From the Guidelines
Intraoperative complications of cataract surgery can be minimized with proper preoperative evaluation and counseling, as well as careful surgical technique, and include posterior capsule rupture, dropped nucleus or lens fragments, suprachoroidal hemorrhage, iris trauma, Descemet's membrane detachment, zonular dialysis, wound burns, endophthalmitis, and anesthetic complications. According to the preferred practice pattern for cataract in the adult eye 1, the ophthalmologist should examine the patient preoperatively, ensure informed consent, and review the results of the presurgical evaluation with the patient. The preoperative evaluation and counseling are crucial in identifying potential risks and complications, such as ocular comorbidities and systemic issues that could impact the performance and outcomes of surgery 1. Some of the potential intraoperative complications include:
- Posterior capsule rupture, which occurs in 1-4% of cases
- Dropped nucleus or lens fragments, requiring vitreoretinal surgery for removal
- Suprachoroidal hemorrhage, though rare (0.1%), is serious and presents as a sudden hardening of the eye with iris prolapse
- Iris trauma, causing bleeding or pupillary damage
- Descemet's membrane detachment, requiring air or gas bubble injection for reattachment
- Zonular dialysis, involving weakening or breaking of lens supporting fibers, requiring capsular tension rings for stability
- Wound burns, developing from excessive phacoemulsification energy
- Endophthalmitis risk (0.1%), existing despite preventive measures
- Anesthetic complications, including retrobulbar hemorrhage or brainstem anesthesia. Early recognition and appropriate management of these complications are essential to prevent permanent visual impairment, as emphasized in the preferred practice pattern for cataract in the adult eye 1.
From the Research
Intraoperative Complications of Cataract Surgery
- Intraoperative complications can occur during cataract surgery, with posterior capsular rupture being one of the most common serious complications 2.
- This can lead to vitreous loss or a dropped nucleus, increasing the risk of post-operative cystoid macular oedema or retinal detachment 2.
- Other complications that may arise during cataract surgery include dysgenesis of the capsular bag, cortical-capsular adhesions, low endothelial cell reserve, dropped nucleus, and bag-lens dislocation 3.
- The use of specialized tools such as capsular tension rings and capsular hooks can help minimize stress on weakened zonules and ensure in-the-bag fixation of the IOL 3, 4.
- In cases of intraoperative complications such as anterior or posterior capsule ruptures, appropriate actions can be taken to minimize damage and ensure optimal outcomes 3, 4.
- The incidence of posterior capsule rupture has been reported to be around 8.17% for phacoemulsification and 5.07% for extracapsular extraction technique 5.
- Light-induced retinal injury is a major irreversible intraoperative complication that can occur during cataract surgery 6.
- The management of intraoperative complications requires a thorough understanding of the causes and types of complications, as well as the use of appropriate techniques and tools to minimize damage and ensure optimal outcomes 3, 5, 4.