Patient Education

SETTING A PROTOCOL FOR CATARACT and GLAUCOMA SURGERY (Padam Shri Dr. Harsh Kumar)

Padam Shri Dr. Harsh Kumar Centre for Sight New Delhi 

Its Important for us to follow certain principles for maintaining the sanctity and faith while performing the comments surgery to be done by an Ophthalmologist.

At the outset the surgery is to be undertaken after a detailed examination has given evidence that the visual impairment being complained by the patient is the result of cataract ruling out other co morbidities like retinal and optic nerve pathologies especially glaucoma and age related macular degeneration.

The examination should also rule out any infection in the eye especially naso-lacrimal duct blockage or local infections which must be cured before taking up the patient for surgery. The consent form must be in the language of the patient and should have been adequately explained to the patient. Only one eye should be operated first followed by the other when patient is comfortable with the first surgery.

All patients must undergo basic biochemical tests and physician clearance when required.

the diabetes and hypertension should be adequately controlled. For all one eyed patients a conjunctival swab to rule out any preexisting infection should be cleared.

All patients along with a relative must be explained the type of procedure, type of lens being implanted and the cost involved.

At the time of surgery the patient and the eye must be identified thrice by the resident , nurse and the operating doctor at the time of surgery. The preoperative painting of eye and surroundings with betadiene and its instillation in the eye for three minutes prior to surgery must be emphasised.

Post operative use of antibiotic drops at frequent intervals starting four hours after surgery in eyes with peribulabar block and one hour after topical anaesthesia should be imperative.

Regular post op visits must be planned with one day and one week being the emphasis.

It should be clearly mentioned that any pain, redness and decrease of vision must be immediately reported.

Protocols must be in place to deal with complications at the same or a nearby referral centre.

The ethical part in glaucoma practise should focus on not doing unnecessary investigations thus a good disc examination followed by a visual field with pachymetry and gonioscopy should form the backbone of glaucoma investigation.

The more expensive investigation of the RNFL layer can be done only in selected cases.

 

 

The decision to undertake glaucoma surgery is a critical one since people usually avoid doing this surgery allowing patients to silently go blind due to technical difficulties in performing the surgery.

If the intraocular pressure can not be controlled on maximum tolerable medications, if the patient is developing allergies to medication or despite medication the visual field is progressively deteriorating, then a surgery is to be performed. The choice of the surgery will be with the treating surgeon. The basic protocol would be same as that of the cataract surgery.

Enquiry Feedback Top