Cataract and Implant
Surgery
DOMINIC MCHUGH MD FRCS
LONDON, UK
Cataract
Causes
• Age
• Congenital
(genetic, metabolic)
• Trauma
• Infection
• Inflammation
• Surgical
• Drugs (eg steroids)
Cataract
• May be induced by surgical procedure:
lens touch; gas; oil
Cataract types
Nuclear sclerosis
Congenital (rubella)
Posterior subscapsular
Trauma
Management of Cataract
• ECCE (Extracapsular cataract extraction)
But longer wound healing time
Cataract Surgery
• Small incisional Phacoemulsification
surgery (Developed by Kelman, USA)
Before IOL implantation was
developed
• Aphakic spectacles
• Contact lenses
Pioneer of intraocular lens
implant
Sir Harold Ridley FRS FRCS
Harold Ridley collaborated with
the Rayner company to develop
the IOL
John Pike, Rayner Company
1949-1950: First IOL implants
Choice of IOL
• Insertion through small incision
• High biomcompatilbility
• Allows good retinal view
• Stable centration
• Low PCO (posterior capsular opacification)
rate
IOL choice
Why foldable/injectable?
Minimise incision size to reduce
healing time and astigmatism
× PMMA(rigid) : Non-foldable+large incision
 Acrylic: Injectable through 2.2-3.2 mm currently.
Preparation for cataract
surgery
Biometry: The calculation of
required IOL power
Keratometry (K) (corneal
curvature)
Axial length (AL) of eye
(ultrasound)
IOL power= A constant-2.5xAL0.9K
Eg: 118-2.5x 24-0.9x45=17.5
dioptres IOL power
Phacoemulsification with IOL
implantation
Phacoemulsification: surgical
sequence
• Corneal tunnel
• CCC (continuous curvilinear capsulorrhexis
• Hydrodissection
• Phacoemulsification
• Aspiration of cortical lens matter
• IOL insertion
Phaco parameters
Phaco+IOL surgery
Hydrodissection
Phaco+IOL surgery
Phacoemulsification
Phaco+IOL surgery
Aspiration of cortex
Phaco+IOL surgery
Foldable IOL insertion
Typical injectable IOL
Superflex lens: 6.25mm x 12.50mm
C-Flex lens 5.75mm x 12.00 mm
Cflex/Superflex injector
Loading the Superflex IOL
Superflex insertion
Superflex insertion
Superflex insertion
Insertion of injectable IOL
Endoscope view of Superflex
Cataract surgery
Postoperative management
Eye pad overnight
Antibiotic+steroid drops for up to one
month
Change glasses at one month
Complications of cataract
surgery (many!)
• Posterior capsular rupture and
vitreous loss
• Dropped nucleus
• IOL dislocation
• Endophthalmitis
• Retinal detachment
Cataract surgery complications
Cataract surgery: complications
Thank you!