaucoma
surgery, and endocyclophotocoagulation.
Cataract Surgery and Keratoplasty
Î If possible, at the time of surgery, phacoemulsification should be
performed before penetrating keratoplasty if visualization is adequate
in order to limit the amount of open-sky time. (III, G, S)
• However, hydration of the vitreous and high posterior pressure is a potential
problem during the keratoplasty phase.
Cataract Surgery and Vitreoretinal Surgery
Î Combined vitreoretinal and cataract surgery offers the advantage of a
single operative procedure and anesthesia, potentially faster recovery,
and cost-effectiveness.
Î A wide range of vitreoretinal disorders may be dealt with
concomitantly, including vitreous hemorrhage, diabetic retinopathy,
epiretinal membrane, macular hole, and retinal detachment.
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