Cataract Group 5 PDF

Cataract Group 5 Objectives 01 Cataract definition and incidence 06 Medical management 02 Pathophysiology 07 Surgical management 03 Risk factors 08 Surgical complications 04 Clinical manifestations 09 Nursing management 05 Ass...

Cataract Group 5 Objectives 01 Cataract definition and incidence 06 Medical management 02 Pathophysiology 07 Surgical management 03 Risk factors 08 Surgical complications 04 Clinical manifestations 09 Nursing management 05 Assessment tests and diagnostic 10 Health education  What is cataract? A cataract is a cloudy area in the eye’s lens (which helps focus light).  The incedences 1- Cataracts are responsible for visual disability in 18 million people worldwide 2- By 80 years of age, more than half of all Americans have cataracts. 3- Cataracts are a leading cause of blindness in the world 4- in Bahrain up to 60 cataract patient diagnosed per day ! So, the doctors tend to call it condition rather than disease.  Pathophysiology Congenital occur due to genetic mutations or Trumatic infections during pregnancy, Result from eye injuries that disrupting lens protein structure disrupt lens structure, causing and leading to clouding. protein denaturation, swelling, and opacification. Senile form with aging as lens proteins degrade, aggregate, and oxidize, leading to clouding.  Risk Factors 1.Aging Accumulation of a yellow-brown pigment, due to the breakdown of lens protein. Clumping or aggregation of lens protein, which leads to light scattering. Decreased oxygen uptake Decrease in levels of vitamin C, protein, & glutathione (an antioxidant) Increase in sodium & calcium Loss of lens transparency  Risk Factors 2.Toxic factors Alkaline chemical eye burns, poisoning Aspirin use Calcium, copper, iron, gold, silver, & mercury, which tend to deposit in the pupillary area of the lens Cigarette smoking Corticosteroids, especially at high doses and in long-term use Ionizing radiation  Risk Factors 3.Physical factors Blunt trauma, perforation of the lens with a sharp object or foreign body, electric shock Dehydration associated with chronic diarrhea, the use of purgatives in anorexia nervosa, & the use of hyperbaric oxygenation Ultraviolet radiation in sunlight & x-ray  Risk Factors 4.Associated ocular conditions Infection (e.g., herpes zoster, uveitis) Myopia Retinal detachment & retinal surgery Retinitis pigmentosa 5.Nutritional fatcors Obesity Poor nutrition Reduced levels of antioxidants  Risk Factors 6.Systemic disease and syndromes Diabetes Disorders related to lipid metabolism Down syndrome Musculoskeletal disorders Renal disorders  Clinical manifestations Reduced contrast sensitivity Painless & blurry vision Dimmer surroundings Sensitivity to glare Light scattering  Clinical manifestations Reduced visual acuity Monocular diplopia Color changes Myopic shift astigmatism Assessment and Diagnostic Findings Decreased visual acuity is directly proportionate to cataract density. Snellen visual Ophthalmoscopy Slit-lamp acuity test biomicroscopic examination Medical Management Medical Management Risk reduction strategies No nonsurgical Patients should be educated about: treatment - medications Smoking cessation Optimal medical - eye drops management is weight reduction Prevention. - eyeglasses optimal blood glucose control (for patient with - cures cataracts DM) or prevents age related cataracts.  Surgical management No need for surgery if reduced vision from cataract doesn’t interfere with normal activities. surgery depends on patient’s functional & visual status. Surgery is performed on an outpatient basis & usually takes less than 1 hour & patient is discharged in 30 min or less inward. Surgery goal Visual function restoration using a minimally invasive and safe technique Achieved with: Advances in topical anesthesia, Smaller wound incision, lens design.  Do we have to do the surgery for both eyes at the same time? One eye is treated at first, with a minimum of a few weeks ideally months between the two treatments. cataract surgery is done to enhance visual function and reduce the other eye's delay:- -Allows the physician and patient opportunity to determine whether the previous surgery's outcomes are sufficient to avoid a second procedure. -Enables the first eye to recover. -The second surgery may be performed differently by the surgeon if difficulties occur.  