According to the National Eye Institute, NEI, by age 80, more than half of all Americans have a cataract or have had cataract surgery. This statistic highlights the fact that cataract surgery is a very common procedure in the U.S. For the vast majority of patients who have cataract surgery, the result is improved vision after an uneventful procedure. As with all types of surgery, however, there are some associated risks.
Inflammation
Because of the physiologic changes in the eye after cataract surgery, there is usually only a small amount of inflammation in the eye. The eye surgeon manages this by prescribing an anti-inflammatory eye drop such as a steroid or an NSAID such as ibuprofen immediately after surgery. In some patients, however, the inflammatory reaction is significantly increased and can cause pain, redness and elevated eye pressure, a condition called glaucoma. For increased inflammation, the eye surgeon might increase the dose of the inflammatory medication and monitor the patient. If needed, additional medication may be prescribed.
Glaucoma
Some patients have a pressure spike inside the eye after cataract surgery. This may be caused by inflammation, but it can also be caused by small, lingering amounts of substances that surgeons use during the cataract surgery. Often the surgeon starts the patient on a glaucoma eye drop while waiting for higher eye pressures to improve. For most patients, the eye pressure will return to normal and the eye medications can be stopped.
Cystoid Macular Edema
In cystoid macular edema, fluid-filled cysts form in the macula of the retina--usually after a period of improved vision--after surgery. This swelling in the retina is often caused by inflammation and causes blurred vision. Typically this condition improves on its own; however, some patients require treatment with an NSAID or steroid eye drop to improve the vision. Occasionally further therapy such as surgery or medications injected into the eye may be needed.
Bleeding
As noted by the Eye Surgery Education Council, an uncommon complication is that the area of blood vessels below the retina may start bleeding either during surgery or after surgery. This can be a devastating complication; if the bleeding occurs in a small area, the damage may be minimal. Sometimes, the surgeon can successfully drain the blood by making an incision in the sclera, or white, of the eye. In the most serious cases, however, the patient can have significant vision loss.
Retinal Detachment
Cataract surgery can increase the risk of a retinal detachment--particularly in susceptible patients such as people who are extremely nearsighted, a condition called myopia. After uncomplicated cataract surgery, retinal detachment occurs in one-half of 1 percent of patients, according to the Eye Surgery Education Council. The eye surgeon should be alerted immediately if this complication occurs; there are treatments available such as laser and retinal surgery that can prevent significant vision loss.
Infection
Endophthalmitis is an infection inside of the eye and can be visually devastating. For this reason, the operating room is a sterile environment. Following surgery, the eye doctor usually prescribes antibiotic eye drops to lessen the risk of developing infection. If a patient develops endophthalmitis, the doctor will inject antibiotics into the eye and sometimes perform surgery to remove the the jelly-like material inside the eye, called vitreous fluid. According to the Digital Journal of Ophthalmology, endophthalmitis occurs in only one in 3,000 cataract surgery cases.
