Nick Strouthidis MBBS MD PhD FRCS FRCOphth FRANZCO

What Are The Possible Complications?

Cataract surgery has a very low complication rate, with about a 1 in 1000 risk of severe complication (infection/endophthalmitis and suprachoroidal haemorrhage) that can cause loss of vision.

More commonly, in about 1 in 100 cases, there may be complications at the time of surgery such as rupture of the capsular bag. This may require a longer procedure or more than one procedure to put things right.

Rupture of the capsular bag may require an additional procedure, called an anterior vitrectomy, at the time of the cataract surgery. This enables vitreous jelly to be removed from the front of the eye. If done correctly, this will allow the intraocular lens to be placed in a safe and stable position. Rupture of the capsule with vitreous loss is associated with an increased risk of infection, retinal detachment and of blurring of vision due to fluid at the macula (macular oedema). These risks will be reduced with an appropriately performed anterior vitrectomy and in most cases, one can expect the same outcome as if no complication had been encountered.

Sometimes all of the natural lens cannot be removed at the time of surgery or the artificial intraocular lens cannot be inserted, so an additional procedure needs to be undertaken at a later date to remove the remaining lens material or to insert the artificial lens.

Retinal detachment may occur after cataract surgery, and this will require an additional surgical procedure to put right.

Whilst these complications are unfortunate and hopefully will be avoided, in experienced hands they should not result in an adverse outcome as long as the complication is addressed appropriately. Recovery time, however, will be much longer than for uncomplicated surgery with best vision taking weeks or months to be achieved rather than just days.

Cystoid Macular Oedema (CMO), which can cause poor post-operative vision, may occur after complicated cataract surgery or in eyes with a previous history of inflammation/uveitis. In some cases it can occur spontaneously without any obvious predisposing cause. In most cases it will either resolve spontaneously or after an appropriate course of anti-inflammatory treatment, with no long term adverse effects to vision.

In the longer term, 1 in 10 cataract surgery patients will develop a fogging behind their intraocular lens called 'posterior capsular opacification'. This can give symptoms of blurring, as though the cataract has grown back. It can be reversed very simply using a laser treatment called laser capsulotomy. This is performed at a slit lamp under topical anaesthesia.