Complications of Cataract Surgery

written by Dr Kenneth Fong Choong Sian on 1 January 2014
Cataract surgery is one of the most common operations done and is very safe and effective at improving your eye sight. It is done under local anesthesia through a sutureless tiny incision and the cataract is removed with a special ultrasound procedure called phacoemulsification. Some people call this a “laser” procedure but in reality, there is no laser used. There are newer laser machines called femtosecond lasers that can create the cut in the eye for the cataract to be removed but it is much more expensive and the result is the same as current conventional phaco cataract surgery.
Despite the safety of cataract surgery, complications rarely occur and the retinal surgeon is often involved in managing these complications. The 3 main complications that I will discuss today are: Endophthalmitis or infection in the eye, dropped nucleus, and, suprachoroidal haemhorrhage or bleeding in the eye.
Endophthalmitis is the most serious complication of cataract surgery
Infection can occur after any type of surgery but if it happens after cataract surgery, this can lead to loss of vision. This is easily recognised as increased redness and pain in the eye. This is an emergency and requires injection of special antibiotics into the eyeball. If the infection does not improve then vitrectomy surgery is required to clear out the bacteria in the eye. Sometimes, the artifical lens that has been put in the eye to replace the cataract may need to be removed. In most cases, the vision can be saved with urgent vitrectomy surgery and antibiotic injection.
Endophthalmitis can be prevented by ensuring that the sutureless corneal wound is secure and not leaking at the end of cataract surgery, good sterility of the operating theatre and instruments, and injection of antibiotics into the eye at the end of surgery.
Dropped nucleus is bits of cataract that have accidentally dropped to the back of the eye during cataract surgery
This complication occurs when there is rupture of the posterior capsule or fine tissue around the cataract. We always try to maintain the posterior capsule so that we can implant the new artifical lens in front of it. This will ensure that the new lens is stable in the eye. If this tissue is accidentally damaged during cataract surgery, the cataract may drop to the back of the eye and is called retained lens matter. This then requires vitrectomy surgery to remove all the cataract safely. This can be done as a separate procedure a few days later. It is important that all the vitreous gel is completely removed so that it does not come out of the eye and cause retinal detachment later on. A new lens can then be put in at the time of the second surgery.
Suprachoroidal haemorrhage is very rare with modern cataract surgery
This rare complication is bleeding in the outer layer of the eye called the choroid. This can be uncontrolled especially if the patient has high blood pressure and is on blood thinning medications. If it happens during cataract surgery, the surgeon has to stop the surgery immediately and suture the wound with stitches and hope that the bleeding will stop. Further vitrectomy surgery may be done 1 week later to complete the cataract surgery and drain out the blood from the eye. Nowadays, this complication is rare as we use very small incisions to remove the cataract and surgery is very fast.