Common Complications and Risks of Cataract Surgery

Cataracts occur when proteins in the eye’s lens break down and form clumps, leading to cloudiness and blurred vision. When cataracts begin to interfere with your daily activities, your doctor may recommend surgery to remove the lens and replace it with an artificial one. Millions of people successfully undergo cataract surgery every year with few complications.

Cataract surgery is among the most successful procedures in modern medicine.

Though cataract surgery is a relatively safe procedure, there is always the possibility of complications. Understanding cataract surgery risks and prevention is critical for making an informed decision about the procedure. Here are some important points:

Some immediate cataract surgery complications include:

•   swelling
•   pain/burning
•   infection
•   reactions to anaesthetic medications
•   Dry or itchy eyes

These complications are monitored over time after surgery. Patients should seek medical attention if their symptoms worsen, their vision deteriorates, or there is any discharge from the eye.

Cataract Surgery Complications-

Cataract surgery complications discussed below can occur immediately but are more severe than those previously mentioned. You can keep a close eye on any symptoms and contact your doctor if anything seems off.

Swelling in the Cornea

The cornea is the clear front part of the eye. It may become swollen and hazy following surgery, making it difficult to see. This is usually a temporary issue that resolves itself within a few days or weeks. Your doctor may treat it with eye drops.

Retinal Detachment

The retina is located in the back of your eye, where it detects light and sends signals to the brain. After surgery, there is a slightly higher chance that it will pull away from the back of the eye, a condition known as retinal detachment.

It’s an emergency that could lead to vision loss. Consult your eye doctor immediately if you experience any of the following cataract surgery complications:

•   Feel as if a curtain has fallen over part of your eye.
•   Have new floating spots in your vision
•   See flashes of light

 

Lens Fragments

When your doctor removes your cloudy lens during cataract surgery, some pieces may fall into your eye and be left there. Small ones are not an issue, but larger ones can be. You may require surgery to remove the vitreous and prevent swelling.

Fluid Buildup in the Retina

Following surgery, blood vessels in the retina can leak. Fluid collects in your eye, blurring your vision.

Your doctor will treat it with eye drops, and it may take weeks or months to recover. It usually gets completely better. In more serious cataract surgery complications, you may need a steroid shot behind the eye or surgery.

Dislocated Intraocular Lens (IOL)

The IOL is the artificial lens that your doctor inserts into your eye during surgery. It may slip out of place, resulting in blurred or double vision.

It can also result in more serious complications after cataract surgery, such as bleeding and swelling. You may need surgery to reposition it or replace it.

Secondary Cataract

The lens capsule protects the eye’s lens. Cataract surgery removes the front part of the lens while leaving the back in place. This is where you may develop a secondary cataract, also known as posterior capsule opacification (PCO). When this occurs, your vision may become cloudy again. It usually occurs sometime after cataract surgery.

A procedure known as YAG laser capsulotomy is required to correct the situation. Your doctor uses a laser to make a hole in the back of the lens capsule. This allows light to pass through so you can see normally. It is painless and takes approximately 5 minutes. This is a natural process that occurs after cataract surgery.

Bleeding

It’s uncommon, but during surgery, blood vessels that supply the retina may begin bleeding for no apparent reason. A small amount of blood is harmless, but larger amounts can cause vision loss.

Following surgery, blood may collect between the cornea and iris, the coloured part of your eye, obstructing your vision. Eye drops may be helpful, and you should rest in bed with your head elevated.

If the blood does not drain or causes excessive pressure in your eye, you may require surgery.

Floaters and Flashes of Light

Surgery can cause posterior vitreous detachment, which is when the vitreous separates from the retina. It causes you to see moving spider webs and clouds in your vision, as well as bright flashes of light.

Usually, such cataract surgery complications improve on their own after a few months. Because the symptoms are similar to retinal detachment, which is a cataract surgery complication, contact your doctor right away to be evaluated.

High Eye Pressure

For some people, surgery causes eye pressure to increase. Ocular hypertension is a condition that can impair your vision. Your doctor may recommend that you treat it with eye drops, shots, or pills. Swelling, bleeding, or residual lens fragments can increase pressure in your eye, leading to glaucoma.

The treatment method for these cataract surgery complications are determined by the specific reason for the occurrence. If your optic nerve is damaged, you may also require glaucoma surgery.

