What is the recommended post-operative care for patients with pseudophakia?

From the Guidelines

Post-operative care for patients with pseudophakia should include topical antibiotics and corticosteroids, as well as measures to manage pain and prevent complications, with follow-up appointments scheduled at 1 day, 1 week, and 1 month post-surgery. The goal of post-operative care is to ensure proper healing, prevent complications, and optimize visual outcomes after lens implantation.

Key Components of Post-Operative Care

• Topical antibiotics, such as moxifloxacin or gatifloxacin, should be administered 4 times daily for 1 week to prevent infection 1
• Topical corticosteroids, such as prednisolone acetate 1%, should be started immediately after surgery and tapered over a period of days to weeks, or in some cases, months 1
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketorolac 0.5% or bromfenac 0.09%, may be prescribed 2-3 times daily for 2-4 weeks to manage pain and prevent cystoid macular edema
• Patients should avoid rubbing their eyes, swimming, or exposing eyes to dust and dirt for at least 2 weeks, and wear eye shields while sleeping for the first week and use sunglasses outdoors
• Activity restrictions typically include no heavy lifting (over 20 pounds) for 1-2 weeks
• Follow-up appointments should be scheduled at 1 day, 1 week, and 1 month post-surgery to monitor healing, check intraocular pressure, and assess visual acuity 1

Additional Considerations

• The use of viscosurgical devices is recommended during surgery to minimize complications 1
• The surgical duration and light exposure should be minimized, and large corneal incisions and the use of aspirating speculums to aspirate excess fluid during cataract surgery should be avoided 1
• Periocular administration or intraocular injection of antibiotics and/or steroids immediately before the end of surgery is recommended, and a clear corneal approach is recommended where applicable 1

From the Research

Post-Operative Care for Pseudophakia

The recommended post-operative care for patients with pseudophakia involves several key considerations:

• Control of postoperative inflammation with topical steroids is crucial to prevent complications such as cystoid macular edema (CME) 2, 3
• The use of topical corticosteroids, such as prednisolone or dexamethasone, has been shown to be effective in reducing the incidence of CME 2
• Combination therapy with anti-inflammatory drugs and orally prescribed acetazolamide may also be beneficial in treating pseudophakic macular edema 3
• Regular administration of corticosteroids is essential in the post-operative treatment of pseudophakia, but may mask bacterial or mycotic infections 4
• Surgical management options, such as secondary piggyback intraocular lens (IOL) implantation, reverse optic capture, and supplementary sulcus-fixated IOLs, may be considered for patients with pseudophakic negative dysphotopsia or residual refractive errors 5, 6

Management of Complications

Complications such as cystoid macular edema, negative dysphotopsia, and residual refractive errors require prompt attention and management:

• Cystoid macular edema can be treated with topical corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and orally prescribed acetazolamide 2, 3
• Negative dysphotopsia can be managed with surgical methods such as secondary piggyback IOL implantation, reverse optic capture, and iris suture fixation 5
• Residual refractive errors can be corrected with supplementary sulcus-fixated IOLs, which offer a reversible and adjustable solution 6

Key Considerations

When managing patients with pseudophakia, it is essential to:

• Monitor for signs of complications such as CME, negative dysphotopsia, and residual refractive errors
• Adjust the treatment plan as needed to address any complications that arise
• Consider the use of combination therapy with anti-inflammatory drugs and orally prescribed acetazolamide to treat pseudophakic macular edema
• Evaluate the benefits and risks of surgical management options, such as secondary piggyback IOL implantation and supplementary sulcus-fixated IOLs, for patients with pseudophakic negative dysphotopsia or residual refractive errors 2, 3, 5, 6