Pearls for the Preoperative Evaluation and Postoperative Management of Cataract and Lens Implant Surgery Patients

Goal: Optimize refractive outcome and visual recovery

Preoperative:

• Detailed history of visual function/performance; eye trauma, surgery or disease; systemic disease (diabetes, autoimmune/collagen-vascular disease) and medications (alpham1-blockers (Flomax), steroids)
• Visual acuity  with attention to manifest and cycloplegic refractions, pinhole vision, glare testing, and contrast sensitivity  when applicable
• Careful anterior segment evaluation with attention to the lids (blepharitis, abnormal position or closure), cornea for any pathology (i.e., dry eye, map-dot-fingerprint dystrophy, cornea guttatae, ectasia), lens (degree of nuclear sclerosis, cortical spoking and vacuoles, and posterior subcapsular changes; presence of pseudoexfoliation syndrome), and pupil (size in bright and dim light conditions and after dilation)
• Detailed fundus exam  with attention to the optic nerve, macula, and peripheral retina
• Treat any ocular surface disease
• Biometry (I prefer optical devices: IOLMaster and Lenstar) and appropriate IOL calculation formula (optimized, newer generation)
• Specialized testing (corneal topography, macular OCT) when necessary
• Start preop medications (antibiotic and NSAID) 1-3 days before surgery

Postoperative:

• Medications: antibiotic for 1-2 weeks; NSAID and steroid for 4-8 weeks depending on risk of CME. My regimen is Besivance TID, Bromday QD, and Lotemax QID then BID. For patients with significant corneal edema or inflammation, I use Durezol for the first 2 weeks and then change to Lotemax
• Continue to treat ocular surface disease if present
• Posterior capsular opacification may require earlier treatment in patients with presbyopia correcting IOLs because mild PCO can significantly impact vision in these patients