Light Sensitivity

This is normal, but if it lasts longer than a few days, consult your doctor.

Sometimes you just need to wear sunglasses for a few months until it passes. However, it could also indicate another problem, such as excessive inflammation in your eye, in which case you may require eye drops.

Dysphotopsia

This causes you to see visual effects. There are two types:

•   Negative, which gives you a curved shadow at the edge of your vision
•   Positive, which you see as halos, starbursts, flashes, or streaks of light

Doctors don’t know why these cataract surgery complications occur, and it usually resolves on its own. When it is negative, it has a better chance of lasting. Typically, you wait to see if it improves. You could try eye drops or thick-rimmed glasses to reduce the amount of shadow you notice.

If it persists for months, your doctor may recommend surgery. You could get a new lens or stack a second lens on top of the first.

Cataract Surgery Risks and Prevention 

Pre-Surgical Assessment: A thorough examination to determine the overall health of the eye and identify potential risk factors.

Sterile Surgical Techniques: To minimize the risk of infection.

Use of Antibiotics: Applied before, during, or after the surgery to prevent infection.

Careful Surgical Technique: Minimising trauma to the eye to prevent complications like retinal detachment.

Post-Surgical Care: Regular follow-up appointments to monitor the eye’s healing process.

Immediate Treatment: Prompt treatment of any complications like inflammation or increased eye pressure.

Patient Education: Instructing patients on signs of complications and the importance of post-operative care.

Customised Approach: Adjusting surgical techniques based on individual patient needs and risk factors.

Age is the most common risk factor for developing cataracts. After the age of 40, the risk of developing a cataract increases gradually.

Other risk factors include a family history of cataracts, an eye injury or trauma, or a history of prior eye surgery. Some medical conditions, such as diabetes, and the use of certain medications, such as corticosteroids, can raise your risk of cataract surgery complications.

Ultraviolet (UV) light or exposure, such as extended sun exposure without sunglasses, as well as smoking, can increase your chances of developing a cataract.

To reduce your risk of cataracts or slow their progression, read through this cataract surgery patient guide.

•   Wear sunglasses to reduce UV exposure. Look for sunglasses that block 99 to 100 percent of UV light (both UV-A and UV-B rays). Wearing a hat or other forms of sun protection can also help to reduce UV exposure.
•   Avoid or quit smoking, which is associated with a significantly higher risk of cataracts
•   Incorporate antioxidants, such as vitamins A, C, and E, carotenoids, lutein zeaxanthin, and selenium into your diet. These can be found in a variety of fruits and vegetables, among other healthy foods.
•   Wear eye protection during high-risk activities, such as sports, home repairs, yard work, and specific work tasks.
•   Work with your primary care provider to manage medical conditions like diabetes and keep your blood sugar in check.

 

Managing Risks in Cataract Surgery

One of the most important steps taken to avoid cataract surgery complications is to use sterile surgical techniques. This is critical to reducing the risk of infections, which, while uncommon, can be severe. Antibiotics, whether taken before, during, or after surgery, can help prevent infections.

The surgical technique plays an important role in risk management. Careful and precise surgical methods help to minimise trauma to the eye, lowering the risk of complications such as retinal detachment or lens dislocation. Posterior Capsule Opacification (PCO), a common problem in which the back of the lens capsule becomes cloudy, is also addressed with meticulous surgical techniques and can be treated after surgery if necessary.

After surgery, risk management entails scheduling regular follow-up appointments. These are essential for tracking the healing process of the eye. Complications, such as inflammation or increased eye pressure, can be detected and treated early during these follow-ups.

Patients play an important role in risk management by closely following post-operative care instructions. This includes taking prescribed medications, like eye drops, and reporting any unusual symptoms to their doctor right away. Educating patients about the warning signs of cataract surgery complications and the significance of post-operative care is also an important part of risk management.

Those with additional health conditions, such as diabetes, or those taking medications like blood thinners, should inform the surgeon because these can affect the risk profile. The surgical approach may be modified based on the individual patient’s needs and risk factors.

To Summarise

To summarise, risk management in cataract surgery is a multifaceted approach that includes thorough pre-surgical evaluation, sterile and precise surgical techniques, post-operative care, and patient education. These measures improve the already high success rate of cataract surgery, ensuring a safe and effective outcome for the vast majority of patients.