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Cataract in the Adult Eye

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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.

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