1. POST CATARACT CARE IN TAKEO EYE HOSPITAL Residency Dr Leang Sam Ann/ Dr Neang Mao

3. Planning of postoperative care The surgeon should evaluate the patient's ability to participate in postoperative care. The surgeon, patient, caregivers should discuss the patient’s ability :  to administer eye drop  Maintain good ocular and general hygiene  Keep postoperative appointments

4. Planning of postoperative care Patient also need to understand the importance of activity restriction:  Patient lifestyle  Type of surgery  Minimal activity limitation

5. EYE PATCH Patch the eye after completing cataract surgery. Eye patch or eye shield The patch until the first postoperative appointment, Usually to cleaning on day after surgery in the next morning.

6. Early post operative complication  Wound related  Wound leak  Iris prolapse  Induce astigmatism  Corneal  Corneal edema  Striate keratapathy  Anterior chamber  AC reaction  Hyphema  Vitreous in AC  IOP related  Raised  Low  IOL related  Decentered  Dislocated  Tilted  Pupillary capture  Capsular block syndrome  Acute endophthalmitis

7. EYE DROP The drop is help to prevent infection and promote wound healing. The doctor usually order two or three different kind of drops for use on specific schedule. (Dexa +Cipro x6) Gradually taper dose of medication.

8. General instructions for postoperative patient after eye surgery Physical activity: walking, talking, TV viewing can be resumed immediately after surgery. Swimming, gardening, contact sport, jogging, etc avoid until 4-6 weeks. Driving: avoid until surgeon give you permission. Joining back duties: 4-6 weeks after surgery depending upon surgery.

9. Patient should not do A.Rub the eye. B.lift heavy weights. C.Avoid contact infection visitors. D.Play with children. E.Strain at toilet. If needed please take laxative. F. Alcoholic and cigarette smoking. G.Handkerchief to mop the eye. Use sterile tissue only.

10. Instruction for installing medicine in the eye A.Always install drop before ointment. B.Leave a gap of 5 minute between two medication. C.Keep the eye close 5 minute. D.Replace the cape of bottle immediately after use. E.Use 5 right method of medication. F.Advice to have separate bottle for two eye. G.Once open is discard and never used other person.

11. Date of follow up after surgery Eye exam with slid lamp one day after surgery. Further appointment usually:  2weeks  1 month after If feel problem please see the doctor before follow up.

12. When should call the doctor Do not hesitate to contact the doctor any of following: Pain is not relieved by medication. Deterioration of vision. Excessive discharge from operative eye. Sudden onset of flashes or floaters.

13. Late postoperative complication  Wound related  Astigmatism  Corneal  Bullous keratopathy  Corneal decompensating  Corneal melting.  Epithelium Down growth  IOP related  Glaucoma  Anterior Chamber  Chronic uveitis  UGH syndrome  Iris atrophy or cyst  IOL related  Malposition, glare  PCO, PHIMOSIS  Posterior segment  Retinal light toxicity  Macular infarction  CME/RD  Chronic Endophthalmitis

14. Age and gender of operated patients AgeMaleFemaleTOTAL N%N%N% 20-39201.6241.0441.2 40-49675.4783.31454.0 50-5923218.733314.156515.7 60-6940432.587737.21,28135.6 70-7940832.884735.91,25534.9 80+1129.01998.43118.6 Total1,243100.02,358100.03,601100.0

15. Ag and gender of operative patients

16. Visual acuity in operated eye pre-op at discharge and follow up Admission N= 3601 1-3weeks N=2865 4- 11weeks N=1702 12+ weeks N=696 WHO norms on outcome Visual acuity Pre-op%Discharge%Presenting % Best%Presenting % Best%Presenting % Best%Presenting % Best% 6/6- 6/18 4.150.053.568.257.572.063.976.9>80%>90% <6/18- 6/60 34.242.739.126.735.723.831.520.0<15%<5% <6/60 *** 61.87.37.45.26.94.24.63.2<5%

