Risks of Cataract Surgery
Cataract surgery is remarkably safe with serious complications occurring in less than 5% of cases, though patients should be counseled about specific intraoperative and postoperative risks that can affect visual outcomes. 1
Intraoperative Complications
Posterior capsular rupture is the most common serious intraoperative complication, occurring in approximately 5.4% of cases. 2 This can lead to:
- Vitreous loss (3.2% of cases), which increases the risk of subsequent complications 2
- Dropped nucleus, requiring additional surgical intervention 1
- Loss of capsular support necessitating anterior chamber IOL placement (3.1% of cases) 2
Other intraoperative risks include:
- Bleeding into the anterior chamber (8.6% of cases), with higher risk in patients on anticoagulants or antiplatelet medications, though sight-threatening hemorrhage is rare 2
- Zonular rupture (6.6% of cases) 2
- Iris prolapse, though modern phacoemulsification techniques have reduced this risk compared to older extraction methods 3
Postoperative Complications
Early Postoperative Period
Common but typically manageable complications include:
- Corneal edema (53.6% of cases), usually transient 2
- Intraocular pressure elevation to ≥30 mmHg (27.6% of cases) 2
- Fibrinous reaction (24.5% of cases), with increased risk in patients taking aspirin 2
Serious Sight-Threatening Complications
Endophthalmitis is the most devastating complication, though rates have declined significantly with intracameral antibiotics from 0.07% to 0.02%. 4 The very elderly (80+ years) face slightly higher endophthalmitis risk. 3
Retinal detachment risk increases postoperatively, particularly in patients with myopia or posterior capsular rupture. 1, 5
Suprachoroidal hemorrhage is a rare but serious complication. 5
Late Complications
Posterior capsular opacification (PCO) is the most common late complication and can be readily treated with YAG laser capsulotomy. 1
Patient-Specific Risk Factors
Higher-risk patients requiring special counseling and management include those with:
- Small pupil size and pseudoexfoliation syndrome - the most important risk factors for both intra- and postoperative complications 2
- Male sex - associated with increased complication rates 5
- Concomitant diabetic retinopathy 5
- Glaucoma - increases risk of vitreous loss, postoperative pressure elevation, and corneal edema 2
- Tamsulosin use - significantly increases surgical complexity; some surgeons temporarily discontinue preoperatively 5, 4
Important clinical caveat: Anticoagulant or antiplatelet therapy (including aspirin) increases bleeding risk but does not require discontinuation, as sight-threatening hemorrhage remains rare and systemic risks of stopping anticoagulation typically outweigh surgical bleeding risks. 2, 4
Overall Safety Profile
Modern phacoemulsification demonstrates better outcomes than older techniques, with:
- Better uncorrected distance visual acuity 3
- Lower rates of iris prolapse and posterior capsule rupture 3
- Greater than 95% safety rate in routine cases 1
- Up to 90% of patients report improvement in functional status and vision satisfaction 3
Recent studies demonstrate a declining trend in serious postoperative adverse events over recent decades due to advances in surgical technique and technology. 5
Risk Communication
Patients overwhelmingly want comprehensive risk disclosure: 93.5% want to be warned of complications with 1 in 50 risk, and 62.4% want disclosure even for 1 in 1000 risks. 6 Written information should be provided to ensure coverage and reinforce verbal counseling. 6