Injection-free topical & intraocular anesthesia Such as 1% lidocaine gel. Ideal for patients receiving anticoagulants. Patients can communicate & cooperate during surgery. IV sedation used to minimize anxiety & discomfort. Applied to the surface of the eye to eliminate the hazards of regional (retrobulbar & peribulbar) anesthesia such as: ocular perforation, retrobulbar hemorrhage, optic injuries, diplopia, ptosis  Phacoemulsification During an extracapsular cataract surgery, the posterior capsule and zonular support remain intact while a part of the anterior capsule is removed to extract the lens nucleus and cortex. The cortex and nucleus are liquefied by an ultrasonic device before being suctioned out by a tube. An intact zonular-capsular diaphragm gives the posterior chamber IOL the necessary secure base. The pupil is dilated to 7 mm or greater. To keep the space between the cornea and the lens from collapsing and to make the insertion of the IOL easier, the surgeon makes a small incision on the upper edge of the cornea and injects a viscoelastic material (clear gel) into the gap. Wound heal more rapidly due to small incision  Lens replacement After removal of the crystalline lens.The patient is referred to as aphakic (without lens). The lens, which focuses light on the retina must be replaced for the patient to see clearly. There are 3 options: aphakic eyeglasses + contact lenses + IOL implants. 1-Aphakic eyeglasses: They are rarely used, yet they are effective. Distortion results from objects being enlarged by 25%, making them look closer than they actually are. Visual acuity is limited. If one eye lacks a natural lens, it is impossible to achieve binocular vision, which is the capacity of both eyes to focus on a single object and combine the two images into one.  2-Contact lens provide people vision that is almost normal. Because contact lenses must be taken out on sometimes, the patient also need a pair of aphakic glasses. The risk of infection is increased by frequent handling and inadequate cleaning. Patients who have trouble putting them in, taking them out, and cleaning them are not recommended.  3-IOL implants The most widely used method of replacing lenses is the insertion of IOLs during cataract surgery. Following phacoemulsification or cataract extraction, the surgeon inserts an IOL. Removal of cataracts and posterior chamber Complications include eye infection, loss of ocular fluid, and implant slipping which is not uncommon with IOLs. contraindicated in patients with: - Recurrent uveitis. Proliferative diabetic retinopathy. Neovascular glaucoma. Rubeosis iridis. Surgical Complications Immediate Preoperative Intraoperative Early Postoperative Late Postoperative Immediate Preoperative Complication Effect Management and outcome Retrobulbar Emergent lateral canthotomy (slitting of the hemorrhage - Increase IOP canthus) is performed to stop central retinal perfusion when the IOP is dangerously elevated. - Proptosis’ can result from If this procedure fails to reduce IOP, a puncture retrobulbar infiltration - lid tightness of the anterior chamber with removal of fluid is of anesthetic agents if considered. the short ciliary artery - subconjunctival is located by the hemorrhage with The patient must be closely monitored for at injectia or without edema least a few hours. Postponement of cataract surgery for 2-4 wks is advised.  Complications could result in a catastrophic visual outcome such as: - iris prolapse - vitreous loss - choroidal hemorrhage Intraoperative Complication Effect Management and outcome Rupture of the May result in Anterior vitrectomy is posterior capsule loss of vitreous required if vitreous loss occurs Suprachoroidal Extrusion of Closure of the incision & administration of a (expulsive) hyperosmotic agent to reduce IOP or intraocular hemorrhage corticosteroids to reduce intraocular inflammation. contents from Vitrectomy is performed 1-2 wks later. Profuse bleeding into the eye or Visual prognosis is poor; some useful vision may the suprachoroidal opposition of be salvaged on rare occasions. space retinal surfaces  Early postoperative Complication Effect Management and outcome Acute bacterial Managed by aggressive antibiotic therapy. endophthalmitis Characterized by Broad-spectrum antibiotics are given while devastating awaiting C/S results. complication (occurs - marked visual in about 1 in 1000 loss cases) Most common Once results are obtained - pain , the appropriate antibiotics are given causative organisms: Staphylococcus - lid edema via intravitreal injection. epidermidis, - hypopyon Staphylococcus - corneal haze Corticosteroid therapy is aureus, Pseudomonas - chemosis also given. & Proteus species  Early postoperative Complication Effect Management and outcome Toxic anterior If there is no growth of segment syndrome Corneal edema microorganisms, the treatment occurs less than is topical steroids alone. Noninfectious 24hr after surgery inflammation that is a complication of anterior Symptoms include: chamber surgery; caused by a toxic agent - Reduce visual (e.g. an agent used to acuity sterilize surgical - Pain instruments)  Late postoperative Complication Effect Management and outcome Suture removal relieves the symptoms. Toxic reactions or Suture-related mechanical injury Topical corticosteroids are used when the problems from broken or incision is not healed & sutures cannot be loose sutures removed. Results in: Mild cases: Miotics is used Severe cases: IOL Malposition of - astigmatism removal & replacement. the IOL - sensitivity to glare - or appearance of halos Late postoperative Complication Effect Management and outcome Corticosteroids & antibiotics are given Persistent - systemically. Chronic low-grade - If the condition persists: (required) endophthalmitis inflammation removal of IOL & capsular bag - - granuloma - vitrectomy - intravitreal injection - of antibiotics. - Opacification of the Visual acuity is Nd: YAG laser is used to create a hole in the posterior capsule diminished posterior capsule. Blurred vision is cleared most common late immediately. complication of extracapsular cataract extraction Cataract Nursing Management Include : Provide Transitional Care Preoperative Care Promoting Home, Provide Community- Postoperative Based Care Care  Providing Preoperative Care The patient receives the usual preoperative care for ambulatory surgical patient undergoing eye surgery. The stander Preoperative tests is CBC+ ECG+ Urinalysis commonly is prescribed only if indicated by patient’s medical history. Nurse in the ambulatory surgery setting begin patient education about eye medication antibiotic + corticosteroid + anti- inflammatory drops that will need to self administered to prevent postoperative infection and inflammation. Dilating Drops are given prior to surgery  Providing Preoperative Care THE NURSE NEEDS TO ASK THE PATIENT ABOUT HISTORY OF TAKING alpha-antagonists Particularly tamsulosin that treats enlarged prostate, are known to cause intraoperative floppy iris syndrome & can occur even though a patient has stopped taking the drug. Can interfere with pupil dilation during the surgical procedure, resulting in miosis + iris prolapse & leading to complications. Intraoperative floppy iris syndrome even if the patient has stopped taking this drugs. THE nures should alert surgical team members if the paitent have history of taking alpha – antagonists to minimal the risk of this complication  Providing Postoperative Care patient receives verbal & written education about Eye Protection Obtaining Medication emergency Care Activates to Recognition of Avoid Complications  Providing Postoperative Care An eye shield is usually worn at night for the first week to avoid injury. There should be minimal discomfort after surgery. Educates the patient about taking a mild analgesic agent, such as acetaminophen, as needed. Antibiotic + anti-inflammatory + corticosteroid eye drops or ointments are prescribed postoperatively & monitored for possible increases in IOP Continuing & Transitional Care  If an eye patch is worn, it is removed after the first follow-up appointment, which should occur within 48 hours of surgery. Nurse educates patients about the importance of follow-up appointments because monitoring of visual status & prompt intervention of postoperative complications enhance good visual outcomes. Vision is stabilized when the eye is completely healed within 6 - 12 weeks, when final corrective prescription is completed. Visual correction may still be needed for any remaining refractive errors. Patients who choose multifocal IOLs should be aware that increased night glare & contrast sensitivity may occur.  Post-Cataract Surgery Care at Home Recovery takes time; proper care ensures healing. Follow these steps to protect your eye and promote recovery. Caring for Your Eye Wear glasses or an eye shield as instructed, especially at night. Clean the eye with a clean tissue, wiping from the inner corner outward. Avoid rubbing or poking the eye. Use a clean, damp washcloth for minor morning discharge. Ensuring a Safe Recovery Avoid lying on the side of the operated eye. Be cautious on stairs and avoid tripping hazards. Seek help for activities like washing your hair or lifting heavy objects. Identify support resources for meals and transportation if needed. Activities to Avoid Avoid lifting, pushing, or pulling objects heavier than 15 lbs. Do not bend or stoop for extended periods. Avoid driving, sexual activity, or strenuous activities until cleared by your doctor. Light activities like walking, reading, or watching TV are encouraged. When to Seek Help Contact your doctor immediately if you experience: Vision changes, continuous flashing lights, or new floaters. Redness, swelling, or pain near the eye. Increased or unusual discharge. Pain not relieved by prescribed medications. Importance of Follow-Up Schedule a follow-up visit within 48 hours of surgery. Vision will stabilize within 6–12 weeks. Discuss any remaining vision issues with your ophthalmologist. Stay Connected With Your Healthcare Team Keep your doctor’s contact information handy. Reach out with any questions, concerns, or emergencies. Remember to adhere to your prescribed medication schedule.