Sunday, September 18, 2005

Chapter 1 Assessment - Difficulty Factors

Why should you assess the difficulty during the preop?

  • Which surgeon should do case (e.g., Attending vs. 1st year resident)
  • Estimate length of case
  • Determine need for additional supplies/equipment
  • Determine the type of anesthesia

Difficulty Factors (in decreasing order of importance):

  • Zonular laxity (e.g., due to pseudoexfoliation syndrome, history of trauma, Marfan's syndrome)
  • Small pupil size (why is it small? pseudoexfoliation syndrome, diabetes after laser treatments, central posterior synechaie (CPS), floppy from Flomax)
  • Cannot lay flat for very long, e.g. COPD, claustrophobia, tremor, severe obesity
  • Big brow limiting superior access
  • Narrow angle limiting anterior chamber space
  • Predisposition to corneal decompensation, e.g., corneal guttata, posterior polymorphous dystrophy (PPMD), and hard nucleus
  • Poor red reflex due to a white or black cataract making case difficult.
  • Previous surgery, such as existing trabeculectomy surgery or pars plana vitrectomy (PPVx)
  • Predisposition to exposure, eg: botox treatment with lid paralysis, previous lid trauma, and diabetes.
  • Patient is taking anticoagulants, e.g., coumadin, aspirin, or Plavix.
  • Monocular

Table: Factors Affecting Difficulty




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