Lens and Cataract Surgery
Core concepts
Understand lens anatomy and cataract types: nuclear sclerotic, cortical, posterior subcapsular, and traumatic. Know indications for cataract surgery and the preoperative evaluation. Learn the steps of phacoemulsification and the complications: posterior capsule rupture, vitreous loss, endophthalmitis, and retained lens material. Understand intraocular lens (IOL) power calculation and the choice of monofocal vs multifocal IOLs. Know the management of a dropped nucleus and of endophthalmitis (intravitreal antibiotics).
Traps
Do not miss endophthalmitis: pain, decreased vision, and hypopyon after surgery require urgent intravitreal antibiotics. Posterior capsule rupture with vitreous loss needs anterior vitrectomy and careful IOL placement. In a patient with a history of trauma, look for zonular weakness. Remember that posterior subcapsular cataract is associated with steroid use and diabetes.
Rule of thumb
Postoperative pain out of proportion with decreased vision and hypopyon = endophthalmitis; act immediately with intravitreal antibiotics and vitreous tap.
Worked example
Three days after cataract surgery, a patient has severe pain, vision loss, and a hypopyon. This is acute endophthalmitis; perform a vitreous tap and inject intravitreal antibiotics urgently.