From the Guidelines
Cataract surgery complications, although relatively rare, can significantly impact patient morbidity, mortality, and quality of life, emphasizing the need for careful preoperative evaluation, meticulous surgical technique, and prompt management of any complications that may arise. The most frequent intraoperative complications include posterior capsule rupture, suprachoroidal hemorrhage, and iris trauma or damage, which can lead to serious consequences such as vitreous loss, dropped lens fragments, and increased intraocular pressure 1. Postoperatively, patients may develop endophthalmitis, a sight-threatening infection requiring urgent treatment with intravitreal antibiotics, or cystoid macular edema (CME), often treated with topical NSAIDs like ketorolac 0.5% four times daily for 4-6 weeks 1.
Some key points to consider in the management and prevention of cataract surgery complications include:
- The importance of preoperative evaluation and counseling to identify ocular comorbidities and high-risk features that could impact surgical outcomes 1.
- The use of intracameral antibiotic administration to reduce the risk of postoperative bacterial endophthalmitis, as supported by substantial evidence 1.
- The potential benefits of minimally invasive glaucoma surgery in enhancing the intraocular pressure-lowering effects of cataract surgery in patients with mild to moderate glaucoma 1.
- The impact of cataract surgery on reducing the risk of falls, hip fractures, and motor vehicle crashes, as well as improving cognitive abilities, mental health, and overall quality of life, particularly in the elderly population 1.
In summary, while cataract surgery is generally safe and effective, careful attention to potential complications and meticulous management are crucial to optimizing patient outcomes and improving quality of life. By prioritizing preoperative evaluation, intraoperative technique, and postoperative care, ophthalmologists can minimize the risk of complications and ensure the best possible results for their patients.
From the Research
Complications of Cataract Surgery
- Endophthalmitis is a severe inflammation of the anterior or posterior chambers of the eye that may be sterile or associated with infection, and is a potentially vision-threatening complication of cataract surgery 2.
- The risk of endophthalmitis can be reduced with the use of perioperative antibiotic prophylaxis, such as intracameral cefuroxime with or without topical levofloxacin 2.
- Other complications of cataract surgery include posterior capsular rupture, vitreous loss, dropped nucleus, cystoid macular oedema, and retinal detachment 3, 4.
- Post-operative posterior capsular opacification is a common complication, but can be readily treated with a YAG capsulotomy 4.
Risk Factors for Complications
- Patient-related factors that increase the risk of serious complications from cataract surgery include male sex, concomitant diabetic retinopathy, same day cataract surgery combined with another intraocular surgery, and tamsulosin use 5.
- Surgeon-related factors that increase the risk of serious complications include low surgical volume, limited experience, and operating on patients who are most prone to adverse events 5.
Prevention and Management of Complications
- The use of intracameral antibiotics, such as cefuroxime, moxifloxacin, and vancomycin, can help prevent endophthalmitis 2, 6.
- Capsular tension rings can be used to achieve in-the-bag implantation in the presence of weak zonules and zonulolysis 3.
- Viscolevitation can be used to rescue sinking implants, and proper lens placement with an open capsule can help prevent complications 3.
- Immediate diagnosis and treatment of complications, such as traumatic optic neuropathy, can help improve outcomes 3.