What are the expected findings and potential complications on slit lamp examination after cataract surgery?

Slit Lamp Examination Findings for Post-Operative Cataract Cases

A comprehensive slit lamp examination after cataract surgery should evaluate the anterior segment, intraocular lens position, and posterior segment to detect expected findings and potential complications that could affect visual outcomes. 1

Expected Normal Findings

• Clear cornea with well-healed incision site(s) that should be examined for proper closure and absence of leakage 1
• Quiet anterior chamber with minimal to no cell and flare, indicating appropriate resolution of surgical inflammation 1
• Well-centered intraocular lens (IOL) in the capsular bag with intact anterior capsulorrhexis visible as a 360° rim 1, 2
• Clear visual axis without significant posterior capsule opacification 1, 2
• Normal intraocular pressure (IOP) within patient's baseline range 1

Potential Complications

Corneal Complications

• Corneal edema - may be diffuse or localized to the incision site, typically resolves within the first week 1
• Descemet's membrane detachment - appears as a translucent membrane in the anterior chamber, often near the incision site 1
• Striate keratopathy - appears as folds in Descemet's membrane due to corneal edema 1
• Epithelial defects or punctate keratopathy - may indicate dry eye exacerbation post-surgery 1

Anterior Chamber Complications

• Persistent inflammation - abnormal cells and flare beyond expected timeframe 1
• Toxic Anterior Segment Syndrome (TASS) - sterile inflammatory reaction typically appearing 12-48 hours after surgery with diffuse corneal edema and significant anterior chamber reaction 1
• Endophthalmitis - severe inflammation with hypopyon, typically appearing 2-7 days postoperatively, requiring urgent intervention 1
• Retained lens fragments - visible in the anterior chamber or angle 1, 2

Intraocular Lens Complications

• IOL decentration or tilt - visible on slit lamp examination 1, 2
• Capsular bag distension syndrome - appears as milky fluid accumulation between IOL and posterior capsule 3, 1
• Posterior capsule opacification (PCO) - appears as hazy posterior capsule behind the IOL, typically developing months to years after surgery 1, 2

Pressure-Related Complications

• Elevated IOP - may be due to retained viscoelastic, inflammation, or steroid response 1
• Hypotony - may indicate wound leak or ciliary body shutdown 1

Posterior Segment Complications

• Cystoid macular edema (CME) - not directly visible on slit lamp but may be suspected with unexplained vision decrease 1
• Retinal breaks or detachment - peripheral retina should be examined with indirect ophthalmoscopy 1, 4

Follow-Up Examination Schedule

• First postoperative day: Evaluate wound closure, corneal clarity, anterior chamber reaction, IOL position, and IOP 1
• 1-2 weeks postoperatively: Assess resolution of inflammation, corneal clarity, IOP, and early visual outcome 1
• 4-6 weeks postoperatively: Final refraction, assessment for PCO development, and dilated fundus examination 1, 4

Special Considerations

• Patients with pre-existing conditions (e.g., Fuchs' dystrophy, glaucoma) require more careful monitoring for specific complications 1
• Patients who underwent combined procedures (e.g., cataract surgery with vitrectomy) need evaluation of both anterior and posterior segments 1
• Patients with premium IOLs (multifocal, toric) require careful assessment of IOL centration and rotation 1, 2

Common Pitfalls to Avoid

• Failing to dilate the pupil at least once postoperatively to examine the peripheral retina and confirm proper IOL position 4, 1
• Missing subtle wound leaks that may lead to hypotony and increased infection risk 1
• Overlooking early signs of endophthalmitis, which requires immediate intervention 1
• Attributing reduced vision solely to PCO without examining for CME or other posterior segment complications 1, 4
• Neglecting to assess dry eye, which is common after cataract surgery and can significantly impact visual outcomes 1