Complication of cataract surgery

Complications of cataract surgery
Complications are varied in time and scope
Intraoperative
Immediate postoperative
Late postoperative
Therefore it is necessary to observe the
postoperative patients at periodic intervals
Major postoperative complications of cataract surgery
Endophthalmitis
Sterile
Infectious
Major postoperative complications of cataract surgery
Corneal edema
Detached Descemet’s membrane
Mechanical trauma
Vitreo-endothelial touch
IOL-endothelial touch
Toxic solutions



Shallow or flat AC
Intraoperative
Inadequate infusion of BSS
Leakage over sized wound
External pressure on the globe
Positive vitreous pressure more common in:
Obese
Bull necked pts.
COPD
Anxious Pts. Who perform valsalva maneuver
Supachoroidal haemorrhage or effusion
Shallow or flat AC (cont’d)
Intraoperative shallow AC
Management
Raise infusion bottle
Place suture across the wound to ¯ its size
External pressure: Readjust surgical drapes or eye lid speculum
Positive vitreous pressure:
I/V manitol ¯ the ­ positive pressure and
Allow the case to continue uneventfully
Suprachoroidal hemorrhage or effusion:
Check red reflex
Examine fundus with indirect ophthalmoscope to confirm diagnosis
Shallow or flat AC (cont’d)
Postoperative shallow AC
Postoperative shallow AC ® opposition of iris to angle ® PAS ® chronic ACG
Irido-vitreal (ICCE) / irido-capsular (ECCE) synechiae
® pupillary block
Corneal contact with vitreous / IOL ® endothelial cell loss ® chronic corneal edema
Shallow or flat AC (cont’d)
Postoperative shallow AC
Causes
Wound leak
Choroidal detachment
Pupillary block
Ciliary block
Suprachoroidal hemorrhage
Cases associated with ocular hypotension are 2ndry to wound leakage / choroidal detachment
Slow or intermittent wound leaks may coexist with formed AC
Shallow or flat AC (cont’d)
B. Postoperative shallow AC
Seidel Test:
To detect an area of wound leakage
Instill one drop of 2% fluorescein and examine the incision with cobalt blue filter on the SL
Aqueous dilution of fluorescein at the site of leakage will produce contrasting area of green stain
Occasionally aqueous flow is so slight that gentle pressure on the globe is necessary to confirm the site of leakage
Postoperative shallow AC (cont’d)
Management
Several Options
Cycloplegics and pressure patching
CAI and topical beta blockers: ¯ Aqueous flow through the woung
Corticosteroid avoidence: Enhance local wound reaction to faciliatte spontaneous closure
Therapeutic contact lens help in opposing wound edges and ¯ aqueous flow through the wound
Tissue adhesive: may seal the wound
Surgical
Postoperative shallow AC (cont’d)
Management
These measures are appropriate for minor wound leaks
Many patients develop associated ciliochoroidal detachment which resolves spontaneously after wound closure


Corneal edema
Factors:
­ IOP
Endothelial cell damage
Edema in the immediate postoperative period
Incidence is increased in preexisting endothelial Dysfunction
Acute endothelial decompensation with increase in corneal thickness














Hyphaema
Early / Late
Early: Immediate postoperative period
Origin: Incision / Iris
Mild resolves spontaneously
Mixed with blood / viscoelastic – resolution longer
Late: Months / years after surgery
Origin: wound vascularization / erosion of vascular tissue by lens implant