Cataract Surgery Risks and Complications

What is a Cataract?

A cataract is the clouding, discoloration, or hazing of the natural lens located behind the pupil inside the eye. As we age the lens can become progressively cloudy and begins to blur the vision. It is not a growth over the eye which most people believe.

The Lens is Composed of Different Portions

The lens is surrounded by a thin capsule similar to plastic wrap. It is held in place by zonules that attach to the lens capsule and the ciliary body. The two main components of the lens is the central nucleus which becomes progressively dense with time and the outer cortex which is softer. Different portion of the lens can become cloudy and therefore there are different types of cataracts.

Cataract Surgery Risks and Complications

Cataract surgery today is one of the most successful types of surgery performed. The surgical success rate is over 95% in the United States. There more than 3 million cataract surgeries performed annually in the United States. This list of complications may vary from doctor to doctor depending on their technique. There are two major divisions in anesthesia. Some eye surgeons use an injection behind the eye for anesthesia and others use topical application of anesthetic to anesthetize the eye.

After Cataract, Posterior Capsule Opacification, or Secondary Cataract

In approximately 30% of patients that have had cataract surgery, the posterior that holds the intraocular lens in place becomes cloudy or opacified. It can be easily opened and the vision cleared with a short Yag laser capsulotomy in under one minute.

Inflammation

There is only a mild inflammatory reaction in the eye after cataract in most cases. In a few cases the inflammation can be more severe. The inflammation can be treated with corticosteroids or non-steroidal anti-inflammatory topical medications.

Cystoid Macular Edema or Swelling of the Macula

This is a syndrome where the macular portion of the retina develops edema and blurs the vision. It can occur within 1 or 2 weeks to as late months after the surgery. It can also be treated with corticosteroids and/or non-steroidal anti-inflammatory eye drops.  A few cases may require more intense treatment.

Visual Distortions or Blurred Areas

In a very small number of cases patients complain of a variety of vision symptoms such as missing vision to the side, glare or streaks around lights, smudge in their vision, or blurred vision. This can be due to several etiologies and you need to ask your eye surgeon about your symptoms. Some problems are related to the difference in optical properties between a human lens and an artificial lens.

Leaking Incision

The incision used during cataract surgery is very small from 1.8mm to 2.75mm and usually is water tight without the use of sutures after cataract surgery. If the incision is leaking, the eye surgeon may watch to see if it will close on its own, apply a contact lens, or suture the incision closed.

Retinal Detachment and/or Retinal Tear (Break)

You are at a slightly increased risk of a retinal detachment after cataract surgery. If you a moderate or high myope, you at an increased risk. The more near-sighted the person and the younger the person, the higher the risk of retinal detachment becomes. In high myopes and people under age 50, there are studies to show a risk of 20%. If you have any symptoms of a retinal detachment call your surgeon immediately.

Intraocular Infection or Endophthalmitis

Depending on the study, the risk or rate of intraocular infection ranges from 1 out 1,000 to 1 out of 10,000 cases. Endophthalmitis can cause complete loss of the vision or eye and needs to be treated quickly and aggressively with antibiotics.

Dislocated or Decentered Intraocular Lens (IOL)

On a rare occasion the IOL can become decentered and cause blurred vision, double vision (diplopia), glare, or halos. In even less likely events the IOL can become dislocated. Depending on the severity of the decentration and symptoms, surgery may be necessary to correct the problem. If the lens has become dislocated, surgery will be necessary.

Glaucoma

Short term, the intraocular pressure may become elevated for a short period of time. In most cases long term the intraocular pressure is lower after cataract surgery.

Bleeding

Since the incision for cataract surgery is in the clear cornea in most cases where there are not any blood vessels, there is usually not any bleeding during cataract surgery.

Black Eye or Bruising

If the eye surgeon uses a needle to deliver the local anesthesia, you may develop bruising or a black eye. This will resolve in a few days or up to 2 weeks depending on the size of the bruising.

Summary

These are a few of the risks or complications related to having cataract surgery. You should ask your eye surgeon about their experience and complication rate.