From the Guidelines
For symptomatic adults before cataract surgery, I do not recommend routine ROPLAS and lacrimal syringing as a standard practice, but rather a comprehensive evaluation for dry eye syndrome and other ocular comorbidities to optimize outcomes and reduce postoperative complications. The most recent and highest quality study, 1, highlights the importance of evaluating and managing dry eye preoperatively, as it is one of the main reasons for patient dissatisfaction following cataract surgery.
Key Considerations
- Dry eye symptoms that continue beyond the normal postoperative period of 3 months might be seen in about one third of individuals 1.
- Baseline ocular surface and tear film parameters predict the patients at risk 1.
- Evaluating and managing dry eye preoperatively is crucial to reduce postoperative complications and improve patient satisfaction 1.
- A comprehensive evaluation should include a thorough medical history, ocular examination, and diagnostic tests to identify any ocular comorbidities or high-risk ocular features that could impact the performance and outcomes of surgery 1.
Recommendations
- Perform a comprehensive evaluation for dry eye syndrome and other ocular comorbidities before cataract surgery.
- Manage dry eye and other ocular comorbidities preoperatively to optimize outcomes and reduce postoperative complications.
- Consider referral for further evaluation and treatment if necessary, to ensure the best possible outcomes for the patient.
- The study 1 emphasizes the importance of identifying any ocular comorbidities, high-risk ocular features, or systemic issues that could impact the performance and outcomes of surgery, which supports the need for a comprehensive evaluation before cataract surgery.
From the Research
ROPLAS and Lacrimal Syringing in Symptomatic Adults Before Cataract Surgery
- The use of ROPLAS (not explicitly defined in the provided studies) and lacrimal syringing in symptomatic adults before cataract surgery is related to the diagnosis and treatment of nasolacrimal duct obstruction, which can cause epiphora (tearing eye) and increase the risk of postoperative endophthalmitis 2.
- Nasolacrimal duct obstruction can be classified into different types, including functional and mechanical, and can be diagnosed using various methods, including patient history, ocular surface conditions, inspection, palpation, and functional and anatomical tests 3.
- Lacrimal syringing is a diagnostic tool used to assess the patency of the nasolacrimal duct, and can help identify obstruction or stenosis 2, 4.
- Studies have shown that unrecognized nasolacrimal duct obstruction can increase the risk of post-cataract surgery endophthalmitis, and that routine screening for symptoms and examination of the lacrimal system prior to cataract surgery is recommended 2.
- In some cases, surgical intervention, such as dacryocystorhinostomy, may be necessary to treat nasolacrimal duct obstruction and prevent complications 3, 4, 5.
Preoperative Care for Cataract Surgery
- Preoperative care for cataract surgery should include a thorough assessment of the patient's overall health and any potential risk factors, including nasolacrimal duct obstruction 6.
- The Society for Ambulatory Anesthesia recommends a position statement for preoperative care for cataract surgery, which includes guidelines for patient evaluation and preparation 6.
- While the provided studies do not specifically address the use of ROPLAS in preoperative care for cataract surgery, they do emphasize the importance of diagnosing and treating nasolacrimal duct obstruction to prevent complications and ensure the best possible outcomes for patients undergoing cataract surgery 3, 2, 4, 5.