Cataract surgery, performed on over 3 million people in the United States each year, has a low rate of serious complications and generally excellent results. Over 95 percent of cataract surgeries result in improved vision, the All About Vision website states. But, like any surgery, cataract surgery can cause complications, some of which can be severe and threaten vision.
Significance
Problems after cataract surgery can range from issues with simple fixes, such as posterior lens opacity, to complications that can result in severe vision loss, such as endophthalmitis, an infection in the eye.
Types
Cystoid macular edema, or CME, a swelling in the center of the macula, the central point of vision on the retina, frequently complicates cataract surgery. Around 8 to 12 percent of patients have CME severe enough to decrease their vision after cataract removal, Steven Virata, M.D. of the Retina Center at Williamson Eye Institute reports, and the percentage may be much higher, he suggests, especially in diabetics.
Around 20 percent of people who have cataracts removed develop clouding of the lens capsule called posterior capsule opacity, or PCO, All About Vision reports. After removal of the lens, the capsule that holds the lens in place, which is not removed so that it can hold the new artificial lens in place, can become cloudy if lens epithelial cells left behind after surgery grow on the capsule.
Endophthalmitis, an infection of the eye, can follow any invasive procedure in the eye. Endophthalmitis occurs after around 1 in 3,000 surgeries, the Eye Surgery Education Council reports. Retinal detachment, separation of the retina from the back of the eye, occurs in around 1 percent of people after cataract surgery, according to All About Vision.
Symptoms
Most cataract complications cause decreased vision. Endophthalmitis symptoms also include pain, light sensitivity and redness of the eye, the Eye Surgery Education Council reports. A sudden increase in flashes of light, floaters--spots or strings that pass across the field of vision--or a curtain or veil over part of a person’s vision may indicate retinal detachment.
Diagnosis
Most complications of cataract surgery are easily diagnosed by dilating the eye and examining the eye with a microscope. Optical coherence tomography, which shows the layers of the retina, and fluorescein angiography, which highlights the blood vessels, reveals fluid leakage into the macula in CME, Dr. Virata states.
Treatment
Treatment of cataract surgery complications depends on the cause. Around 90 percent of patients with CME heal spontaneously, according to Dr. Virata. For those who don’t, steroid ophthalmic drops, non-steroidal anti-inflammatory eye drops and possibly steroid injections into the eye help reduce swelling. Vitrectomy, removal of the vitreous, the gel in the center of the eye, may become necessary. A special laser, called a YAG laser, is aimed at the capsule in PCO, creating a hole that removes the opacity and improves vision, All About Vision explains. The procedure, called a YAG laser capsulotomy, takes just a few minutes.
Antibiotics injected into the eye help cure endophthalmitis. Removal of the vitreous may be necessary in rare incidences to control the infection. Surgery or laser treatments can reattach the retina to the back of the eye to reduce vision loss in retinal detachment.
