7
Intraocular Lenses
Î Noncapsular-bag IOL fixation may at times be necessary due to
zonular abnormalities or anterior or posterior capsular tears. The
surgeon should have backup IOLs available as a contingency. (III, G, S)
Î Because noncapsular bag fixation may increase the potential for
optic tilt and decentration, the surgeon should reconsider whether
multifocal IOLs or IOLs with higher degrees of negative spherical
aberration should be Implanted. (III, In, D)
Î A peripheral iridectomy should be used to reduce the risk of pupillary
block associated with an anterior chamber IOL. (III, G, S)
Optical and Refractive Considerations
Î An effort should be made to determine the true corneal refractive
power, which incorporates both the anterior and posterior corneal
power. (III, G, S)
Î The candidacy of patients with amblyopia or abnormalities of the
cornea, optic disc (such as glaucoma), and macula for a multifocal
IOL must be carefully considered. (III, In, D)
Complications of Cataract Surgery
Incisional Complications
Î An incision that is not watertight can lead to several complications,
including postoperative wound leak, hypotony, and endophthalmitis.
Î Factors associated with wound burn in order of decreasing significance
are: lower surgical volume, the surgical technique, and the type of
ophthalmic viscosurgical device (OVD) used.
Iris Complications
Î Damage to the iris can result from iris prolapse due to conditions such
as intraoperative floppy iris syndrome (IFIS) or a poorly constructed
incision.
Î The causes of surgical iris trauma due to a shallow chamber may
include iris aspiration or agitation from the phacoemulsification tip,
sphincterotomies, and excessive stretching or manipulation from
expansion devices (iris hooks and rings) and instruments.
Î The sequelae of such trauma may include iridodialysis; hyphema;
transillumination defects; traumatic mydriasis; and an irregular,
atonic, or misshapen pupil.
Î Sphincter necrosis may occur perioperatively as a result of
endophthalmitis, TASS, or excessively increased IOP.
