kei-cpof

Cataract Post-Op Form

Patient Name: *

Date of Exam: *

Surgeon:

Dr. Kevin J. Kovach Dr. Mateen AliNiazee Dr. Fatima Ali

Date of Surgery:

Operated Eye:

OD OS

Pt doing well:

Yes No

(Comments)

Current Eye Drops:

Other:

Monovision:

Yes No

Dominant Eye:

OD OS

Va (sc): *

OD:

D:

I:

N:

IOP:

OS:

D:

I:

N:

IOP:

OU:

D:

I:

N:

MRx:

OD:

Va(bc)

OS:

Va(bc)

The Following are ALL Within Normal Limits:

Yes No

Conjunctiva:

WNL Other:

WNL

Cornea:

WNL Edema Other:

WNL

A/C:

WNL Cell Other:

WNL

Iris:

WNL Other:

WNL

IOL:

Position:

WNL Other:

Position: WNL

Posterior Segment:

WNL Tear/Detachment Other:

WNL

iStent?

Yes No

IOL Type:

Plan:

D/C Antibiotic (rec. D/C antibiotic after Post Op Week #1) Taper Drops (rec. taper steroid and NSAID drops to BID until finish bottles) MRx given Other:

Co-Managing Doctor: *

Practice Name: *

Phone Number: *

Fax Number:

Address: *

City: *

Email: *

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