title: Cataract surgery in patients with left ventricular assist device support.
abstract: Left ventricular assist devices (LVADs) have been increasingly used for 20 years in terminally ill patients with advanced heart failure or awaiting cardiac transplantation. Despite improvement in morbidity and mortality from use of these devices, quality of life may be limited by cataract. Access to cataract surgery in this predominantly elderly population is essential but limited by unfamiliarity with these devices. We describe phacoemulsification and intraocular lens implantation in 2 patients with LVADs. The patients had extensive preoperative cardiology evaluations and were instructed to continue warfarin through the day of surgery. Monitored sedation was used with fentanyl and midazolam. Both patients experienced significant improvement in visual acuity and quality of life. Neither experienced intraoperative hemodynamic instability. Cataract surgery may be safely performed in patients with LVAD support when adequate monitoring resources are available.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Department of Ophthalmology (Eghrari, Alkharashi, Rajaii, Sikder) and the Department of Anesthesia and Critical Care (Rivers, Nyhan), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Allen O
authors.initials: AO
authors.lastname: Eghrari
authors.affiliation: From the Department of Ophthalmology (Eghrari, Alkharashi, Rajaii, Sikder) and the Department of Anesthesia and Critical Care (Rivers, Nyhan), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rivers
authors.affiliation: From the Department of Ophthalmology (Eghrari, Alkharashi, Rajaii, Sikder) and the Department of Anesthesia and Critical Care (Rivers, Nyhan), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Majed
authors.initials: M
authors.lastname: Alkharashi
authors.affiliation: From the Department of Ophthalmology (Eghrari, Alkharashi, Rajaii, Sikder) and the Department of Anesthesia and Critical Care (Rivers, Nyhan), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Rajaii
authors.affiliation: From the Department of Ophthalmology (Eghrari, Alkharashi, Rajaii, Sikder) and the Department of Anesthesia and Critical Care (Rivers, Nyhan), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Nyhan
authors.affiliation: From the Department of Ophthalmology (Eghrari, Alkharashi, Rajaii, Sikder) and the Department of Anesthesia and Critical Care (Rivers, Nyhan), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Electronic address: ssikder1@jhmi.edu.
authors.forename: Shameema
authors.initials: S
authors.lastname: Sikder
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D002386:Cataract / Q000523:psychology; D006333:Heart Failure / Q000628:therapy; D006353:Heart-Assist Devices; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D014859:Warfarin / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D014859:Warfarin