Cataract Surgery Complications -
Early Complications after Surgery

Cataract surgery complications is not something that many people talk about. Due to the advances in technology and surgical techniques, the success rate of cataract surgery (or cataract extraction) is now very high in many centers. That means that nothing can go wrong, can it? So many people now have had successful cataract operations, and some are now talking about cataract surgery as being only a 'minor' procedure. Doesn't this mean that cataract surgery complications are a thing of the past?

No, it does not. Cataract surgery complications still can, and do, happen even in the most experienced of surgical hands!

(Image adapted from the internet)

Cataract surgery is the removal of the cataract and its replacement with a lens implant.

But don't worry. It is common to have some discomfort, grittiness, sensation of something in the eye, and blood on the surface of the eye after surgery. More serious complications are uncommon and occur in only around 3% of cases. The great majority of problems are mild and will clear up over a few days to a few weeks without treatment, or are easily treated without long term consequences. Occasionally, a second operation will be needed to fix problems from the cataract operation. Severe cataract surgery complications resulting in blindness are very rare (less than 0.1%).

Cataract surgery complications can occur during surgery itself, within a few days/weeks of surgery, or months after surgery. Often, these complications occur not because of anything you have or have not done. If at any point, you are concerned that you may have developed any cataract surgery complications, consult your ophthalmologist without delay. It is better to be safe and get your eye examined. Your ophthalmologist would also prefer the reassurance that your eye has not run into any problems, so please do not worry about 'wasting' your ophthalmologist's time.

Eye bruising: Your eye and eyelid may look and feel bruised. This is relatively common and will settle over a week or two. Depending on the type of local anesthetic given during the operation, this may be associated with double vision, which is also transient and will clear up without treatment.

Eye bruising after cataract surgery may look unsightly, but it will resolve over a few days without affecting the recovery of the eye. It is more common in those who had peribulbar or retrobulbar anesthesia for surgery.

(Image adapted from the internet)

Swelling of the cornea (corneal edema): The cornea is the clear window at the front of your eye that allows entry of light rays into the eyeball. 10% of cataract operations may result in corneal edema, where there is accumulation of fluid in the cornea, causing it to swell up. Your sight will become cloudy and you may experience some pain. This swelling is usually temporary and will go away by itself after a few days. Very rarely (less than 1%), the cloudiness in the cornea becomes permanent. If this happens, you will most likely require a corneal graft operation to see better again.

Corneal edema is the accumulation of fluid in the corneal stroma. This affects the normal corneal architecture that allows light to pass through unhindered, thereby resulting in the hazy appearance. Mild corneal edema is expected after surgery; this is generally transient and will settle after a week or so. Rarely, the edema remains persistent and requires treatment with corneal graft.

(Image adapted from the internet)

Increased pressure in the eye (raised intraocular pressure): This can be uncomfortable, and happens in around 10% of the time, usually within the first 2 days following cataract surgery. You may experience blurring and aching around the eye, as well as nausea and sickness. The raised pressure is usually temporary. Depending on how high the pressure is, your ophthalmologist may physically release some fluid from the eye, or give you eye drops or tablets to bring the pressure down. This usually does not cause any lasting damage unless you already suffer from glaucoma.

(Image adapted from the internet)

Measurement of the intraocular pressure is important during the immediate postoperative period after cataract surgery. Sometimes, the eye pressure may be high enough to require treatment. This is particularly important for those who have pre-existing glaucoma.

Swelling of the macula (cystoid macular edema): The macula is the central part of the retina and is vital for activities requiring central vision, such as when you are reading a book, watching television or looking at road traffic signs. Fluid may build up in the macula between 2 and 12 weeks after cataract surgery. When it happens, you'll notice that your vision becomes blurry after a period of clear vision. This usually settles after a few weeks without treatment and problems. More often, you will be given a course of anti-inflammatory eyedrops to encourage recovery. In some cases,  there will still be some residual visual blurring, despite complete resolution of the cystoid macular edema. This is more common after complicated cataract surgery and if the lens capsule had been ruptured. If you have age-related macular degeneration or diabetic retinopathy, then you are prone to this even if surgery was routine.

(Image adapted from the internet)

Cystoid macular edema (CME) occurs when fluid accumulates within the retinal architecture at the macula. This disrupts the macular function and thus causes reduced vision.

Infection of the eyeball (endophthalmitis): Of all the possible cataract surgery complications, endophthalmitis is one of the most dreaded. It is extremely serious, and you can lose your vision permanently.

How would you know if you have endophthalmitis?  Well, your eye will be extremely painful and you will have very poor sight. There may be yellow discharge from the eye and you may even see a yellow fluid level in the eyeball (hypopyon). This condition is an ophthalmic EMERGENCY, so please do not wait and see 'if it gets better over the next few days'. It won't. Your eye needs immediate injection of antibiotics into the eyeball. You will most likely be admitted to hospital for intensive eyedrops and oral medications. The earlier treatments are started, the better the chances of retaining good vision. However, it can take several months before the eye settles down.

Postoperative infective endophthalmitis is one of the worst possible complications to occur following cataract surgery. This is infection affecting the entire eye, and if not treated expediently with antibiotic injections into the vitreous cavity, will result in permanent blindness. Note the yellow fluid level or hypopyon in this eye.

(Image adapted from the internet)

Luckily, this condition is very rare (less in 0.1%) due to the meticulous cleaning and infection control techniques before and after surgery that have been adopted by most ophthalmologists. If you have a condition that lowers your immune system and predisposes towards infection, do highlight it to your ophthalmologist so that even more precautions can be taken to prevent infection.

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