Complications and Risks of Cataract Surgery

Complications and Risks of Cataract Surgery

These complications can include infection, retinal detachment, inflammation inside the eye, swelling in certain parts of the eye, retention of a piece of the cataract inside the eye, glaucoma, hemorrhage (bleeding), possible worsening of certain eye conditions (such as diabetic retinopathy), and failure to improve vision if other eye diseases are present (such as macular degeneration). Sometimes, these complications may require further treatment or surgery in an attempt to repair them.

Tina D. Turner, M.D., VisionAware's Resident Cataract Specialist

Dr. Turner is a staff comprehensive ophthalmologist at Henry Ford Health System's Grosse Pointe Ophthalmology. She graduated magna cum laude from the University of Tennessee with a BA in chemistry, received her MD degree from Baylor College of Medicine in Houston, and completed her ophthalmology residency at the University of Michigan's Kellogg Eye Center.
She lectures widely on many topics in ophthalmology to ophthalmology residents, family medicine residents, emergency medicine residents, ophthalmic technicians, surgical technicians, and patients.
Dr. Turner is the author of An Introduction to Cataracts and Cataract Surgery on the VisionAware website, where you can learn more about cataracts, including:

• The causes of cataracts
• How cataract surgery is performed
• The different types of artificial lenses
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Endophthalmitis

Endophthalmitis is a serious infection inside the eye that can develop after cataract surgery. Although many precautions are taken to prevent complications after cataract surgery, infection can still develop. The chance of developing infection after cataract surgery in the United States is approximately 0.1%.
Endophthalmitis after cataract surgery is usually the result of a bacterial infection. The most common bacteria found to be the culprits in this type of infection are the "staph" (staphylococcus) and "strep" (streptococcal) bacteria, which normally live on human skin.
Endophthalmitis usually develops in the first week after cataract surgery and causes a range of symptoms, including pain, redness, decreasing vision, eyelid redness or swelling, or a yellow/green discharge from the eye.
Should any of these symptoms develop after cataract surgery, it is extremely important to seek medical care immediately. The sooner endophthalmitis is treated, the better the prognosis for the eye and vision. Endophthalmitis is treated either with antibiotics injected into the eye or with surgery plus antibiotics injected into the eye. Even with treatment, the vision and the eye can be permanently damaged.

Retinal Detachment

Retinal detachment occurs when the retina, the light-sensitive tissue that lines the inside surface of the eye, develops a hole or tear and subsequently detaches, or falls away, from the wall of the eye.
Once separated from the wall of the eye, the retina loses part of its blood supply; without a blood supply, the cells in the retina begin to die. Once lost, retinal cells do not regenerate.
It is the retina that is responsible for processing visual information and sending it to the brain. Thus, once the retina is damaged, it results in permanent loss of vision.
The chance of developing a retinal detachment after cataract surgery is approximately 1 in 3,000. If diagnosed early, a retinal tear can be treated with thermal laser photocoagulation. Retinal detachment usually requires surgical intervention.
It is important that you fully understand the risks, benefits, and alternatives to cataract surgery, and that you ask any questions and voice any concerns you may have. In order to make a well-informed decision to have surgery, it is extremely important that you fully understand these risks.

• Next: After the Decision to Have Surgery
• Previous: Considering Cataract Surgery

• What Happens After the Decision Is Made to Have Cataract Surgery?

  By Tina D. Turner, M.D.
  Once a patient decides to have cataract surgery, the patient and surgeon should discuss plans for the surgery, such as the anesthesia that will be used, the patient's expectation for his or her vision, and what the patient should expect during and after the surgery.
  

  Anesthesia and Medication

  Commonly, cataract surgery is performed with topical anesthesia. This is accomplished by instilling a very strong numbing medication into the eye. It is usually accompanied by medication in the patient's arm intravenously to help him or her feel relaxed and comfortable.
  This is the least risky form of anesthesia and most patients do extremely well with topical anesthesia and some intravenous sedation. Sometimes, medication is injected around the eye socket to numb the eye and paralyze eye and eyelid movement. These injections carry their own risk, however, and are being used less frequently.
  

  General Anesthesia

  On occasion, general anesthesia may be needed. Since cataract surgery performed with topical anesthesia requires patient awareness and cooperation, general anesthesia is usually required for children, patients with developmental delays, and patients with dementia. During cataract surgery, patients must lay flat and still; therefore, patients with movement disorders, such as Parkinson's Disease or restless leg syndrome, may also require general anesthesia.
  Patients who have difficulty breathing while lying flat, or who have back or neck pain/disorders that prevent them from being comfortable when lying flat may also require general anesthesia for cataract surgery.
  

  Discuss Your Options

  After deciding to have cataract surgery, the patient and physician should discuss the options for correcting his or her vision post-surgery. Artificial lenses, which are implanted in the eye during cataract surgery to replace the natural lens that is being removed, can make vision clear once again and, in some cases (but not always), reduce the need for corrective eyeglasses after surgery.
  The surgeon will take special eye measurements before surgery, including the length of the eye and the curvature of the cornea, to determine what power the artificial lens should be.
  Cataract surgery can decrease an individual's dependency on eyeglasses and, in some cases, eliminate the need for eyeglasses after surgery. However, some patients will still need eyeglasses to fully correct their distance and/or reading vision to 20/20.