Perioperative Care
This section covers perioperative care: preoperative assessment, consent, medication management, anaesthesia, prophylaxis, and postoperative instructions. The exam tests safety and documentation.
Core rules and concepts
- Preoperative assessment includes visual acuity, IOP, fundus, comorbidity review, and allergic history; for cataract surgery, biometry and corneal assessment are essential.
- Informed consent requires discussion of benefits, alternatives, and risks, including endophthalmitis, retinal detachment, and refractive surprise.
- Fasting follows local anaesthesia guidelines; clear fluids are usually allowed until 2 hours before sedation, but check institutional policy.
- Anticoagulants are usually continued for cataract surgery after risk assessment; stopping warfarin without indication can cause thromboembolism.
- Prophylaxis against endophthalmitis includes povidone-iodine, sterile technique, and sometimes intracameral antibiotics; postoperative warning signs include pain and visual loss.
Worked example
A 70-year-old on warfarin for atrial fibrillation is scheduled for cataract surgery. His INR is 2.4, within the therapeutic range. The cataract surgery is low-bleeding-risk, so warfarin is continued after checking INR and documenting the cardiology plan. A clear corneal phacoemulsification is performed with povidone-iodine preparation. The patient is warned to seek urgent review for severe pain or declining vision, which could signal endophthalmitis.
Traps that cost marks
Do not stop anticoagulants routinely for minor ophthalmic surgery. Missing a consent discussion about refractive surprise is a common complaint. Do not use topical antibiotics as a substitute for sterile technique. Postoperative pain out of proportion is endophthalmitis until proven otherwise.