{"id":188,"date":"2016-08-26T03:41:55","date_gmt":"2016-08-26T03:41:55","guid":{"rendered":"http:\/\/www.cataractcourse.com\/?page_id=188"},"modified":"2017-02-01T01:31:06","modified_gmt":"2017-02-01T01:31:06","slug":"presurgical-screening","status":"publish","type":"page","link":"https:\/\/cataractcourse.com\/surgery\/presurgical-screening\/","title":{"rendered":"Presurgical screening"},"content":{"rendered":"<p style=\"text-align: left;\">Routine preoperative labs (ECG, CBC, electrolytes, creatinine, BUN, blood glucose and others) do not reduce postoperative complications and are not cost effective.<\/p>\n<p>Systemic diseases and medications are taken into consideration prior to surgery:<\/p>\n<ul>\n<li>Diabetic patients should be scheduled early in the morning to avoid hypoglycemia.<\/li>\n<li>Hypertension medications should be continued through the morning of surgery.\u00a0Blood pressure control limits the risk of suprachoroidal hemorrhage.<\/li>\n<li>Although respiratory diseases are not absolute contraindications, cough can make surgery more difficult.<\/li>\n<li>Patients can typically continue their anticoagulation regimen prior to surgery as there is a low risk of bleeding with cataract surgery.\n<ul>\n<li>Aspirin can safely be continued through the day of surgery, but stopping aspirin within 2 weeks of surgery is also associated with low risk.<\/li>\n<li>Warfarin similarly appears to be associated with low risk whether continued or discontinued before surgery.<\/li>\n<li>Clopidogrel is less well studied in cataract surgery but can usually be continued in patients on chronic antiplatelet therapy.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Certain preoperative medications increase the risk of <a href=\"https:\/\/www.youtube.com\/watch?v=Te9wPFtWk6M\" target=\"_blank\">intraoperative floppy iris syndrome (IFIS)<\/a>:<\/p>\n<ul>\n<li>\n<figure id=\"attachment_578\" aria-describedby=\"caption-attachment-578\" style=\"width: 281px\" class=\"wp-caption alignright\"><img class=\"wp-image-578 \" src=\"http:\/\/cataractcourse.com\/wp-content\/uploads\/2016\/08\/Iris-prolapse-AA0_4949.jpg\" width=\"281\" height=\"422\" srcset=\"https:\/\/cataractcourse.com\/wp-content\/uploads\/2016\/08\/Iris-prolapse-AA0_4949.jpg 1000w, https:\/\/cataractcourse.com\/wp-content\/uploads\/2016\/08\/Iris-prolapse-AA0_4949-200x300.jpg 200w, https:\/\/cataractcourse.com\/wp-content\/uploads\/2016\/08\/Iris-prolapse-AA0_4949-768x1154.jpg 768w, https:\/\/cataractcourse.com\/wp-content\/uploads\/2016\/08\/Iris-prolapse-AA0_4949-681x1024.jpg 681w\" sizes=\"(max-width: 281px) 100vw, 281px\" \/><figcaption id=\"caption-attachment-578\" class=\"wp-caption-text\">Iris prolapse<\/figcaption><\/figure>\n<p>IFIS includes a triad of a flaccid iris that moves out through the surgical incision, iris prolapse, and intraoperative pupillary constriction.<\/li>\n<li>IFIS increases difficulty of the surgical procedure and\u00a0also increases the risk of posterior capsule rupture, retinal detachment, and endophthalmitis.<\/li>\n<li>Alpha-1 antagonists increase the risk of IFIS.\n<ul>\n<li>Tamulosin (Flomax) increases risk of IFIS about 2 fold, but stopping tamulosin before surgery does not appear to reduce risk.<\/li>\n<li>Palliperidone and risperidone (second generation antipsychotics) also increase risk of IFIS.<\/li>\n<\/ul>\n<\/li>\n<li>Intraoperative techniques to reduce complications from IFIS include use of iris retractors, low flow fluidics, and preoperative <a href=\"http:\/\/www.slideshare.net\/nithinnithinm7\/mydriatics-and-cycloplegics\" target=\"_blank\">cycloplegia<\/a>.\u00a0Foreknowledge of the risk of IFIS and use of these precautions can reduce risk of posterior capsule rupture to less than 1%.<\/li>\n<\/ul>\n<p>All patients need a comprehensive preoperative ocular exam including:<\/p>\n<ul>\n<li>Refraction of both eyes<\/li>\n<li>Topography<\/li>\n<li>Assessment for dry eye, which can impair accurate keratometry<\/li>\n<li>Assessment for blepharitis, which can increase the risk of postoperative endopthalmitis<\/li>\n<li>Assessment for <a href=\"https:\/\/www.youtube.com\/watch?v=ycRXsvnMSog\" target=\"_blank\">phacodenesis<\/a> (lens vibration with eye movement)<\/li>\n<li>Evaluation of dilated pupil size<\/li>\n<li>A\u00a0full dilated fundoscopic exam<\/li>\n<\/ul>\n<p>Patients\u00a0also need to be evaluated to determine the type of lens and prescription strength to be used\u00a0during surgery.<\/p>\n<div id=\"textbox\">\n<p class=\"alignleft\"><a href=\"http:\/\/cataractcourse.com\/surgery\/overview-and-indications-for-surgery\/\">Previous<\/a><\/p>\n<p class=\"alignright\"><a href=\"http:\/\/cataractcourse.com\/surgery\/complicated-surgery\/\">Next<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Routine preoperative labs (ECG, CBC, electrolytes, creatinine, BUN, blood glucose and others) do not reduce postoperative complications and are not cost effective. Systemic diseases and medications are taken into consideration prior to surgery: Diabetic patients should be scheduled early in the morning to avoid hypoglycemia. Hypertension medications should be continued through the morning of surgery.\u00a0Blood pressure control limits the risk of suprachoroidal hemorrhage. Although respiratory diseases are not absolute contraindications, cough can make surgery more difficult. Patients can typically continue&#8230;<\/p>\n<p class=\"read-more\"><a class=\"btn btn-default\" href=\"https:\/\/cataractcourse.com\/surgery\/presurgical-screening\/\"> Read More<span class=\"screen-reader-text\">  Read More<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":183,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v19.11 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Presurgical screening - The Cataract Course<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/cataractcourse.com\/surgery\/presurgical-screening\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Presurgical screening - The Cataract Course\" \/>\n<meta property=\"og:description\" content=\"Routine preoperative labs (ECG, CBC, electrolytes, creatinine, BUN, blood glucose and others) do not reduce postoperative complications and are not cost effective. Systemic diseases and medications are taken into consideration prior to surgery: Diabetic patients should be scheduled early in the morning to avoid hypoglycemia. Hypertension medications should be continued through the morning of surgery.\u00a0Blood pressure control limits the risk of suprachoroidal hemorrhage. Although respiratory diseases are not absolute contraindications, cough can make surgery more difficult. Patients can typically continue... 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Systemic diseases and medications are taken into consideration prior to surgery: Diabetic patients should be scheduled early in the morning to avoid hypoglycemia. Hypertension medications should be continued through the morning of surgery.\u00a0Blood pressure control limits the risk of suprachoroidal hemorrhage. Although respiratory diseases are not absolute contraindications, cough can make surgery more difficult. Patients can typically continue... 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