Factor

Surgeon

Time

Equipment/Anesthesia

Zonular Laxity

3rd year

Double

  • Iris retractors available
    • May need to hold capsule
  • Capsular Ring (CTR) [view video]
  • Ready for sutured IOL
  • Ready for intracapsular cataract extraction (ICCE), e.g. have the cryo probe available
  • Consider retrobulbar anesthesia

Small Pupil

3rd year

Add 50%

  • Stretch Pupil
  • Consider Iris retractors [view video]
  • Consider retrobulbar anesthesia

Flomax

3rd year

Add 50%

Poor Red Reflex

extracapsular cataract extraction (ECCE) with junior phacoemulsification with 3rd year

Add 50%

  • Indocyanine Green (ICG)
    or Trypan Blue to stain the capsule
  • Consider retrobulbar anesthesia

Big Brow

Needs temporal experience

Add 25%

  • Consider superior/inferior bridal sutures
  • Consider retrobulbar anesthesia

Narrow Angle

Needs moderate experience

Add 25%

  • Consider smaller phaco-tip

Predisposition Corneal decompensation

extracapsular cataract extraction (ECCE) with junior phacoemulsification with 3rd year

0%

  • Balanced Salt Solution with glutathione; phaco chop
  • Arshinoff shell with ophthalmic viscoelastic device (OVD)

Existing Trabeculectomy Bleb

Best with temporal clear cornea experience

0%

  • Avoid fixation ring
  • Avoid conjunctival manipulation

Past PPVx

3rd year

0%

  • Consider topical
  • Possible CTR
  • Careful during irrigation/aspiration

Cannot Lay flat

Fastest surgeon

 

0%

  • Monitored anesthesia care (MAC) recommended
  • Consider general

Anticoagulation

CCT/topical experience

0%

  • Use topical anesthesia to avoid risk of bleeding due to RB injection.

Monocular

Attending

0%

  • Topical anesthesia for faster rehabilitation
  • Try not to focus on the patient being monocular.

Copyright © 2005 Thomas A. Oetting, MS, MD

Medrounds Publications, Inc.

http://www.medrounds.org/