Cataract surgery complications

Bullous keratopathy is a major complication of cataract surgery. In the past, penetrating keratoplasty was considered the most effective therapy for the symptomatic stage of the disease. Other surgical options have included conjunctival flaps, enucleation (reserved for blind, painful eyes) and, more recently, deep phototherapeutic keratectomy and amniotic membrane transplantation. Medical therapy of bullous keratopathy using hypertonic saline (Nad 5%) has been of marginal benefit due to its relatively weak osmotic effect. 

In the absence of other pathology, the patient s vision should be fully correctable within a few weeks after cataract surgery. Vision that is initially clear after cataract extraction but then deteriorates is suggestive of a postoperative complication, such as capsular opacification, bullous keratopathy, CME, or retinal detachment. 

CME is a well-documented complication of cataract surgery. The pathogenesis includes accumulation of fluid in the macular intracellular and extracellular spaces as a result of increased permeability of perifoveal capillaries. The mechanism is likely mediated by release of prostaglandins and leukotrienes from the injured tissue or as a direct result of traction on the macula by vitreal tissue movement, especially secondary to vitreous entrapment in the wound. Prostaglandin analogue ocular hypotensive agents may play a role in pseudophakic CME. 

Lidocaine gel 2% has been compared with 0.5% tetracaine drops for topical anesthesia in cataract surgery in 25 patients (331). There were no corneal epithehal or ocular surface complications, demonstrating the safety of the gel, which may provide a more practical and efficient method of anesthesia, because it needs to be applied only once as opposed to three applications of the drops. 

The device was implanted via the pars plana and a posterior infusion was used in three eyes that had undergone prior vitrectomy. Cataract surgery was undertaken at the time of the device implantation in two eyes. There were no intraoperative complications in any of the eyes. The mean follow-up was 10 months. All seven eyes had stabilized or improved visual acuity while four eyes improved three or more lines. Mean postoperative visual acuity was 20/57, which was significantly better than the mean preoperative visual acuity. 

Nelson JD, Farris RL. Sodium hyaluronate and polyvinyl alcohol artificial tear preparations A comparison in patients with keratoconjuncitvitis sicca. Arch Ophthalmol 1988 106 484-487 Neuhann Th. Capsulorhexis. In Steinert R. (ed) Cataract Surgery technique, complications S. 134-142... 

Facio F, Kashiwabuschi R, Nishi Y, Leao R, McDonnell P, Burnett A. Benign prostatic hyperplasia. Clinical treatment can complicate cataract surgery. Int Braz J Urol 2010 36(5) 563-70. 

The use of periocular steroids circumvents many of the side effects associated with systemic steroids however, complications may still arise. lOP response is a particular concern, because depot medications cannot be removed easily, as compared with tapering or discontinuing an oral preparation. Cataractogenesis may occur with any steroid preparation with intravitreal corticosteroid implants, the incidence of cataract formation requiring surgery over 2 years is nearly 90%. 

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