1. Dominic McHugh MD FRCS London, UK
Cataract and Implant Surgery
Dominic McHugh MD FRCS London, UK

2. Cataract Causes Age Congenital (genetic, metabolic) Trauma Infection
Inflammation
Surgical
Drugs (eg steroids)

3. Cataract
May be induced by surgical procedure: lens touch; gas; oil

4. Cataract types Nuclear sclerosis Posterior subscapsular
Congenital (rubella)
Trauma

5. Management of Cataract
ECCE (Extracapsular cataract extraction)
But longer wound healing time

6. Cataract Surgery
Small incisional Phacoemulsification surgery (Developed by Kelman, USA)

7. Before IOL implantation was developed
Aphakic spectacles
Contact lenses

8. Pioneer of intraocular lens implant
Sir Harold Ridley FRS FRCS

9. Harold Ridley collaborated with the Rayner company to develop the IOL
John Pike, Rayner Company

10. : First IOL implants

11. Choice of IOL Insertion through small incision High biomcompatilbility
Allows good retinal view
Stable centration
Low PCO (posterior capsular opacification) rate

12. IOL choice Why foldable/injectable
IOL choice Why foldable/injectable? Minimise incision size to reduce healing time and astigmatism
PMMA(rigid) : Non-foldable+large incision
Acrylic: Injectable through mm currently.

13. 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-2.5xAL-0.9K
Eg: x x45= dioptres IOL power

14. Phacoemulsification with IOL implantation

15. Phacoemulsification: surgical sequence
Corneal tunnel
CCC (continuous curvilinear capsulorrhexis
Hydrodissection
Phacoemulsification
Aspiration of cortical lens matter
IOL insertion

16. Phaco parameters

17. Phaco+IOL surgery Hydrodissection

18. Phaco+IOL surgery Phacoemulsification

19. Phaco+IOL surgery Aspiration of cortex

20. Phaco+IOL surgery Foldable IOL insertion

21. Typical injectable IOL
Superflex lens: 6.25mm x 12.50mm
C-Flex lens 5.75mm x mm

22. Cflex/Superflex injector

23. Loading the Superflex IOL

24. Superflex insertion

25. Superflex insertion

26. Superflex insertion

27. Insertion of injectable IOL

28. Endoscope view of Superflex

29. Cataract surgery Postoperative management Eye pad overnight
Antibiotic+steroid drops for up to one month
Change glasses at one month

30. Complications of cataract surgery (many!)
Posterior capsular rupture and vitreous loss
Dropped nucleus
IOL dislocation
Endophthalmitis
Retinal detachment

31. Cataract surgery complications

32. Cataract surgery: complications

33. Thank you!