Forewarned is forearmed in cataract patients with systemic disease

Roibeard O’hEineachain

Posted: Sunday, February 21, 2021

Betty Lorente Bulnes MD FEBO

Looking beyond the eye during preoperative assessment can optimise the outcomes of cataract surgery in patients with systemic disease with ocular manifestations, said Betty Lorente Bulnes MD FEBO, Spain, at the 25th ESCRS Winter Meeting Virtual 2021.
“Sometimes we are too focused on the eyes of our patients and we forget that they might have diseases outside of their eyes,” Dr Lorente Bulnes said.
She noted that a thorough good preoperative exam is crucial in determining systemic diseases, such as Down’s syndrome, Alzheimer’s, Parkinson’s disease and musculoskeletal disorders, that may affect the patient’s ability to cooperate and collaborate with the surgeon.
Also important is careful questioning of the patient regarding their medical history. For example, in patients with a history of prostatic disease, even a brief regimen of alpha blockers such as tamusolin can leave its imprint on the iris. In such cases, the surgeon will need to be prepared to deal with intraoperative floppy iris syndrome. Research now shows that intracameral phenylephrine is very helpful in these eyes, Dr Lorente Bulnes added.
Marfan’s syndrome is another condition that requires modifications in cataract procedures. Special instrumentation such as iris retractors and capsular tension rings should be ready to hand in such cases in order to stabilise the bag, she said.
She added that in eyes with a history of uveitis, those receiving corticosteroids require adjustment of their regimen to 0.7mg/kg/day in the week prior to surgery. In addition, special care is needed to prevent infection in those receiving immunomodulators. Furthermore, in patients receiving biologic treatments the surgery should be performed between treatments.

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