Dealing with the scariest complication in cataract surgery

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Dealing with the scariest complication in
cataract surgery

• Ian Francis

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Surfing
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• Leonardo era un
• pittore straordinario

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First the most important word in the English
language

• Ontological
• do you believe what you just saw ??

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ONTOLOGICAL

• The way things really are
• FOR EXAMPLE
• 1. Life
• 2. Your spouse
• 3. Your children
• 4. God
• 5. Surfing
• 6. Medicine
• 7. Optometry
• 8. Ophthalmology
• 9. Refractive surgery
• 10. Neuro-ophthalmology

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Its ontological

• All Ophthalmology and
• Optometry is
• Neuro-ophthalmology

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All Ophthalmology and Optometry is
Neuro-ophthalmology

• Why ?? .
• because much as anyone
• may or may not like it
• The eye bone is connected to
• 1. the brain bone
• 2. the body bone

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• Dealing with the
• scariest
• complication in
• cataract surgery

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• Endophthalmitis
• E

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E

• Only happens because someone has been operated !!

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Anthony Pane Neuro-ophthalmologist
extraordinaire

• Everyone in Medicine should read this.

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• Med J Aust October 2008
• Misdiagnosis of acute eye diseases by
• primary health care providers incidence and
  implications .
• 1. Michael O. Statham RMO MB BS(Hons),
  BAppSci(Optom)(Hons)
• 2. Anamika Sharma Registrar BmK
  BS(Hons), BMedSci(Hons)
• 3. Anthony R. Pane VMO
  MB BS(Hons), MMedSc, FRANZCO

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For E

• It is of supreme importance not to
• 1. underdiagnose E
• 2. misdiagnose E
• 3. treat E as of little consequence

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E

• 1. Is either local or metastatic
• 2. May requires lots of medical work to confirm
• 3. May be life-threatening.

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E metastatic patient referred urgently
from the EH
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Sinus venosus
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Diagnosing E

• YOU MAY BE IN
• THE BOX SEAT

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E

• 1. Vast majority have had cataract surgery
• 2. Within a few days of the operation, things
  head south,
• often rapidly
• 3. Day 1 vision 6/4 or
  6/12 vision
• 4. Vision on day 4 HM or worse
• 5. Pain
• 6. Loss of the red reflex
• 7. Hypopyon

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examination requires finesse
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E

• Is getting the instructions for the postoperative
  drops correct really important ?

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• The story of a patient of mine
• with E

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E story

• Don DOB 280726
• 280704 R phaco Wednesday uneventful
• 290704 Thursday Day 1 pop VAR 6/4
• 020804 Monday 7.40pm Day 5 pop
• VAR
  PL
• All stops pulled out by the VR team ..

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E VA last week was npl
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E the other eye 6/4
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Endophthalmitis following cataract surgery the
sucking corneal wound

• Athena Roufas MBBS (Hons), MM (Ophthal Sci)
• Vivek B. Pandya MBBS (Hons), MM (Ophthal Sci)
  
• Edwin C. Figueira MBBS, MSc, MS (Ophthal)
• Shahriar Amjadi B Sc (Hons), MBBS
• Gaurav Bhardwaj BMed
• Josh Baker
• Katherine Masselos MPH, MB, BS (Hons)
• Fiona Stapleton PhD
• Sarosh Batliwalla BEc, MEc, MIntS, FIAA
• Katherine E. Francis BE (Hons)
• Rahul Dubey MBBS (Hons)
• Jeanie Chui B Med Sci (Hons) MBBS PhD
• Ian. C. Francis FASOPRS, PhD

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The sucking chest wound !!
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Is E important ?

• What is the world accepted rate of E
• It is said to be 0.1 1/1000

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Is E important in Oz?
NSW has a rate (1998-2004) of 0.823
gt8/1000 Is this really true ??
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• Risk factors for acute endophthalmitis after
  cataract surgery a population-based study.
• Hatch WV et al
• Ophthalmology.
• March 2009
• 116425-30.

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• 
  April 2009

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April 2009
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April 2009

• Nick Mamalis
• Editor JCRS
• Professor of Ophthalmology
• Nick.Mamalis_at_hsc.utah.edu  
• (John A.) Moran Eye Center 0011 1 801 581
  23520011 1 801 581 2121 (Emergency Switch the
  best number they will contact his home)Office
  801 581 6586Pager 801 339 0763

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1st May 2009

• Emanuel Rosen FRCSE
• Editor JCRS
• Manchester , England