ISSN 2398-2977      

Eye: phacoemulsification

pequis
Contributor(s):

Tim Knott

Johana Premont

Synonym(s): Lens extraction, Cataract removal


Introduction

  • Gold standard for removal of cataract   Cataract: overview  .
  • Consists of fragmentation and aspiration of cataractous material via a small corneal incision, using high frequency ultrasonic vibrations.
  • Performing the surgery early on during the process of cataract formation considerably improves the long-term success rate.
  • Aim of cataract surgeons is to handle tissue with care, minimize surgical tissue trauma, shorten surgical time, maintain normal intra-ocular pressure and to use smaller incisions to improve success rate.

Uses

  • Removal of:
    • Inherited, congenital and acquired cataracts in juvenile and adult horses.
    • Perforated lens due to penetrating trauma, eg foreign body.
    • Luxated, unstable lenses (zonular deficiency).

Advantages

  • Performing the surgery through a keyhole incision minimizes the risk of peri-operative complications compared to extra-/intracapsular lens extraction.
  • Minimize surgical and anesthesia time.
  • Minimizes surgical trauma.
  • Small clear corneal incision minimize hemorrhage and scarring at the incision site.

Disadvantages

  • Requires neuromuscular blockade and general anesthesia.
  • Requires specialized equipment, instrumentation and operating microscope.
  • Fragmenting of a cataract at a mature state may prolong surgical time.
  • Maintaining the integrity of the posterior lens capsule is necessary to implant an intraocular artificial lens (IOL).
  • Clear corneal incision may cause some degree of astigmatism and corneal scarring.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Prognosis for vision favorable for horses following phacoemulsification.
  • Success rate depends on age, cause, pre-existing ocular disease.
  • Highest success rate in eyes with traumatic cataract.
  • Lowest success rate in eyes with equine recurrent uveitis.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Brooks D E, Plummer C E, Carastro S M & Utter M E (2014) Visual outcomes of phacoemulsification cataract surgery in horses: 1990-2013. Vet Ophthal Suppl 1 17PubMed.
  • Edelmann M L et al (2014) Retrospective evaluation of phacoemulsification and aspiration in 41 horses (46 eyes): visual outcomes vs. age, intraocular lens, and uveitis status. Vet Ophthal Suppl 1 17, PubMed.
  • Harrington J T, McMullen R J Jr, Clode A B & Gilger B C (2013) Phacoemulsification and +14 diopter intraocular lens placement in a Saddlebred foal. Vet Ophthal 16 (2), 140-148 PubMed.
  • Mouney M C, Townsend W M & Moore G E (2012) Association of height, body weight, age, and corneal diameter with calculated intraocular lens strength of adult horses. Am J Vet Res 73 (12), 1977-1982 PubMed.
  • Townsend W M, Jacobi S & Bartoe J T (2012) Phacoemulsification and implantation of foldable +14 diopter intraocular lenses in five mature horses. Equine Vet J 44 (2), 238-243 PubMed.
  • McMullen R J Jr & Utter M E (2010) Current developments in equine cataract surgery. Equine Vet J Suppl (37), 38-45 PubMed.
  • Fife T M et al (2006) Clinical features and outcomes of phacoemulsification in 39 horses: a retrospective study (1993-2003). Vet Ophthal (5), 361-368 PubMed.
  • Brooks D E (2005) Phacoemulsification Cataract Surgery in the Horse. Clin Tech Equine Pract 4, 11-20 VetMedResource.

Other sources of information

  • Colitz C M H & McMullen R J Jr (2011) Diseases and Surgery of the Lens. In: Equine Ophthalmology. 2nd edn. Ed: Gilger B C. Elsevier Saunders, USA. pp 282-316.

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