17. Proportion of good/ Borderline/poor outcome by follow up (presenting VA) Total ops N Good N %Borderl ine N %Poor N %No data N % Discharge 3,6001,79950.01,53842.72637.310.0 1-3weeks 2,8651,53253.51,12039.12137.473620.4 4- 11weeks 1,70297857.560735.71176.91,89952.7 12+weeks 69644563.921931.5324.62,90580.7 WHO norms >80%<15%<5%

18. Proportion of good/ Borderline/poor outcome by follow up (presenting VA) Total ops N Good N %Borderl ine N %Poor N %No data N % Discharge 3,6001,79950.01,53842.72637.310.0 1-3weeks 2,8651,53253.51,12039.12137.473620.4 4- 11weeks 1,70297857.560735.71176.91,89952.7 12+weeks 69644563.921931.5324.62,90580.7 WHO norms >80%<15%<5%

20. Operative complication by place of surgery Base hospital N=3601 Other hospital N=0 Out of hospital N=0 N% of total opsN N Capsule rupture without vitreous loss 140.400.00 Vitreous loss 591.600.00 Zonular dehiscence 150.400.00 Retain lens matter 20.100.0 Striated keratopathy 20.100.00 Endophthalmitis 391.100.00 other 361.000.00 Wound leak o0.00 0 Total 1674.600.00

22. Operative complication by cadre of surgeon Consultan t N=2346 Trainee N=1255 Non-doctor N=0 N% of total opsN N Capsule rupture without vitreous loss 110.530.200.0 Vitreous loss 190.8403.200.0 Zonular dehiscence 120.530.200.0 Retain lens matter 10.010.100.0 Striated keratopathy 00.020.200.0 Endophthalmitis 241.0151.200.0 other 120.5241.900.0 Wound leak O0.00 0 Total 793.4887.000.0

24. Operative complication by additional ocular pathology Corner scar N=103 Old iritis N=11 Retinal disease N=143 Glaucoma N=38 Others N=53 N% of total ops N N N N Capsule rupture without vitreous loss 11.000.010.700.00 Vitreous loss 11.000.010.700.011.9 Zonular dehiscence 00.00 0 0 23.8 Retain lens matter 00.00 0 0 0 Striated keratopathy 00.00 0 0 0 Endophthal mitis 11.000.00 0 0 other 00.00 10.700.011.9 Wound leak O0.00 0 0 0 Total 32.900.032.900.043.9

26. Operative complications by type of surgery and IOL Total operated case Total complica ted case Total complicate d case % CR without VL VLZonule dehiscenc e Retained lens matter Wound leak Striated keratopat hy Endophtha lmitis Others ICCE+AC IOL 000.000000000 ICCE+No IOL 000.000000000 ECCE+PC IOL 37513.502000003 ECCE+AC IOL 000.000000000 ECCE+No IOL 000.000000000 SICS+PC IOL 3,3501273.8114062023531 SICS+ AC IOL 121191.702900000 SICS+No IOL 241145.8010000001 Phaco+PC IOL 177137.335000041 Phaco+AC iol 000.000000000 Phaco+No IOL 100.000000000 Total 3,6011674.61459152023936

28. Case of poor outcome at discharge and follow up TotalSelectionSurgerySpectacle s Sequelae Number% of all ops Number% poor outcome Number% poor outcome Number% poor outcome Number% poor outcome Discharge 2637.313852.512547.500.02 1-3weeks 2135.911252.69745.520.92 4- 11weeks 1173.26959.04740.200.010.9 12+weeks 320.91856.31443.800.00

29. Reference Annual report cataract outcome in Takeo Eye Hospital. Leave let for education of postoperative care in TEH. Section 11, basic and clinical science course (AAO). Internet of Singapore National Eye Center(Care after cataract surgery.

31. Thank you for attendance