From the Guidelines
Intraoperative complications during cataract surgery include a range of serious issues that can impact patient outcomes, such as posterior capsule rupture, iris trauma, suprachoroidal hemorrhage, and globe perforation, as reported in a recent study 1. These complications can lead to significant morbidity and mortality if not managed promptly and effectively. Some of the key complications to be aware of include:
- Posterior capsule rupture, which can lead to vitreous loss and potentially dropped nuclear fragments into the posterior segment
- Iris trauma, which may occur during phacoemulsification, causing bleeding or iris prolapse through the surgical wound
- Suprachoroidal hemorrhage, a rare but serious complication characterized by sudden eye pain, shallowing of the anterior chamber, and hardening of the globe
- Globe perforation, which can occur during injection or surgery, with a reported incidence of 0.08%–5.1% 1
- Oculocardiac reflex or asystole during surgery or suture adjustment, which may be self-limited or require urgent medical attention
- Pulled-in-two syndrome or lost muscle, which can occur in adults, particularly during strabismus surgery 1
- Operating on the wrong eye or muscle, which can happen due to human error, with a reported incidence of 1 in 2,506 1 It is essential to prioritize the prevention and management of these complications to minimize their impact on visual outcomes and recovery, as emphasized in recent guidelines 1. Preventive measures, such as the use of viscosurgical devices, minimizing surgical duration and light exposure, and avoiding large corneal incisions, can help reduce the risk of complications 1. Additionally, careful patient selection, thorough preoperative evaluation, and meticulous surgical technique are crucial in minimizing the risk of intraoperative complications during cataract surgery.
From the Research
Intraoperative Complications During Cataract Surgery
- Posterior capsular rupture, which can lead to vitreous loss or a dropped nucleus, increasing the risk of post-operative cystoid macular oedema or retinal detachment 2
- Anterior or posterior capsule ruptures and loss of nuclear fragments into the vitreous cavity 3
- Zonulopathy and pseudoexfoliation, which can pose challenges to cataract surgery 3
- Vitreous prolapse associated with posterior capsule rupture, requiring classic or pars plana anterior vitrectomy 4
- Corneal decompensation, which can significantly affect the prognosis after cataract surgery 4
- Traumatic optic neuropathy, which can occur with noninjection sub-Tenon anesthesia 5
- Foldable lens complications, which can be avoided with proper lens placement and handling 5
- Bag-lens dislocation, which can be prevented with proper placement and fixation of the intraocular lens 5
- Dropped nucleus, which can occur due to weak zonules or zonulolysis, and can be managed with pars plana anterior vitrectomy 5, 3
Risk Factors for Intraoperative Complications
- Patient age, with older patients being at higher risk for posterior capsule tear and vitreous loss 6
- Resident handedness, with right-handed residents being at higher risk for posterior capsule tear and vitreous loss 6
- Small pupils, which can increase the risk of vitreous loss 6
- Presence of diabetes mellitus, glaucoma, or age-related macular degeneration, which can increase the risk of complications 6
- History of vitrectomy, which can increase the risk of complications 6
- Axial length, which can affect the risk of complications 6
- Pseudoexfoliation, which can increase the risk of zonulopathy and pseudoexfoliation syndrome 3, 6