Cataract Surgery Complications -
Late 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.

Cloudy lens capsule (posterior capsular opacification): The capsule is the thin membrane that forms a bag that supports the lens inside your eye. During surgery, your cataract is removed from the capsule, and a synthetic intraocular lens implant is inserted into the capsule in place of the cataract. Posterior capsular opacification occurs when this thin membrane becomes cloudy. Approximately 20% experience this, although newer intraocular lens implants may be able to reduce its occurrence.

(Image adapted from the internet)

Posterior capsular opacification causes the thin capsule membrane behind the intraocular lens implant to become cloudy. This affects the passage of light rays through the lens implant, and results in mistiness and blurriness of the vision.

How do you know when you have posterior capsular opacification? Simple. You find that your vision gradually becomes misty again, almost similar to what it was previously before your cataract operation. Posterior capsular opacification does not go away by itself. However, it is easily treated with laser and takes no more than 5 minutes. This YAG laser posterior capsulotomy effectively 'punches' a hole through the cloudy capsule; this allows light to pass freely into your eye and thus enables you to see clearly again. This laser procedure is quick, safe. effective, and can be done in the consulting rooms.

(Image adapted from the internet)

Fortunately, posterior capsular opacification is easily treated with YAG laser posterior capsulotomy. The laser creates a central opening in the middle of the cloudy membrane.

Intraocular lens dislocation: Usually, the stability of the implanted intraocular lens in the eye is lifelong. There is no requirement to remove or to replace the intraocular lens unless specifically indicated. However, in rare occasions, the capsular bag stability may weaken, resulting in intraocular lens subluxation (part of the lens is still in the correct location) or dislocation (entire intraocular lens is no longer in the correct position). The risk of this happening is higher in eyes with complicated surgery, prior eye trauma and preexisting eye conditions such as pseudoexfoliation. Treatment depends on how much the intraocular lens has moved, how much vision is affected and whether there is damage to other ocular tissues. If there is mild subluxation and you are still able to see reasonably clearly, then there is no need to intervene. If the entire intraocular lens is dislocated, you will generally need surgery to remove the displaced lens and to replace it with a new one.

Retinal detachment: The retina is the innermost layer of the eye, and it functions to convert light into biochemical signals which are then transmitted to the brain. Retinal detachment occurs when the retina peels away from the wall of the eye. 0.5% of patients experience this after cataract extraction. It is more common in cataract operations that have experienced complications during surgery. Retinal detachment will cause blindness if the retina is not put back in place in a timely manner.

(Image adapted from the internet)

In this patient, the upper part of the retina is detached, resulting in the appearance of a shadow or curtain effect at the bottom half of visual field.

How do you know you have a retinal detachment? There are 3 main symptoms to look for: flashing lights, floaters, and a shadow or curtain obscuring your field of vision. If you notice any of these, please consult your ophthalmologist without delay. Retinal detachments can only be treated with retinal detachment surgery. In the case of retinal detachment following cataract surgery, the surgery will most likely be a vitrectomy combined with laser and oil or gas injection.

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