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Cataract in the Adult Eye

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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) 16

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