Lanjutan – CATARACT SURGERY PREOPERATIVE EVALUATION

  • 21/06/2021
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C. Medical History

A complete past medical history can explain the cause of early onset cataracts and can help with planning the case.

1. Steroids

Patients with any condition requiring steroids, such as asthma, arthritis, or organ transplant, are at increased risk for early cataracts.

Figure 2-3. Pseudoexfoliation creates lenticular instability and poor dilation. (Reprinted with permission of Joseph Halabis, OD.)

2. Systemic diseases

Patients who have received radiation near the eye or have atopic dermatitis, diabetes, galactosemia, hypocalcemia, Wilson disease, or myotonic dystrophy have an increased risk of cataract formation. Marfan syndrome and homocys- tinuria are notorious causes of lenticular subluxation and zonular weakness.

3. Conditions that compromise a patient’s ability to cooperate or position during surgery

Patients with chronic obstructive pulmonary disease, congestive heart fail- ure, obesity, arthritis, kyphosis, dementia, Parkinson’s disease, head tremors, or language barriers may be unable to lie still for surgery without a general anesthetic.

4. Ocular conditions that may worsen after surgery

Patients with diabetic retinopathy are at risk for progression of disease following cataract surgery.

D. Medications

1. Medications that are known to cause cataracts

The medications that are known to cause cataracts are corticosteroids, phenothiazines, anticholinesterases, amiodarone, and statins.

2. Medications that compromise the cataract surgery itself

Tamsulosin HCl (Flomax) is known to cause intraoperative floppy iris syndrome (IFIS), causing poor pupillary dilation and an unstable iris with ten- dencies to prolapse into the wound. Progressive intraoperative miosis is also common. Studies are continuing to further elucidate the role of tamsulosin and other medications with IFIS.

3. Anticoagulants

Anticoagulants do not increase the incidence of bleeding; however, if bleeding occurs it tends to be larger and can complicate retrobulbar anes- thesia and visualization. Over-the-counter products (aspirin, ibuprofen, and naproxen) should also be included in this group. Although anticoagulants are generally not stopped for cataract surgery even when retrobulbar anesthesia is used, the surgeon should be aware that these medications are being used.

As an aside, it is important to remind patients to continue chronic eye medications, such as glaucoma drops, during the perioperative period.

E. Allergies/Adverse Reactions

Allergies and adverse reactions should be documented. The patient should be specifically questioned about latex and iodine allergies as well as anesthesia difficulties. Often patients have reactions to systemic medications such as NSAIDs or fluoroquinolones. In these cases, it is important to understand the exact reaction and determine if the topical medications pose a significant risk.

F. Family History

Some patients have a strong family history of cataracts that can explain early onset cataract formation.

G. Social History

  1. Alcohol and sedative use or abuse may require further intraoperative sedative medications.
  2. Smoking may cause early onset cataract.
  3. It is important to know if the patient will be able to perform post- operative instructions such as restrictions on lifting and instillation of eye medications.

*Dikutip dari Buku Essentials of Cataract Surgery 2nd Ed, halaman 12-14

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