Early Complications After Cataract Surgery

settled.

Injury to the iris: Less than 10% of people have an injury to the iris (coloured part of the eye). It may also result in an irregularly shaped pupil. Intra-operative floppy iris syndrome is the number one risk factor for this complication and generally occurs in men who have taken prostate-related drugs such as Tamsulosin. Generally, this complication is harmless but it can cause mild symptoms such as glare in bright sunlight.

Damaged capsule (posterior capsule rupture): The capsule is the “bag” which surrounds the lens inside the eye. The capsule is an extremely thin structure, as thin as our hair, flimsy and transparent. In 2 to 3% of cataract surgery the capsule can tear or break. In most cases, the problem can be managed during the surgery itself. Occasionally you will be left without a intraocular lens and it will be put in at a later date, once the eye has settled. Posterior capsule rupture can lead to complications such as infection, glaucoma, persistent inflammation, cystoid macular oedema and retinal detachment which may require a second operation, such as retinal detachment surgery.

Anaethesia (local and general): Rare but serious incidents can occur in relation to the administration of anaesthesia. The most extreme circumstances can be life-threatening.

EARLY COMPLICATIONS AFTER CATARACT SURGERY

Most early complications which do not involve another procedure and are not serious will settle over a few

weeks, if treated appropriately. Occasionally, early complications may require a second procedure. The following complications listed are to inform you and not alarm you. There may be others that are not listed.

These complications are monitored over time following cataract surgery. If there is progression to pain, decrease

in vision, or any discharge from the eye, you are advised to promptly present for an eye examination.

EALY COMPLICATIONS AFTER CATARACT SURGERY WHICH DO NOT INVOLVE ANOTHER PROCEDURE:

Bruising of the eye or eyelids. This is quite common and settles within weeks

Allergy to the post-surgery eye drops. This may cause redness and irritation of the eye and eyelid. This requires a change of eye drops.

Raised intraocular pressure. The intraocular pressure can sometimes be elevated in the first few days after surgery. Measurement of the intraocular pressure is important during the immediate post-operative period after cataract surgery, particularly for those who have pre-existing glaucoma. This usually settles without any issues or treatment. However, if the eye pressure remains persistently high, it can be treated with pressure lowering eye drops or tablets.

Fluid at the central part of the retina (macular oedema).

This is usually mild and settles with a course of antiinflammatory eye drops. This is the most frequent complication after an uncomplicated cataract surgery occurring in 1 to 2% of cataract surgery with a peak incidence at about 6 to 8 weeks post-operatively. Risk factors are age-related macular degeneration or diabetic retinopathy, if the cataract surgery was routine. This is more common after complicated cataract surgery and if the lens capsule had been ruptured. Rarely, macular oedema can be severe and cause reduced vision in the long term.

EARLY COMPLICATIONS AFTER CATARACT SURGERY WHERE TREATMENT MAY REQUIRE ANOTHER PROCEDURE:

Retained piece of cataract: A bit of the lens can

break off during cataract surgery and become lost in the front part of the eye. This happens in less than 10% of operations. It is usually harmless and the lens fragment often slowly degrades away without causing any consequences. However, surgical removal may be needed if the fragment is too large or causes persistent ocular inflammation.

Refractive surprise: This is uncorrected long-sightedness or short-sightedness. Before surgery, based on your vision requirements, calculations are used to predict the most suitable intraocular lens. The calculations are up to 95% accurate, meaning there is a chance you may need spectacles for some tasks after cataract surgery, even though the refractive aim was to avoid this. This can usually be corrected with spectacles or contact lenses. However, if severe, further laser or surgical exchange of the intraocular lens implant can be considered.

Infection Inside The Eye (Endophthalmitis): Of all the possible cataract surgery complications, endophthalmitis is one of the most feared. Microorganisms gain entry into the eye and may cause permanent vision loss, or rarely loss of your eye, despite treatment expediently with antibiotic injections into the vitreous cavity or surgery (1 in 2000 risk).

Intraocular lens haptic out of capsular bag. This is treated promptly with surgical re-positioning of the intraocular lens.

Retinal detachment. A tear in the retina requires laser treatment, usually in the outpatient clinic. A detachment of the retina is rare but more serious and requires retinal detachment surgery. Retinal detachment is a vision threatening complication which occurs when the retina separates from the layer underneath.

Drooping of the eyelid (ptosis). This is usually transient. If it is permanent you will require ptosis surgery to lift the eyelid.