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Cataract surgery has been practiced since the 1700s. There are less postoperative adverse effects as a result of recent improvements in technology, infectious disease control, and equipment. However, problems do occur both during and after surgery. The current purpose of cataract surgery is to remove the cataract and replace it with an intraocular lens, which is usually inserted in the posterior chamber’s capsular bag.
There are dangers involved with the operation and the post-operative condition, as with any surgical treatment. The general variables that enhance the risk of problems with cataract surgery are listed below.
Factors of Risk
Risk factors linked to poor visual outcomes
- Age-related macular degeneration
- Alpha blockade
- Corneal opacity/pathology
- Diabetic retinopathy
- Older age
- Female sex
- Previous retinal detachment
- Intraoperative complications
- Previous vitrectomy
Complications
Complications might range from the immediate to the delayed aftereffects of the surgery. Some acute difficulties may occur as a result of the surgical treatment. These symptoms include eyelid irritation, bruising, and swelling, elevated intraocular pressure, and an allergic response to the steroid or antibiotic drop. Following surgery, these problems are evaluated over time. Patients are urged to seek medical assistance if there is a progression of discomfort, a reduction in vision, or any discharge from the eye.
Posterior capsular opacification is a long-term side effect of cataract surgery (PCO). The most common complication of cataract surgery is PCO. PCO can develop at any time after cataract surgery. In modern cataract surgery, a capsular bag is formed that incorporates a portion of the anterior capsule, the complete posterior capsule, and the implanted intraocular lens. Despite the surgical stress, epithelial cells survive in the residual anterior capsule. These epithelial cells will proceed to populate the posterior capsule after settling on the anterior capsule. The cells will continue to divide, altering the lens matrix and, as a result, the lens’s refraction. PCO can be effectively treated using YAG laser capsulotomy, which results in practically instantaneous eyesight improvement.
Rupture of the posterior capsule/Vitreous loss
Because of the nature of cataract surgery, posterior capsule rips can happen at any time throughout the procedure. The capsulotomy phase of the operation is the most important, not only because it creates an opening to reach the nucleus of the lens, but also because of the significant dangers involved with it if done incorrectly. Loss of the vitreous owing to capsular rupture can result in significant visual impairment as well as other issues such as retinal detachment. Deep-set eyes, small palpebral fissures, severe myopia, glaucoma, past pars plana vitrectomy, and a history of vitreous loss are risk factors that lead to an increased probability of vitreous loss. Marfan syndrome, morbid obesity, hypertension, and diabetes are all systemic risk factors. Deepening of the anterior chamber, absence of lens material that has not yet been removed, sudden appearance of an area of the posterior capsule that appears “too clear,” vitreous in the phaco or aspiration tip, or movement of the lens away from the phaco tip are all intraoperative signs that the posterior capsule has been broken. Rupture of the posterior capsule might result in additional difficulties after cataract surgery. Early detection is critical for averting additional harm. Cystoid macular edema, retinal tears/detachment, glaucoma, corneal decompensation, endophthalmitis, retained lens debris, extended postoperative inflammation, delayed case time, and patient pain are all possible consequences.
Cystoid Macular Edema
CME is the most common complication following simple cataract surgery. Its peak incidence occurs 6 to 8 weeks after surgery. Although fluorescein angiography is considered the gold standard, optical coherence tomography (OCT) is the standard approach for diagnosis and monitoring of CME. CME occurs in roughly 1 to 2% of cataract surgeries using contemporary phacoemulsification procedures. It is caused by increased permeability of perifoveal capillaries and disruption of the blood-ocular barrier, which allows cystoid spaces to develop in the Henle’s and outer plexiform layers to collect and store fluid. Fluid accumulation puts mechanical stress on the Muller cells, resulting in the patient’s diminished central vision and scotoma.
Endophthalmitis
Endophthalmitis is a dangerous complication of cataract surgery caused by bacteria that enter the eye. Endophthalmitis is more likely to develop if the posterior capsule ruptures or if anterior vitrectomy is required during the surgery, if the patient is over the age of 85, and if he is male. Patients receiving intracapsular cataract extraction had a higher risk of endophthalmitis than those undergoing extracapsular cataract extraction. The most prevalent infectious organism is Staphylococcus epidermidis, which is endemic to the eyelid, skin, and conjunctiva and can seed the eye during the operation.
Vitreous/Suprachoroidal Hemorrhage
Hemorrhage is a potentially blinding complication linked with incisional intraocular surgery. Myopia, glaucoma, diabetes, atherosclerotic vascular disease, and hypertension have all been identified as risk factors for bleeding
Tears/Detachment of the Retina
Retinal detachment is seen as a postponed consequence of cataract surgery. Those who have very myopic eyes or a history of retinopathy of prematurity and acquire early cataracts are more likely to experience retinal detachment after surgery. The risk of retinal detachment is also raised in individuals who have had YAG laser capsulotomy after surgery and the development of PCO.
Dislocation of the Lens
Though uncommon, IOL displacement is a major complication of cataract surgery. Improvements in the design of foldable IOLs have reduced the occurrence of postoperative dislocation. Inadequate capsular support is the most common cause of lens dislocation, which usually happens early after surgery. However, late, “in-the-bag” dislocations can develop months after straightforward surgery due to increasing zonular dehiscence. IOL relocation with or without scleral fixation sutures, or replacement with an anterior chamber IOL, are options for treatment.
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