Ophthalmology Surgical Procedure & Post-Op Note

Clinician Specialty: Veterinarian Procedure Date and Time: 1 November 2024, 10:30 AM Patient Information: Whiskers, Smith, Feline, Domestic Shorthair, 7 years old, 4.5 kg Pre-operative Assessment: Pre-operative ophthalmic examination revealed a dense cataract in the left eye (OS), consistent with mature senile cataractation. The right eye (OD) presented with incipient cataracts but good menace response and pupillary light reflexes. Intraocular pressure (IOP) was within normal limits in both eyes (OD 18 mmHg, OS 17 mmHg). Systemic examination was unremarkable, and bloodwork showed no contraindications for anaesthesia. Diagnosis: Primary diagnosis: Mature senile cataract, left eye (OS). Secondary diagnosis: Incipient cataracts, right eye (OD). The cataract was causing significant visual impairment and behavioural changes in the patient. Procedure Performed: Phacoemulsification with intraocular lens (IOL) implantation was performed on the left eye (OS). A superior limbal incision was made, followed by continuous curvilinear capsulorhexis. The cataractous lens material was emulsified using a 2.2 mm phaco tip (Alcon Legacy 20000). Following aspiration of all cortical material, a 15.0 D hydrophobic acrylic IOL (AcrySof SA60AT) was implanted into the capsular bag. The incision was closed with 10-0 nylon sutures. No complications were encountered during the procedure. Anaesthesia: General anaesthesia was induced with propofol and maintained with isoflurane in oxygen. Pre-medication included buprenorphine and midazolam. Local anaesthesia was achieved with a retrobulbar block using bupivacaine. Anaesthesia was stable throughout the procedure with no complications. Intraoperative Findings: Observations during surgery confirmed the presence of a dense, hypermature cataract with some liquefaction of the cortex. The anterior capsule was slightly brittle but allowed for a successful capsulorhexis. No synechiae or significant capsular defects were noted. The zonules appeared strong and intact. The vitreous was clear. Post-operative Status: Immediately post-operatively, the patient was recovering well from anaesthesia. The left eye showed mild conjunctival hyperaemia and corneal oedema, which is expected. The intraocular lens was well-centred, and the anterior chamber was deep and clear. IOP was 15 mmHg. The patient showed immediate improvement in navigation within the kennel. Medications Prescribed: Prednisolone Acetate 1% ophthalmic drops: 1 drop to OS three times daily for 2 weeks, then twice daily for 2 weeks. Tobramycin 0.3% ophthalmic drops: 1 drop to OS three times daily for 2 weeks. Meloxicam oral suspension: 0.1 mg/kg once daily for 5 days with food. Post-operative Care Instructions: Owner instructed to restrict activity for 2 weeks post-operatively, avoiding jumping and rough play. A buster collar is to be worn at all times for 2 weeks to prevent self-trauma. Keep the surgical site clean and dry; do not rub or wipe the eye directly. Avoid dusty environments. Owner instructed to administer eye drops as prescribed, ensuring drops enter the eye. Monitor for increased redness, swelling, discharge, squinting, or pain. Contact the clinic immediately if any of these signs are observed, or if the patient becomes lethargic or loses appetite. Follow-up Schedule: Recheck appointment scheduled for 1 week post-operatively, then at 3 weeks and 3 months to monitor healing and visual acuity. Prognosis: The prognosis for visual recovery in the left eye is good, with most patients achieving functional vision. The long-term prognosis depends on preventing post-operative complications such as glaucoma or posterior capsular opacification. Complications to Monitor: Increased redness or swelling around the eye Excessive discharge (yellow, green, or thick white) Squinting, pawing at the eye, or signs of pain Sudden loss of vision Cloudiness or haziness within the eye Surgeon: Dr. Eleanor Vance, DVM, Dip. ACVO If you have any queries about this patient or any other cases do not hesitate to contact me. Yours sincerely, Dr. Eleanor Vance, DVM, Dip. ACVO Board-Certified Veterinary Ophthalmologist