Preoperative Evaluation of Patients Before Cataract and Refractive Surgery

Abstract

Recent advances in premium intraocular lens (IOL) have allowed eye surgeons to significantly improve visual results during cataract surgery greater than ever before and achieve excellent refractive results. For the first time IOLs alone allow eye surgeons to reduce corneal astigmatism while replacing a cataract with a toric IOL and reestablishing the range of near and far vision with the multifocal and accommodative presbyopic IOLs. As impressive and dramatic as visual results can be, it important to identify and treat underlying conditions to maximize successful surgical outcomes.Patients' overall health should be stable and free of systemic disease. The visual system of the eye itself can also affect surgical outcomes in several places in the anterior and posterior portions of the eye. The ocular surface, the clarity of the cornea, and the curvature of the cornea can all effect surgical outcomes. Strabismus or glaucoma and pathology posterior in the macula can have an effect as well. Residual refractive error after cataract surgery can also reduce successful outcome and cannot be ignored.Lastly, when proceeding with any surgical procedure patient selection is essential. Patients undergoing surgery must not only be systemically stable but their visual demands and comprehension of their potential outcomes must be evaluated to a greater level than before. It remains paramount to gauge patients' expectations and prevent or avoid patients who demand unrealistic results. ' Medical HistoryBefore pursuing cataract surgery it is important to get a good medical history and confirm whether the patient's systemic health is stable. Hypertension, cardiac disease, and diabetes are very common www.internat-ophthalmology.com | 97

Corrective techniques and future directions for treatment of residual refractive error following cataract surgery

“…Preexisting systemic comorbidities and general ocular health are important parameters to assess preoperatively, as they can have a substantial impact on postoperative visual acuity [11]. Inaccuracies of topographic and keratometric measurements as a result of underlying corneal disease (i.e.…”

“…retinal disease, glaucoma, corneal disease/previous refractive surgery) [11]. Postoperative loss of accommodation may be distressing to certain patients as well; an extensive preoperative explanation regarding postsurgical expectations will aid in decreasing apprehension related to this matter.…”

Optical Quality Variation of Different Intraocular Lens Designs in a Model Eye: Lens Placed Correctly and in an Upside-Down Position

“…Prior to surgery, it is necessary to follow some biometrical measurements in order to calculate the IOL power: axial length, corneal keratometry, anterior chamber depth, among others. These measurements should be taken accurately to avoid postoperative refractive error caused by a wrong IOL power selection [6, 7].…”

“…Even if cataract surgery is safe, it is not exempt from complications that entail different consequences. Before surgery, as explained before, the most relevant complication is the wrong IOL power selection due to inaccurate preoperative biometrical measurements [6, 7]. Erroneous selection of the IOL overall diameter may be another complication as it must fit the capsular bag size.…”