‘Close’ and Double-Check

All right. Here we are. The final installment. All that’s left now is to ‘close’ and double-check:

The incisions were then hydrated…

One method of closing the incision is to hydrate’ it. Essentially, a sterile salt solution is injected into the cornea. This results in a local swelling around the incision forcing the incision closed. Often this acts as a substitute for suturing the incision. The problem is that we really don’t know how long this swelling lasts. Will it keep the incision closed long enough to protect the eye from infection? For this reason I will often add a suture (see last post).

…and the anterior chamber was formed to physiologic pressure (confirmed by intraoperative tonometry) at which pressure the incisions were checked and felt to be watertight and of good integrity.

Basically, sterile saline is injected into the eye through the paracentesis (small 1mm incision) to bring the pressure in the eye back up to a ‘normal’ pressure. The incisions are then checked for leaks.

The lid speculum and drapes were then removed followed by placement of Vigamox drops in the fornices on the left.

Remember the bent-paperclip-like device used to keep the eye open? We don’t need that anymore as the surgery is over. As a final step to protect from infection a drop of antibiotic is placed on the surface of the eye. Some surgeons inject an antibiotic into the eye at the end of surgery. To date there is no agreement in the US as to which provides more protection. There is a recently published European study that supports using an injection. However, the antibiotic used in the European study is not readily available for intraocular use in the USA. Therefore, most North American surgeons feel the risks of using a ‘compounded’ antibiotic (made by hand) outweights the potential protection it might provide. As mentioned in my last post, I have not had an episode of acute endophthalmitis in over 2,000 cases of cataract surgery using topical, not intraocular antibiotics. As this rate is similar to that experienced with the European method there does not seem to be a convincing reason to change. Again, using the wisdom of my father, ‘If it’s not broke, don’t fix it.’

A shield was then placed over the left eye which the patient was instructed to keep on the eye except during placement of Nevanac, Vigamox, Omnipred 1% drops which she is to use including the day of surgery.

With topical anesthetic there is no need to patch the eye. A shield with little holes in it is sufficient to protect the eye from rubbing when the patient is sleeping. Additionally a shield is easier to take on and off than a patch. This is important in order to get the antibiotic and anti-inflammatory protection of the prescription drops.

She was instructed to avoid any heavy exertion…

Basically, I tell my patients not to pick up anything over 20 pounds, avoid swimming, gardening, high-impact aerobic activities, and “jerking” activities such as roller coaster riding, bungee jumping, skydiving, and the like. Most standard daily activities are just fine.

…and is to follow up in my office the day after surgery.

It is also acceptable to follow-up the day of surgery.

She tolerated the procedure well.

This is an understatement. Most people find cataract surgery to be a painless procedure and look forward to having surgery on their second eye shortly after their first eye has healed from surgery.

 © 2009 David Richardson, MD

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