CATARACT SURGERYCOMPLICATIONS

surjeet acharyaVMC

PRE-OPERATIVE

ANXIETYRx: DIAZEPAM 2-5mg at bed time

NAUSEA AND GASTRITIS

ACETAZOLAMIDE

Rx: ORAL ANTACIDS

ALLERGIC CONJUCTIVITIS

CORNEAL ABRASION

ANESTHESIACOMPLICATIONS

RETROBULBAR HEMORRHAGE

Rx: 1 drop PILOCARPINE (2%) with pressure bandage

OCULOCARDIAC REFLEXBradycardia +/- Cardiac arrhythmia

Rx; ATROPINE (iv)

PERFORATION OF GLOBESUBCONJUCTIVAL HEMORRHAGEDISLOCATION OF LENS

OPERATIVE

POOR PRE-OP

HYPOGLYCEMIA

COUGH/SNEEZE, move head towards sides

Excess Bleed if patient is on anticoagulants

POOR SURGICAL SKILL

Superior Rectus laceration/haematoma

seen in ECCE/SICSno treatment required

Excess bleed

Incision related

Irregular incision- in ECCE

Button holing of anterior wall of tunnelPremature entry into anterior chamberScleral disinsertion

MANUAL SICS & PHACO

Corneal Injury

when A.C is entered with sharp instruments

CAPSULORRHEXIS COMPLICATIONS

Escaping capsulorrhexisSmall capsulorrhexisEccentric capsulorrhexisVery large capsulorrhexis

POSTERIOR CAPSULAR RUPTURE

Feared complication in all Cataract surgeriesOccurs due to-

forceful hydrodissectiondirect injury by instruments

cortex aspiration (ACCIDENTAL PCR)

ZONULAR DEHISCENCEIn all ECCE and SICS

VITREOUS LOSS

• To decrease vitreous volume- pre op mannitol

• To decrease aqueous volume- pre op acetazolamide

• To decrease orbital volume- ocular massage and compression

• Better ocular akinesia and anesthesia• Minimising external pressure- carefull

handling, minimum pull on bridle suture

• Posteriorsclerotomy + vitreous drain from pars plana- in case of high IOP and surgery cannot be postponed

if vitreous loss has occuredanterior vitrectomy

clear vitreous from AC and Incision site

This prevents post-op complication due to vitreous loss

NUCLEUS DROPmostly seen in PHACO

Rx- refer case to VITRORETINAl surgeon

POSTERIOR LOSS OF LENS FRAGMENTS

Due to PCR or ZD during PHACOCan lead to glaucoma, uveitis, RD

Rx- refer to vitreoretinal surgeon (pars plana vitrectomy)

EXPULSIVE CHOROIDAL HEMORRHAGE

seen in HT and arteriosclerosis changes patientsMOSTLY in ICCE, ECCELEAST in SICS and PHACO

Ch: WOUND GAPING; LOSS OF LENS, VITREOUS, IRIS, RETINA, UVEA & finally gush of blood

Rx- unsatisfactory EYE IS LOST so EVISCERATION IS DONE

POST-OP

Hyphaema

Rx: usually gets absorbs by itself

Drain out blood (if not resolved in 1 week)

Treat for raised IOP (acetazolamide)

IRIS PROLAPSE

Common in ICCE and ECCE

STRIATE KERATOPATHY

Due to endothelium damage (cornea)corneal edema with descement folds

Rx: hypertonic saline drops + steroids

ENDOPTHALMITISCauses- instruments, solutions, surgeon hand,

patient own flora

ocular pain, conjuctival congestion, corneal edema, exudates, diminished vision, hypopyon

Rx: IntraVitreal Antibioticssteroids

supportivevitrectomy

CMECommon in all cataract surgery but insignificant

develops 1-3 months later

EP: vitreous incarceration and iritis

Rx: anterior vitrectomy+steroids+anti-PGs

Prevention: preop and postop anti-PGs

CHRONIC POSTOP ENDOTHALMITIS

AgentsRx: pars plana vitrectomy + Ab/Af therapy

PSEUDOBULLOUS KERATOPATHY

Continued corneal edema

RDAphakic>>>>phakic

ICCE >>> ECCER/F- vitreous loss, myopics

EPITHELIAL INGROWTHConjuctival epithelium enters AC and can

block TM causing GlaucomaIn late stages, it can extend upto iris and

anterior part of vitreous

FIBROUS DOWNGROWTH

Due to abnormal apposition of cataract wound

Can lead to secondary glaucoma, anterior segment disorganisation and finally, phthisis bulbi

AFTER CATARACTa.k.a SECONDARY CATARACT

Generally after ECCECauses: - residual lens matter

- proliferative cataract may develop from remains of anterior cells in capsular bag

Clinical Types

Dense membranous: thickened PCORx: membranectomy

Soemmering’s ring: thick ring behind iris enclosed between

2 layers of capsule

Elschnig’s pearls: vacuolated subcapsular epithelial cells are clustered in posterior capsule

Rx: YAG-laser capsulotomy

IOL RELATED COMPLICATIONS

Anterior chamber and Iris supported lens

CME, uveitis, secondary glaucoma, UGH syndrome (uveitis, glaucoma, hyphema)

IOL malpossitionSunset syndrome- inferior subluxation of iol

Sunrise syndrome- superior subluxation of iol

Loss lens syndrome- dislocation into vitreous

Windsheild-wiper syndrome

Pupillary capturePostop iritis or proliferation of lens fibre

remnants

Toxic Anterior Segment Syndrome

Violent inflammation of uveal tissueCauses: - ethylene gas (for sterlising IOL)

- lens material

PRE-OP OPERATIVE POST OP IOL related

Anesthesia related

SR laceration Hyphaema Malposition of lens

Corneal abrasion

Excess bleed Iris prolapse Pupilary capture of lens

Conjuctivitis Injury to cornea, iris Striate keratophy TASS

Anxiety PCR Bullous keratopathy

Hypoglycemia Zonular dehiscene Endopthalmitis

Gastritis Vitreous loss CME, RD

Nucleus drop into vitreous cavity

Epithelial and fibrous growth

Expulsive choroidal hemorrhage

After cataract

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