From the Guidelines
Phacoemulsification complications include iris prolapse and posterior capsule rupture.
Common Complications
- Iris prolapse
- Posterior capsule rupture These complications are less common with phacoemulsification compared to manual extracapsular cataract extraction (ECCE) or manual small-incision cataract extraction (MSICS) 1.
Additional Considerations
Other potential complications and considerations in phacoemulsification include:
- Cystoid macular edema (CME), which can be reduced with topical nonsteroidal anti-inflammatory drugs (NSAIDs) 1
- Postoperative bacterial endophthalmitis, which can be reduced with intracameral antibiotic administration 1
- Dry eye disease (DED), which can be a multifactorial and complex condition associated with cataract surgery, and asymptomatic DED is highly prevalent 1 To minimize these complications, considerations during surgery include:
- Minimizing surgical duration and light exposure
- Avoiding large corneal incisions and aspirating speculums
- Keeping thermal energy of the phacoemulsification device low
- Using periocular administration or intraocular injection of antibiotics and/or steroids immediately before the end of surgery 1
From the Research
Intraoperative Complications
- Posterior capsule rupture is a common complication, occurring in 6.7% of cases 2, 9% of cases 3, and 18% of cases in patients with posterior polar cataract 4
- Vitreous loss is another complication, occurring in 5.4% of cases 2 and 3.7% of cases in combined phacoemulsification and vitreoretinal surgery 5
- Dislocated lenticular fragments can occur, with a frequency of 1.0% 2
- Iatrogenic retinal hole is a complication, occurring in 5.3% of cases in combined phacoemulsification and vitreoretinal surgery 5
- Transient corneal edema can occur, with a frequency of 3.2% in combined phacoemulsification and vitreoretinal surgery 5
Postoperative Complications
- Posterior capsule opacification is a common complication, occurring in 21.5% of cases in combined phacoemulsification and vitreoretinal surgery 5 and 8% of cases in phacoemulsification after pars plana vitrectomy 3
- Elevated intraocular pressure can occur, with a frequency of 9.7% in combined phacoemulsification and vitreoretinal surgery 5 and 7% of cases in phacoemulsification after pars plana vitrectomy 3
- Macular edema can occur, with a frequency of 8.1% in combined phacoemulsification and vitreoretinal surgery 5
- Retinal detachment can occur, with a frequency of 6% of cases in phacoemulsification after pars plana vitrectomy 3 and 3.2% of cases in combined phacoemulsification and vitreoretinal surgery 5
- Vitreous hemorrhage can occur, with a frequency of 3.7% in combined phacoemulsification and vitreoretinal surgery 5
Risk Factors
- Previous vitrectomy can increase the risk of complications during phacoemulsification, including posterior capsule rupture 3, 6
- Posterior polar cataract can increase the risk of posterior capsule rupture during phacoemulsification 4
- Hard nucleus cataract in a vitrectomized eye can increase the risk of posterior capsule rupture during phacoemulsification 6