Cataract Surgery Complications

Dr. Gary Foster – Fort Collins & Loveland, CO

Complications of Cataract Surgery

Know Cataract Surgery complications

Cataract surgery complications are rare. This has made cataract surgery one of the most commonly performed and successful surgeries in the world. It is important to consider the potential complications as you make your decisions.

Target Error Complications

Missing the intended target goal is a potential complication. We place an intraocular lens (IOL) in your eye during cataract surgery.  These intraocular lenses have a prescription power.  Prior to surgery, a series of measurements are taken to determine the correct power IOL for your eye.

The intraocular lens moves a small amount as it locks into place after your surgery.  This movement could leave you a bit near sighted or farsighted.  Glasses, contact lenses, or LASIK are potential options to treat this target error.

Inflammation Cataract Complications

Surgery creates inflammation.  A little bit of inflammation is good as it helps protect the eye from infection and starts the healing process.  Too much inflammation can damage the eye and is one of the potential cataract surgery complications.

If the inflammation reaches the back of the eye it can cause swelling in the retina called cystoid macular edema (CME).  There are treatments for this, but it is better to prevent CME in the first place.

I have my patients start a non-steroidal, anti-inflammatory eye drop called Ilevro the day before surgery and then continue using the eye drop for six weeks after surgery.

I also prescribe durazol, which is a steroidal anti-inflammatory to be used for the first two weeks after surgery.

Patients with diabetes are more prone to swelling so I have them start the drops sooner and use them longer to decrease the chances of this complication.

Post Cataract Surgery Infection (endophthalmitis)

Infection inside the eye is a serious potential complication that could have a significant impact on your vision.  Fortunately, the chances of having an infection are low (around 1 out of every 1,500 patients).

To help protect against this we use a special disinfectant to clean your eye and use sterile technique during surgery.  I will also have you start an antibiotic the day before surgery to add a further measure of protection from infection.

Dropped Nucleus

There is a thin capsule that surrounds your cataract.  During surgery I make an opening in the front part of the capsule.  Your cataract is removed through this opening.  If the back part of the capsule breaks during surgery, pieces of cataract can fall into the back part of the eye.  If this happens, it usually requires a second surgery with a retinal specialist to remove the fragments from the back of the eye.  The inconvenience and attendant risks of a second surgery make this one of the more difficult cataract surgery complications.

Cataract Surgery Complications and complications of cataract surgery

Fibrae Zonulares = Zonules that hold the lens capsule in place.

Loose Zonules

The lens capsule is held in place by a series of tiny fibers called the zonules.  If these zonules are strong then after the cataract removal, the intraocular lens can be placed inside the capsule where it is held securely in place.  If the zonules are a bit weak or missing in areas, the IOL will might have to be placed in a different location to be stable.

If the zonules are extremely weak, then the cataract and capsule could fall into the back part of the eye during the procedure.  This would require a second surgery with a retinal specialist to complete the cataract removal.

A great advance in the past decade involves a series of special implants called capsular tension rings (CTRs) that can help compensate for weak zonules.  These CTRs have decreased complications.

Posterior Capsular Opacity

The back part of your lens capsule will occasionally turn cloudy in the months after the operation. This is called a posterior capsular opacity (PCO) and causes glare and cloudiness to your vision. If this happens, a yag laser is used to polish an opening in the posterior lens capsule to restore your vision.  Around 20% of those that have had this procedure need to have this laser to clear the posterior capsule making PCO the most common complication.  Fortunately, it is easy to fix for most.

Retained Cataract (hide and seek)

On rare occasions, a very small piece of cataract slides back behind the iris (colored part of the eye) where the surgeon cannot see it, and it become lodged there.  The piece eventually works itself free and is detected during a postoperative visit.  This could require a quick trip back to the operating room to remove the piece.

Eye Pressure after Cataract Surgery

There is an ideal amount of pressure inside your eye.  If the pressure is higher or lower than this, it can cause problems with your vision.

If the wounds are not fully secure, the pressure could be too low. Often, a suture is placed to further secure the wound. If the eye pressure is too high after cataract surgery, pressure-lowering drops are often added to return the eye pressure to normal during the healing phases.

