Cataract Extraction Procedures

Ophthalmic viscoelastic device (OVD, visco)

a viscous gel injected into the anterior chamber in order to maintain the space of the anterior chamber during cataract surgery as well as to prevent endothelial lost. Must be completely removed following the procedure in order to prevent the obstruction of aqueous outflow and the development of secondary glaucoma.

Lidocaine

anesthetic that is injected into the anterior chamber during cataract surgery

Capsulorhexis

a circular opening of the anterior capsule for extraction of the lens and insertion of a lens implant during extracapsular cataract extraction

Fibrin sealant

a combination of human fibrinogen and thrombin used for the gluing of tissues together. This is used to seal the conjunctiva following cataract extraction

Tamponade

the injection of air, C3F8 gas, BSS, or silicon oil into the anterior chamber in order to maintain its shape during ocular procedures

Phacoemulsification

the most commonly performed method of lens extraction. Extracapsular cataract extraction involving breaking up the lens into fragments within the lens capsule by ultrasonic energy and removal via aspiration. Requires a smaller rhexis. Major benefit of this procedure is that it does not require sutures.

Aspiration

the removal of fragmented lens via the phacoemulsification hand tool

Irrigation

the replacement of removed lens material and aqueous with a balanced salt solution (BSS) via the phacoemulsification hand tool

Tetracaine

topical anesthetic applied during cataract surgery

Miochol

topical miotic that may be optionally instilled following cataract surgery

two week

Cataract surgery can only be performed on one eye at a time with a minimum of a _____ period between eyes in order to ensure insurance reimbursement

pain management (not for anti-inflammatory properties)

During cataract surgery, NSAIDs are used for...

anterior chamber depth, corneal endothelium

Viscoelastic material is injected into the anterior chamber for maintaining _____ and protection of the _____

Paracenthesis

an incision in the cornea for access of instruments into the anterior chamber

Diazepam (Valium) 5-10 mg

mild sedative given to patients prior to cataract surgery

Hexachlorophene

alternative sterilization solution used to povidone iodine when the patient has an iodine allergy

Hemostasis

cessation of bleeding

Manual expression

extracapsular cataract extraction involving lens removal through a limbal scleral incision. Is useful in hypermature hard cataracts with stable zonules which would require too much energy during phacoemulsification posing risk for endothelial and iris damage. Requires a larger rhexis.

Femtosecond Laser Assisted Cataract Surgery (FLACS)

extracapsular cataract extraction procedure involving laser emulsification of the lens guided by OCT imaging. Manual aspiration, irrigation, and lens implantation are then performed. Creates a more accurate rhexis which may make it superior in the implantation of multifocal IOLS, however is it very expensive and has not been proven to be superior to phacoemulsification.

Cautery

instrument that seals bleeding blood vessels usually with Bovie (heat) or electrical diathermy

Anterior chamber intraocular lens (ACIOL)

intraocular lens that is placed anterior to the iris with its haptics located within the anterior chamber sulcus

Extracapsular cataract extraction (ECCE)

lens removal technique involving the removal of the lens ONLY through a hole made in the anterior capsule known as a capsulorhexus (rhexus). The lens can be removed via manual expression or by phacoemulsification. An implantation of an intracapsular IOL is then required. This is the procedure of choise for all types of lens extraction and IOL implantation.

Intracapsular cataract extraction (ICCE)

lens removal technique involving the use of a cryogenic probe, inserted through a limbal incision, for removal of the lens AND its capsule. An implantation of an anterior chamber IOL is then performed or the patient is left aphakic. This procedure is indicated for hypermature cataracts or in eyes with poor zonular support.

Divide and conquer

method of lens removal during phacoemulsification where the lens is initially broken in half

Phaco chop

method of lens removal during phacoemulsification where the lens is initially broken into quarters and then eighths

1-2 mm

size of the limbal incision that is made for insertion of the Sinsky hook

2-3 mm

size of the limbal incision that is made for insertion of the phaco probe and IOL injector