PRE OPERATIVE ASSESSMENT

Patient Profile No. .................

Name :

Age/ Sex :

No. Medical Record :

Diagnosis :

Visual Acuity

OD OS
Intra Ocular Pressure

OD OS
Anterior Examination

OD OS

Posterior Examination

OD OS

Biometry OD OS
ACD :
AXL :
LT :
Constanta : Power Error Power Error
……………..

Department of Ophthalmology, Airlangga University Cataract Portofolio

Page ……….
 POST OPERATIVE ASSESSMENT

Visual Acuity

OD OS
Intra Ocular Pressure

OD OS
Anterior Examination

OD OS

Posterior Examination

OD OS

Difficulty :
Analitic

Verificator

( )

Department of Ophthalmology, Airlangga University Cataract Portofolio

Page ……….
 DURANTE OPERATIVE

ICO – OSCAR ExtraCapsularCataractExtraction SCORE (0-5)

1 Draping
2 Eye position and stability
3 Scleral access & Cauterization
4 Scleral or Corneo-scleral Incision
5 Viscoelastic: Appropriate Use and Safe Insertion
6 Anterior Capsulotomy
7 Wound Enlargement
8 Nucleus Hydrodissection
9 Nucleus Extraction
1 Irrigation and Aspiration Technique With Adequate Removal of Cortex
0
1 Lens Insertion, Rotation, and Final Position of Intraocular Lens
1
1 Wound Closure: Suture handling & Placement
2
1 Wound Closure: Suture tying & Knot rotation
3
1 Wound Closure: viscoelastic removal, wound hydration, wound security
4
Global Indices
1 Wound Neutrality and Minimizing Eye Rolling and Corneal Distortion
5
1 Eye Positioned Centrally Within Microscope View
6
1 Conjunctival and Corneal Tissue Handling
7
1 Intraocular Spatial Awareness
8
1 Iris Protection
9
2 Overall Speed and Fluidity of Procedure
0

Score Supervisor
Not applicable.Done bypreceptor : 0
Novice : 2
Beginner : 3
Advanced Beginner : 4
Competent : 5 ( )

Comment ( from supervisor and operator)

Department of Ophthalmology, Airlangga University Cataract Portofolio

Page ……….
 DURANTE OPERATIVE

ICO – OSCAR ExtraCapsularCataractExtraction SCORE (0-5)

1 Draping
2 Scleral access & Cauterization
3 Sclerocorneal Tunnel
4 Corneal entry
5 Paracentesis & Viscoelastic Insertion
6 Capsulorrhexis: Commencement of Flap & followthrough.
7 Capsulorrhexis: Formation and Circular Completion
8 Hydrodissection: Visible Fluid Wave and Free prolapse of one pole of nucleus
9 Prolapse of nucleuscompletely into AC
10 Nucleus extraction
11 Irrigation and Aspiration Technique With Adequate Removal of Cortex
12 Lens Insertion, Rotation, and Final Position of Intraocular Lens
13 Wound Closure (Including Suturing, Hydration, and Checking Security
Global Indices
14 Wound Neutrality and Minimizing Eye Rolling and Corneal Distortion
15 Eye Positioned Centrally Within Microscope View
16 Conjunctiva and Corneal Tissue Handling
17 Intraocular Spatial Awareness
18 Iris Protection
19 Overall Speed and Fluidity of Procedure

Score Supervisor
Not applicable.Done bypreceptor : 0
Novice : 2
Beginner : 3
Advanced Beginner : 4
Competent : 5 ( )

Comment ( from supervisor and operator)

DURANTE OPERATIVE

ICO – OSCAR ExtraCapsularCataractExtraction SCORE (0-5)

Department of Ophthalmology, Airlangga University Cataract Portofolio
Page ……….
 1 Draping
2 Scleral access & Cauterization
3 Sclerocorneal Tunnel
4 Corneal entry
5 Paracentesis & Viscoelastic Insertion
6 Capsulorrhexis: Commencement of Flap & followthrough.
7 Capsulorrhexis: Formation and Circular Completion
8 Hydrodissection: Visible Fluid Wave and Free prolapse of one pole of nucleus
9 Prolapse of nucleuscompletely into AC
10 Nucleus extraction
11 Irrigation and Aspiration Technique With Adequate Removal of Cortex
12 Lens Insertion, Rotation, and Final Position of Intraocular Lens
13 Wound Closure (Including Suturing, Hydration, and Checking Security)
Global Indices
14 Wound Neutrality and Minimizing Eye Rolling and Corneal Distortion
15 Eye Positioned Centrally Within Microscope View
16 Conjunctiva and Corneal Tissue Handling
17 Intraocular Spatial Awareness
18 Iris Protection
19 Overall Speed and Fluidity of Procedure

Score Supervisor
Not applicable.Done bypreceptor : 0
Novice : 2
Beginner : 3
Advanced Beginner : 4
Competent : 5 ( )

Comment ( from supervisor and operator)

DURANTE OPERATIVE

ICO – OSCAR Phacoemulsification SCORE (0-5)

1 Draping
2 Incision & Paracentesis: Formation & Technique
3 Viscoelastic: Appropriate Use and Safe Insertion  
4 Capsulorrhexis: Commencement of Flap & follow-through.
5 Capsulorrhexis: Formation and Circular Completion
6 Hydrodissection: Visible Fluid Wave and Free Nuclear Rotation
7 Phacoemulsification Probe and Second Instrument: Insertion Into Eye
8 Phacoemulsification Probe and Second Instrument: Effective Use and Stability
9 Nucleus: Sculpting or Primary Chop
10 Nucleus: Rotation and Manipulation

Department of Ophthalmology, Airlangga University Cataract Portofolio

Page ……….
 11 Nucleus: Cracking or Chopping With Safe Phacoemulsification of Segments
12 Irrigation and Aspiration Technique With Adequate Removal of Cortex
13 Lens Insertion, Rotation, and Final Position of Intraocular Lens
14 Wound Closure (Including Suturing, Hydration, and Checking )
Global Indices
15 Wound Neutrality andMinimizing Eye Rolling and Corneal Distortion
16 Eye Positioned Centrally Within Microscope View
17 Conjunctiva and Corneal Tissue Handling
18 Intraocular Spatial Awareness
19 Iris Protection
20 Overall Speed and Fluidity of Procedure

Score Supervisor
Not applicable.Done bypreceptor : 0
Novice : 2
Beginner : 3
Advanced Beginner : 4
Competent : 5 ( )

Comment ( from supervisor and operator)

POST OPERATIVELY

Visual Acuity

Anterior Segment

Comment Analitic Condition

Department of Ophthalmology, Airlangga University Cataract Portofolio

Page ……….