Cataract Surgery - Complications

Complications

Complications after cataract surgery are relatively uncommon.

• PVD — Posterior vitreous detachment does not directly threaten vision. Even so, it is of increasing interest because the interaction between the vitreous body and the retina might play a decisive role in the development of major pathologic vitreoretinal conditions. PVD may be more problematic with younger patients, since many patients older than 60 have already gone through PVD. PVD may be accompanied by peripheral light flashes and increasing numbers of floaters.
• Some people can develop a posterior capsular opacification (also called an after-cataract). As a physiological change expected after cataract surgery, the posterior capsular cells undergo hyperplasia and cellular migration, showing up as a thickening, opacification and clouding of the posterior lens capsule (which is left behind when the cataract was removed, for placement of the IOL). This may compromise visual acuity and the ophthalmologist can use a device to correct this situation. It can be safely and painlessly corrected using a laser device to make small holes in the posterior lens capsule of the crystalline. It usually is a quick outpatient procedure that uses a Nd-YAG laser (neodymium-yttrium-aluminum-garnet) to disrupt and clear the central portion of the opacified posterior lens capsule (posterior capsulotomy). This creates a clear central visual axis for improving visual acuity. In very thick opacified posterior capsules, a surgical (manual) capsulectomy is the surgical procedure performed. A YAG capsulotomy is, however, a factor which must be taken in consideration in the event of IOL replacement as vitreous can migrate toward the anterior chamber through the opening hitherto occluded by the IOL.
• Posterior capsular tear may be a complication during cataract surgery. The rate of posterior capsular tear among skilled surgeons is around 2% to 5%. It refers to a rupture of the posterior capsule of the natural lens. Surgical management may involve anterior vitrectomy and, occasionally, alternative planning for implanting the intraocular lens, either in the ciliary sulcus, in the anterior chamber (in front of the iris), or, less commonly, sutured to the sclera.
• Retinal detachment is an uncommon complication of cataract surgery, which may occur weeks, months, or even years later.
• Toxic Anterior Segment Syndrome or TASS is a non-infectious inflammatory condition that may occur following cataract surgery. It is usually treated with topical corticosteroids in high dosage and frequency.
• Endophthalmitis is a serious infection of the intraocular tissues, usually following intraocular surgery, or penetrating trauma. There is some concern that the clear cornea incision might predispose to the increase of endophalmitis but is no conclusive study to corroborate this suspicion.
• Glaucoma may occur and it may be very difficult to control. It is usually associated with inflammation, specially when little fragments or chunks of the nucleus get access to the vitreous cavity. Some experts recommend early intervention when this condition happens (posterior pars plana vitrectomy). Neovascular glaucoma may occur, specially in diabetic patients. In some patients, the intraocular pressure may remain so high that blindness may ensue.
• Swelling or edema of the central part of the retina, called macula, resulting in macular edema, can occur a few days or weeks after surgery. Most such cases can be successfully treated
• Other possible complications include: Swelling or edema of the cornea, sometimes associated with cloudy vision, which may be transient or permanent (pseudophakic bullous keratopathy). Displacement or dislocation of the intraocular lens implant may rarely occur. Unplanned high refractive error (either myopic or hypermetropic) may occur due to error in the ultrasonic ecobiometry (measure of the length and the required intra-ocular lens power). Cyanopsia, in which the patient sees everything tinted with blue, often occurs for a few days, weeks or months after removal of a cataract. Floaters commonly appear after surgery.