What are the risks associated with cataract surgery?
Cataract surgery is the most commonly performed type of eye
surgery. In the vast majority of cases, approximately 95% of
the time, the surgery is uncomplicated. Cataract surgery usually
results in improved vision and a well satisfied patient. However,
cataract surgery should never be trivialized. In a small percentage
of patients, events occur which can lead to less than ideal results.
Most of these events are known risks of the surgery itself and can
occur even if the operation is performed well by an experienced
surgeon. The occurrence of these events is often unpredictable.
Patients should be aware of such possibilities when they decide
to proceed with surgery. Some of the most common risks are
reviewed in this article.
Ophthalmic surgeons normally make great efforts at the time
of surgeryto reduce the possibility of introacular infection,
which is called "endophthalmitis". Patients usually receive topical
antibiotic eye drops n the day of surgery. The surface of the eye
and the skin around the eye are disinfected with antiseptic
compounds, the patient's face except the eye is covered with
sterile drapes. Sterile techniques are used for all instruments,
similar to those used for all modern surgeries. After the surgery
is completed, surgeons prescribe topical antibiotic eye drops.
Nonetheless, even with these precautions, endophthalmitis still
occurs in approximately one out of 3,000 cases. Symptoms
and signs of endophthalmitis include excessive eye redness,
pain, light sensitivity, and worsening vision.
In some cases, the patients may be fairly comfortable on the first
day or so after urgery, but then worsen in terms of pain, vision,
and light sensitivity several days later. Patients who undergo
cataract surgery should be instructed to call their ophthalmologist
immediately if they worsen in these ways. If a patient develops
endophthalmitis, intraocular antibiotics are often injected INTO
the eye to minimize the spread of the infection. Sometimes an
additional surgery (vitrectomy) is performed to remove the
jelly-like substance of the eye; this may help control the infection.
Cystoid Macular Edema
The retina is the neural tissue which lines the entire inside of
the back part the eye. The very center of the retina is called
the macula, which is responsible for central vision. After cataract
surgery, inflammation can sometimes cause retinal blood vessels
to leak fluid which accumulates in the macula, causing decreased
central vision. This swelling is referred to as "cystoid macular edema".
When vision is affected by macular edema, the ophthalmologist may
recommend a specialized test, called a fluorescein angiogram, in ORDER
to determine the extent of swelling. Ophthalmologists often treat
macular edema with topical steroid eye drops or non-steroidal
anti-inflammatory eye drops which help quiet the inflammation, often
improving the situation over weeks or months. Sometimes injections
of steroids behind the eye, or even intra-ocular vitrectomy surgery
are useful in improving the vision.
A retinal detachment occurs when liquid vitreous fluid gets through
a fine tear in the retina, allowing it to separate abnormally FROM
the back wall of the eye. A retinal detachment may cause a curtain
across part or all of the vision of the eye. Retinal detachments can
occur in patients who have not had any prior eye surgery, especially
in patients who are highly nearsighted. However, cataract surgery
increases the risk of retinal detachment. After cataract surgery,
retinal detachments occur in approximately 1.5% of patients. You
should contact your ophthalmologist immediately if you develop a
curtain blocking the vision, flashes of light like lightening streaks, or
new floating spots in your vision. These symptoms can sometimes
herald a retinal detachment.
Posteriorly Dislocated Lens Material
In some instances, lens material can fall INTO the back cavity
(vitreous cavity) of the eye. Often small pieces of posteriorly
dislocated lens material are well tolerated by the eye without problems.
When larger pieces are dislocated, the ophthalmologist may recommend
a second surgery, called a vitrectomy, to remove the lens material. This
emoval prevents excessive inflammation FROM developing.
Infrequently and unpredictably during cataract surgery, acute bleeding
can occur in the choroid, which is the delicate pattern of blood vessels
underlying and nourishing the retina. Although this complication, called
"choroidal hemorrhage" is more common among elderly patients, it is
truly unpredictable. In some cases of choroidal hemorrhage, the bleeding
is localized, and patients do well. In more severe cases of choroidal
hemorrhage, visual loss can be substantial.
Information about the risks associated with cataract surgery
Before cataract surgery, ophthalmologists usually discuss the risks,
benefits and alternatives of the surgery. If unexpected events occur
at the time of surgery, or develop after the surgery, the ophthalmologic
surgeon will discuss the particular implications and help formulate a
specific treatment plan.
1-Cataracts- Yichieh Shiuey, MD; Peter K. Kaiser, MD
Massachusetts Eye and Ear Infirmary, Harvard Medical School
2-Cataract Surgery- Vincent J. Patalano II, MD
Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear
Somerville Eye Center
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