Posterior Vitreous Detachment

The jelly that fills the back of the eye pulls away from the back at some point in our lifetime. This is called a posterior vitreous detachment.  Cataract surgery can make this happen at a younger age.

Surgeon Experience and Cataract Surgery Complications

Multiple studies have shown that more experienced cataract surgeons have less after cataract surgery complications .  This process of improvement does not plateau at some certain number.  I sense a palpable leap forward in surgical ability about every 1,000 to 1,500 cases.

It is reasonable to ask eye surgeons how many cases they have done, how many they do per week, who has the most experience in the region, and who they would have perform their operation.

The second phenomenon that affects skill is that as a surgeon becomes recognized as an expert in a region, the other surgeons begin sending him/her the more difficult cases.  This further escalates the skills of the more experienced surgeons.

This list is representative of potential cataract surgery complications, but not exhaustive.  If you have further questions about cataract surgery complications , please leave a comment/question or schedule a time to meet with me at one of my offices.

Comments

  1. Laurel Williams says:

    Dr. Foster………………
    I wrote to you several weeks ago re: abrasions in the eyes following cataract surgery. Also wondering why I’m having such a difficult time with “light sensitivity”. Would appreciate some discussion.

    • Laurel:
      We anticipate light sensitivity after cataract surgery. That is why we provide wrap around sun glasses for you to use in the early post op period. Anything that causes increased inflammation or irritation in your eyes can increase your light sensitivity. After cataract surgery there is inflammation inside your eyes and healing incisions on the outside and both cause light sensitivity. The nerves that grow back across the incisions are sometimes hypersensitive. In addition, most of the eye drops used have preservatives that can irritate and dry your eyes. The good news is that as the inflammation heals and the eye drops are no longer needed, the light sensitivity usually goes away also.

  2. Marilyn E. Zimmann says:

    Dear Dr. Foster,
    Thank you for providing such easy-to-understand information in your articles. I appreciate the opportunity to gain this extra knowledge. Marilyn Zimmann

  3. Mary Kirkpatrick says:

    I simply am not able to find an answer to the following question. Is it safe to take a yellow fever immunization (live virus) 4 weeks following laser cataract surgery with a lingering inflammed eye? Thank you. mkk

    • Mary:
      It is not common to have lingering inflammation four weeks after cataract surgery. It would be advisable to have this resolved before any other interventions.

      If your planned travel is imminent, you would need to consider with your travel clinic physician the relatively low risk of issues from a live virus vaccine compared to the risk of contracting yellow fever depending our your travel plans.
      God Bless,
      Gary Foster

  4. Steve Martin says:

    Eye History…R. and M. Detachment one year ago….Surgery…Gas Bubble ..Recovered
    Had Already Cataract in eye…one year later…Cataract Surgery….Very Dense ..Dr. said
    was actually two Cataracts in eye…29 minute surgery….follow up…..>Cornea Edema
    and small piece of Cataract discovered in Cornea…plan operate to get small piece
    and medication to correct Edema….>Dr said if after three months if Edema there
    will need transplant…age 68….was extreme nearsighted…..after five days Dr said
    will need YAG later….wants to proceed too second surgery in about a month for other
    eye….of course wonder if had Laser less energy different outcome
    Question..does Cornea Edema usually correct? time frame?
    if need Cornea I Read that DSEK is latest technique to try with less recovery time too
    Is there specialists that only do Cornea surgery? appreciate general comments in reply
    thanks..

    • Steve:
      Sorry you have had such a complicated path with your vision. The gas bubble from the retinal surgery speeds up cataract progression in many.

      Most have minimal corneal edema and a healthy endothelium (inside of the cornea) that can resolve the edema in the first day or so after cataract surgery. If the surgery is more difficult (causing extra edema) or the endothelium is weaker (less able to clear the edema), it can persist for a week or so. In extremes of edema with weak endothelial cells, it can take a month or so to resolve and in more extreme cases never resolve forcing a surgery like a DESK to replace the weak endothelium with strong cells from a donor cornea. These tend to have good results.
      There are surgeons that do specialize in DESK. They are called corneal specialists, and in each region there are some corneal specialists that do more of the surgery than others.
      God Bless,
      Gary Foster