Indicaties voor chirurgie (uit buitenlandse richtlijnen)

Indications for Surgery
The primary indication for surgery is visual function that no longer meets the patiënt's needs and for which cataract surgery provides a reasonable likelihood of improved vision. Other indications for a cataract removal include the following:

• clinically significant anisometropia in the presence of a cataract;
• the lens opacity interferes with optimal diagnosis or management of posterior segment conditions;
• the lens causes inflammation or secondary glaucoma (phacolysis, phacoanaphylaxis);
• the lens induces angle closure (phacomorphic).

 

Contraindications to Surgery
Surgery for a visually impairing cataract should not be performed under the following circumstances:

• tolerable refractive correction provides vision that meets the patiënt's needs and desires;
• surgery is not expected to improve visual function, and no other indication for lens removal exists;
• the patiënt cannot safely undergo surgery because of coexisting medical or ocular conditions;
• appropriate postoperative care cannot be arranged;
• the patiënt or patiënt's surrogate decision maker is unable to give informed consent for nonemergent surgery.

 

Bron: American Academy of Ophthalmology Cataract and Anterior Segment Panel (2011). Preferred Practice Pattern Guidelines. Cataract in the Adult Eye. San Francisco, CA. American Academy of Ophthalmology.

 

Indications for Surgery
Underlying principles:

• the patiënt should have sufficient cataract to account for the visual symptoms;
• the cataract should affect the patiënt’s lifestyle;
• the risks and benefits of surgery should be discussed with the patiënt and relevant written information supplied;
• the patiënt should wish to undergo cataract surgery.

 

Patiënts who do not meet all of the criteria should not be overlooked. Patiënts with co-morbidity who might appreciate only slight benefit from surgery may wish to consult with an ophthalmologist to discuss their case. Patiënts with lifestyle impairment due to cataract who do not complain should, if necessary, be encouraged to consider cataract surgery, particularly those who live alone or act as carers.

Other indications for cataract surgery include facilitating treatment and / or monitoring posterior segment disease e.g. diabetic retinopathy, correcting anisometropia or treating lens induced ocular disease.

 

 

Bron: Royal College of Ophthalmologists. Cataract Surgery Guidelines (2010). London. Royal College of Ophthalmologists

 

Recommendations

• cataract surgery is indicated primarily for the correction of visual impairment that cannot be adequately improved nonsurgically and that is directly attributable to the presence of a lens opacity [Level 3];
• even in the absence of functional symptoms, cataract surgery is indicated to meet visual acuity standards when a patiënt’s visual acuity falls below legal standards for activities (such as driving, military service, or flying) and the patiënt wishes to continue to perform these activities [Consensus];
• patiënts who decline surgery, even after consultation with collateral sources of information, should be made aware that cataract surgery, where indicated, has been shown to decrease the incidence of motor vehicle accidents [Level 2] and in patiënts at high risk, to decrease falls and fractures [Level 2];
• cataract surgery is indicated for medical reasons, such as phacomorphic glaucoma, lens-induced uveitis, or treatable posterior segment pathology, that cannot be adequately managed due to lens opacity [Consensus].

 

Bron: Canadian Ophthalmological Society Cataract Surgery Clinical Practice Guideline Expert Committee (2008). Canadian Ophthalmological Society evidence-based clinical practice guidelines for cataract surgery in the adult eye. Can J Ophthalmo,. 43 Suppl 1, S7-57.