CATARACT SURGERY -- COMPLICATIONS & PROGNOSIS

Complications & Prognosis:

1. Capsular rupture & Vitreous loss (common, potentially serious)
- Not every patient will suffer a poor outcome
- Can retain excellent vision if complication is managed well
- Incidences is decreasing with more complex surgeries made available

2. Endopthalmitis (rare, devastating)
- Endophthalmitis involves inflammation of the intraocular cavities (i.e., the aqueous or vitreous humour) usually caused by infection.
-The 2 types of endophthalmitis are endogenous (i.e., metastatic) and exogenous. Endogenous endophthalmitis results from the hematogenous spread of organisms from a distant source of infection (eg, endocarditis). Exogenous endophthalmitis results from direct inoculation as a complication of ocular surgery, foreign bodies, and/or blunt or penetrating ocular trauma.
-Most feared complication of intraocular surgery
-In most European studies, Staphylococcus epidermidis is the most common infecting microorganism. This bacterium is found in normal eyelid skin and conjunctiva, and it enters the eye during surgery.
-In South India, Nocardia species were the commonest cause of infection.

3. Inflammation
4. Infection
5. Bleeding
6. Swelling
7. Retinal detachment
8. Glaucoma
9. Second cataract

Preventing Complications:

1) Follow up with patient’s condition before and after the surgery
2) Meticulous sterilisation of all surgical instruments and fluids and careful aseptic techniques

Managing complications:

With all complications, including capsular rupture and vitreous loss, and even endophthalmitis, the prognosis is better if the complication is managed effectively.

For endopthalmitis -- Early recognition and prompt treatment with intravitreal vancomycin and either ceftazidime or amikacin seems to offer the best hope of visual recovery. With immediate use of intravitreal antibiotics, some eyes will recover useful vision.

For Posterior Capsular Rupture -- If the tear leaks vitreous, then an anterior vitrectomy is performed à Anterior vitrectomy can be automated (using a probe called ocutome) or mechanical, which entails applying sponges on the wound then pulling them out and cutting any sticking vitreous strands.

For Expulsive haemorrhage (due to acute drop in intraocular pressure) – A surgeon will rapidly close the wound and give intra-venous osmotic agents to lower the intra-ocular pressure. Steroids should be given post-op to decrease the inflammation. Drainage of the blood should take place after two weeks when clots start liquefying. The visual prognosis is usually dismal.

http://www.eyeweb.org/cataract_surgery.htm
www.emedicine.com/emerg/topic880.htm
www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2377378
www.mayoclinic.com/health/cataract-surgery/EY00014