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Risks and Complications

What are the risks associated with cataract surgery?

Philosophy

This information is intended to allay some of the concern, about cataract surgery, which comes from not being fully informed. Today modern cataract surgery is undertaken as a same day procedure, overnight hospital stays and general anaesthesia are part of a bygone era. Rehabilitation is rapid and most patients are able to return to full normal activities within a few days. Strict adherence to instructions is of course essential and generally commonsense is an excellent guide in other areas.

What are the risks associated with cataract surgery?

Cataract surgery is the most commonly performed type of eye surgery. In the vast majority of cases i.e., more than about 95% of the time, the surgery, is uncomplicated. Cataract surgery usually results in improved vision and a satisfied patient, however, cataract surgery should never be trivialized which is why compliance to instructions about medications and activities is essential. In a small number of patients events can lead to less than ideal results. Most of these events are known risks of the surgery itself and can occur even if the operation is performed well by an experienced surgeon. The occurrence of these events is often unpredictable. Patients should be aware of such possibilities when they decide to proceed with surgery. Some of the common risks are reviewed in this article.

  • Endophthalmitis
    Endophthalmitis

    Ophthalmic surgeons normally make great efforts at the time of surgery to reduce the possibility of intraocular infection, which is called endophthalmitis. The surface of the eye and the skin around it are disinfected with antiseptic compounds and the face around the eye is covered with sterile drapes. All instruments are sterilized in a similar way to all modern surgical procedures. Patients usually receive topical and intraocular antibiotics at the time of surgery. After the operation is completed eye drops containing antibiotics are prescribed. Nonetheless, even with these precautions intraocular infection called endophthalmitis occurs in approximately 1 in 1000 cases. Symptoms and signs include eye redness, pain light sensitivity and worsening vision. In most cases the patient is fine for several days but then the symptoms of the problem begin to appear. Patients who have had cataract surgery are instructed to contact the rooms (08 8359 2422) if they feel their eye is worsening in any way. If a patient develops endophthalmitis, intraocular antibiotics are usually used. A posterior vitrectomy (removal of some of the jelly-like substance in the eye) may be recommended. This may help to control the infection.

  • Glaucoma
    Glaucoma

    An unexpected rise in eye pressure occurs in about 5% of patients in the first few weeks after the operation. This is usually easily treated with drops and tablets. It is almost always transient and long term treatment is rarely necessary.

  • Cystoid Macular Edema
    Cystoid Macular Edema

    The retina is the neural tissue which lines the back part of the eye. The very central part of the retina is called the macula. It is responsible to the central vision. After cataract surgery inflammation can sometimes cause retinal blood vessels to leak fluid which accumulates in the macula causing decreased vision. This swelling is called cystoid macular edema. When the vision is affected by CME a specialized test called a fluoroscein angiogram may be ordered in an effort to determine the extent of the swelling. CME is often treated with eye drops and tablets to reduce the inflammation and improve the vision. This is associated with heart and circulation problems.

  • Floaters
    Floaters

    These are the small black specks, which can be seen in the vision. Often these are much more apparent after cataract surgery. Sometimes these are floaters, which were present prior to the operation and are more clearly seen post surgery and sometimes they are newly developed. Generally they are of no importance but should be mentioned if noticed. Usually they settle down quite quickly without treatment.

  • Retinal Detachment
    Retinal Detachment

    A retinal detachment occurs when vitreous fluid gets through a tiny retinal tear and causes the retina to separate from the back of the eye. A retinal detachment may cause a sensation like having a curtain across the vision. Note that flashing lights and black spots often precede a retinal detachment. These should be mentioned if noticed. Retinal detachments also occur in patients who have not undergone surgery of any kind. Patients with marked short sightedness are more likely to develop a retinal detachment. A retinal detachment may require surgery by a retinal specialist.

  • Posteriorly Dislocated Lens Material
    Posteriorly Dislocated Lens Material

    In some cases small pieces of the lens cortex can fall into the (vitreous) cavity of the eye. Often small pieces of lens material are well tolerated by the eye and dissolve in a few days or weeks. When larger pieces are present a second operation may be necessary to remove the lens material. This removal prevents excessive inflammation from occurring. This is more likely with more advanced cataracts and certain other eye diseases.

  • Hyphaema
    Hyphaema

    Occasionally a moderately large blood vessel is cut during the operation and this leads to a collection of blood in the front of the eye called a hyphaema. This always clears after a few days or a week or so. It is common if a combined glaucoma operation is also done.
     

  • Choroidal Haemorrhage
    Choroidal Haemorrhage

    Infrequently and unpredictably during cataract surgery acute bleeding from within the eye can occur. This comes from the fine blood vessels which nourish the retina. Although the complication is more common in older patients it is truly unpredictable. In very severe cases it can result in considerable vision loss. It is fortunately very rare.

  • Unexpected Ametropia
    Unexpected Ametropia

    The power of the implant is calculated by taking a series of careful measurements of the eye. Generally these result in an accurate prediction of the post operative refractive status of the eye. Most patients are able to see well in the distance without glasses after the operation. Most need glasses for close work. Occasionally the glasses correction after the surgery is not in accord with the preoperative calculations. When this happens it is sometimes necessary to recommend a further procedure to correct the residual refractive error. Problems are more likely if the cataract is advanced. This makes the measuring process less accurate.
     

  • Sympathetic Ophthalmitis
    Sympathetic Ophthalmitis

    This is an extremely rare inflammatory condition of both eyes which can occur after a cataract operation. It can result is poor vision and is very difficult to treat.

  • Ocular Motility Changes
    Ocular Motility Changes

    Occasionally changes in muscle balance occurs resulting in problems with fusion of vision. This can result in problems with spectacle correction and even, rarely, double vision.

  • Ptosis
    Ptosis

    This is also only seen occasionally, it results from weakness in the eyelid muscle and is characterised by a drooping of the upper lid. Usually it resolves quite quickly but sometimes a relatively small operation is necessary to lift the lid again.

  • Epiphora
    Epiphora

    After cataract surgery some patients note an increase in tearing. Generally this settles rapidly as the eye heals but occasionally it is prolonged.

  • Grittiness
    Grittiness

    This is common for some weeks after the operation and settles as healing progresses.

  • Diabetes
    Diabetes

    Cataracts are more common in diabetics. In addition, diabetes may worsen the visual outcome after cataract surgery. The development of retinopathy in eyes with pre-existing untreated retinopathy has been noted as well as the development of other diabetic eye diseases. Usually laser treatment is recommended in those patients who are considered high risk candidates. This is done prior to the cataract operation.

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