Parkinsons Patient plagued by Advanced Cataracts
Advanced Eye Hospital and Institute, Sanpada - Navi Mumbai is trusted and loved by many due to the being the best eye surgery hospital in Western India having both advanced technologies and highly qualified expertise in all forms of eye surgeries. At times we get patients from distant villages too seeking relief and help to regain sight.
Mrs. Gayathri*, a 75 year old elderly lady visited Advanced Eye Hospital, Sanpada - Navi Mumbai, suffering from severe cataract in both eyes. The patient had been visited many other eye hospitals previously but had been refused cataract surgery due to also suffering from dementia and involuntary movements. Even though age had caught on, Mrs. Gayathri wished to be able see her family, grandchildren and her environment clearly for as long as possible, but each denial kept breaking her heart and destroying this simple wish of hers.
She kept having periodic tremors which consisted of involuntary shaking or oscillatory movements even while at rest. She was also exhibiting a general reduction of spontaneous movement, leading to abnormal stiffness. There was also a marked decrease in facial expressivity. She had stiffness of the limbs, neck and body. Muscles were normally stretching when they move, but went suddenly rigid or started oscillating when at rest. She also showed a tendency to be unstable when standing upright. She had been previously diagnosed with Parkinson`s disease and was on regular treatment for the same.
She was finally referred to us at Advanced Eye Hospital and Institute by well-wishers. After all preliminary tests, she was referred over to Glaucoma and Cataract Specialist Dr. Rajesh Mishra. who after going through her current and previous medical records and advanced tests, advised an advanced cataract surgery with Intra Ocular Lens (IOL) placement under conscious sedation with propofol and monitored anaesthesia care.
We at Advanced Eye Hospital believe that no patient, even one suffering from cases such as Parkinson`s should be refused any form of eye related treatment or surgery, in this case a cataract surgery, because improved vision will invariably lead to improved social life and increased physical activity.
Cataract operation with IOL implantation with aid of propofol is a simple and effective technique. Parkinson`s patients are observed to be having difficulty in hearing as well. Hence, any form of sedation/anaesthesia administration, should not result in a communication gap with the patient. The patient was sedated for short duration under the condition of being capable of awakening on verbal stimuli.
Parkinson`s patient cannot remain still for long time, she had periodic tremors in both her upper limbs as well as neck. The cataract surgery of her left eye was done under conscious sedation and excellent anaesthesia care. On the operation table, patient was made to lie in a custom designed position that was confirmed as comfortable by the patient herself. Also adequate support with cotton drapes were given beneath her head and neck and a pillow was placed below the knee joint. All Medical necessities were confirmed and secured before commencing the operation - heart rate monitoring, blood pressure measurement, continuous ECG and pulse oximetry monitoring and intravenous access. For the operation itself, Phacoemulsification with foldable IOL surgery for the left eye was done under conscious sedation with monitored anaesthesia and propofol. There were involuntary movements during the surgery as well as upon completion but apart from that her cataract surgery was uneventful and completed unhindered. All the hemodynamic parameters were stable throughout the surgical period that lasted for about 15-20 minutes and approx, 30 min post its successful completion, the patient became fully conscious.
The day after the surgery, an overjoyed Mrs. Gayathri paid a visit as per regulations. Though she would have to wait a while for her vision to stabilize, after being denied time and time again, she was finally rid of the cataract in one of her eyes and she just couldn’t wait to undergo the surgery for the other eye. Her joy at being able to see properly in spite of her medical conditions cannot be expressed in words. The relatives who accompanied her during this tenure were also equally joyous and thankful.
In conclusion, I will only say that elderly patients suffering from hearing loss, dementia and/or involuntary movements should not be deprived of any eye surgery and instead are to be treated with extreme care, love and compassion. Any cataract surgery can be carried out under good anaesthetic care by a certified and highly trained surgeon with assistance of a talented team, advanced technologies and conscious sedation with anaesthesia. A cataract surgery, especially one for a Parkinson’s patient can become the ray of light that the patient most desires and thus help them regain better hopes from future.
Take Home message:
*Not her real name.