Cataract surgery is a widely performed and generally successful procedure designed to restore vision by replacing a cloudy natural lens with an artificial intraocular lens (IOL). While the vast majority of these surgeries proceed without issues and lead to excellent visual outcomes, like any surgical intervention, there is a small potential for complications.
Common Complications of Cataract Surgery
One of the most frequent complications after cataract surgery is Posterior Capsule Opacification (PCO), often referred to as a “secondary cataract.” This condition is not a new cataract forming but rather a clouding of the membrane that holds the implanted lens, which can occur months or even years after the initial surgery. Epithelial cells remaining on the anterior capsule can migrate and colonize the posterior capsule, causing this clouding.
Retinal detachment is a rare but serious complication where the retina, the light-sensitive tissue at the back of the eye, separates from its supporting layers. Symptoms can include sudden flashes of light, new floaters, or a shadow appearing in the field of vision. The risk of retinal detachment after cataract surgery is approximately 0.39% within the first four years, representing about a 2.3-fold increase compared to individuals who have not had the surgery.
Infection inside the eye, known as endophthalmitis, is a rare but severe complication. It can lead to vision loss if not treated promptly. This condition occurs when microorganisms enter the eye during or after the procedure. The incidence of endophthalmitis following cataract surgery is very low, usually less than 0.1% of cases.
Cystoid Macular Edema (CME) involves swelling in the macula, the central part of the retina responsible for sharp, detailed vision. This swelling can cause blurred or wavy central vision, making reading difficult. CME typically develops within weeks of surgery but can occur later, caused by inflammation that makes tiny blood vessels in the retina leak fluid.
A dislocated intraocular lens (IOL) occurs when the implanted artificial lens moves out of its correct position. This can result in blurred or double vision, or a tilted appearance of objects. IOL dislocation is a rare complication, reported at a rate of 0.2% to 3%, and can be caused by weakness in the structures holding the lens, incorrect positioning, or eye trauma.
Corneal edema refers to swelling of the cornea, the clear front surface of the eye. This can lead to hazy or blurred vision, often worse in the mornings. It usually resolves within a few days, but in some cases, the swelling may persist.
Recognizing Signs of Trouble
After cataract surgery, be aware of certain symptoms that could indicate a complication and require immediate medical attention. A sudden decrease in vision, beyond the expected post-surgery blurriness, warrants prompt evaluation. This unexpected loss of clarity can signal various underlying issues.
Experiencing increased pain or discomfort that goes beyond mild, typical post-operative sensations should also be reported. Similarly, new or worsening redness in the eye that is not part of the normal healing process is a concerning sign. These symptoms can suggest inflammation or infection.
Increased sensitivity to light, known as photophobia, especially if it is persistent or severe, should also raise an alarm. The sudden appearance of new floaters (specks or cobwebs in vision) or flashes of light can be indicative of a retinal issue. Any drainage or discharge from the eye is also an abnormal symptom that needs immediate assessment. If any of these symptoms appear, contacting the eye surgeon or seeking emergency medical care without delay is important, as early detection can significantly improve outcomes.
Addressing Complications and Restoring Vision
When complications arise after cataract surgery, an eye care professional will conduct specific tests to accurately diagnose the issue. Once diagnosed, various treatment approaches are available to manage these complications and work towards restoring vision.
Posterior Capsule Opacification (PCO) is typically treated with a YAG laser capsulotomy. This quick, painless outpatient procedure uses a laser beam to create a small opening in the clouded posterior capsule, allowing light to pass through clearly to the retina. Vision often improves within days after the procedure.
Retinal detachment, a serious complication, usually requires surgical repair. Procedures like laser surgery (photocoagulation) or cryopexy can seal retinal tears, while pneumatic retinopexy involves injecting a gas bubble to push the retina back into place. More extensive detachments may necessitate scleral buckling surgery or vitrectomy, where the vitreous gel is removed and the retina is repaired.
In the case of infection (endophthalmitis), treatment often involves injecting antibiotics directly into the vitreous of the eye. In severe cases or if initial treatment is not effective, a vitrectomy may be performed to remove infected material and allow better distribution of antibiotics. Systemic antibiotics and topical eye drops may also be part of the treatment regimen.
Cystoid Macular Edema (CME) is commonly managed with anti-inflammatory eye drops. Oral medications, such as carbonic anhydrase inhibitors, may be prescribed for more persistent cases.
A dislocated intraocular lens (IOL) may sometimes be managed with special eye drops or patches if the dislocation is mild. However, surgical repositioning or replacement of the IOL is often necessary. The surgical approach depends on the degree of dislocation and the integrity of the remaining eye structures.
Corneal edema can be treated with hypertonic salt and water drops or ointments, which help draw excess fluid out of the cornea. In persistent or severe cases, surgical interventions may be considered to restore vision.