Chapter 4- Post-Operative Care
Phacoemulsification
- Usually requires 2 or 3 post operative visits
- same afternoon 4-6 hours later (to catch IOP peak) or next AM
- (optional) one week later (to check on inflammation)
- 3-4 weeks later to give glasses
First Visit | RAPD, VFF to CF | |
VA |
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Slit Lamp Examination (SLE) |
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IOP |
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Usually can see fundus without dilation. Document no RD or choroidal | ||
Plan |
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give |
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Week #1 | RAPD, VFF to CF | |
VA |
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SLE |
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Consider fundus exam with poor vision, diabetes, floaters, etc.. | ||
plan |
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Week #2-4 | RAPD, VFF to CF | |
VA | expect about 20/25 pinhole 20/20 | |
Manifest Refraction (MR) | consider suture induced astigmatism | |
plan | give manifest refraction (MR) for glasses | |
follow up 1 year |
ECCE or ICCE
- Usually at least 3 post operative visits
- same afternoon 4-6 hours later (to catch IOP peak) or next AM
- one week later (to check on inflammation)
- 4-5 weeks later to check astigmatism for suture removal or give glasses
- Much of the emphasis is on suture removal for astigmatic control
Day #1 | RAPD, VFF to CF | |
VA | expect about 20/200 better with pinhole | |
SLE | expect significant corneal edema | |
IOP | if < 8 look hard for leak with Seidel test | |
Usually can see fundus without dilation and, document no RD or choroidal. | ||
plan | fluoroquinolone 1 drop qid | |
Give | a post operative instruction sheet | |
Week #1 | RAPD, VFF to CF | |
VA | expect 20/100 and about 20/50 with pinhole | |
SLE | expect little corneal edema and 1-2 cell and flare | |
usually can see fundus when on cyclogyl, document no RD | ||
plan | Discontinue antibiotic (tell patient to keep bottle in refrigerator for suture removal) | |
Follow up 5 weeks later (allows healing time before suture removal) | ||
Week #6 | RAPD, VFF to CF | |
VA | expect 20/80 and about 20/40 with pinhole | |
keratometry | expect about 5.0 diopters at 90 | |
Manifest Refraction (MR) | Start with streak retinoscopy or auto refract (usually on with clear media) Start with 2/3 of cylinder from K's and adjust SE to -1.0 (usually very close) | |
SLE | Look at the wound and decide which sutures look tight. | |
suture lysis | Indicated when cylinder is >= 2 D on Manifest Refraction (MR), or | |
plan | Full activity | |
follow up | If no sutures need to be removed (will never happen)
otherwise return every 1-2 weeks for additional suture lysis | |
After that, | you really have about three three choices (don't stall):
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Don't waste time thinking about other possibilities because not everybody is going to be 20/20. |
WARNING SIGNS OF POST-SURGICAL INFECTION (ENDOPHTHALMITIS)
- increased pain
- sudden drop in vision
- increased redness
- mucopurulent discharge
- usually occurs within 1-2 weeks post-operatively
- when in doubt, see your patient
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