undergraduate teaching ppt for complications of cataract surgery

1. COMPLICATIONS OF
CATARACT

2. Complications
 PREOPERATIVE COMPLICATIONS
 INTRAOPERATIVE COMPLICATIONS
 EARLY POSTOPERATIVE COMPLICATIONS
 DELAYED(LATE) POSTOPERATIVE COMPLICATIONS
 IOL- related COMPLICATIONS

3. PREOPERATIVE COMPLICATIONS
 Anxiety
 Nausea and Gastritis
 Irritative or Allergic conjunctivitis
 Corneal abrasion
 Complications during local anesthesia
1. Retrobulbar Hemorrhage
2. Oculocardiac Reflex
3. Perforation of globe
4. Subconjunctival hemorrhage
5. Spontaneous dislocation of lens

4. OPERATIVE COMPLICATIONS
1. Superior rectus muscle laceration
2. Excessive bleeding
3. Incision related complications
 In manual SICS and phacoemulsification:
----Button holing of anterior wall of tunnel
----Premature entry into anterior chamber
----Scleral disinsertion

5. 4. Injury to the Cornea, Iris and Lens
5. Iris injury and Iridodialysis(tear of iris from root)
6. Complications related to anterior capsulorhexis
 Escaping capsulorhexis
 Small capsulorhexis
 Very large capsulorhexis
 Eccentric capsulorhexis

6. 7. Posterior capsular rupture
 During forceful hydrodissection
 By direct injury with some instrument like Sinkey hook, chopper
or phacotip
 During cortex aspiration
8. Zonular dehiscence

7. 8. Vitreous loss-adequate measures should be taken to prevent this like:
 To decrease vitreous volume
 To decrease aqueous volume
 To decrease orbital volume
 Better ocular akinesia and anaesthesia
 Minimising external pressure on the eye
 Use of flieringa ring to prevent collapse of sclera

8. 10. Nucleus drop into the vitreous cavity
11. Posterior loss of lens fragment
12. Expulsive choroidal hemorrhage

9. [C] Early postoperative
complications
1. Hyphaema.
Treatment. Most hyphaemas absorb spontaneously and need
no treatment.
hyphaema may be large and associated with rise in IOP.
In such cases, IOP should be lowered by acetazolamide and
hyperosmotic agents.

10. 2. Iris prolapse. It is
usually caused by
inadequate suturing
of the incision
3. Striate keratopathy.
corneal oedema with
Descemet’s folds
due to endothelial
damage during
surgery.

11.  4. Flat (shallow or
nonformed) anterior
chamber. wound leak,
ciliochoroidal detachment or
pupil block
 5. Postoperative anterior
uveitis can be induced by
instrumental trauma, undue
handling of uveal tissue,
reaction to residual cortex or
chemical reaction induced by
viscoelastics, pilocarpine etc.

12. 6. Bacterial endophthalmitis. This is one of the most dreaded
complications with an incidence of 0.2 to 0.5 percent.
The principal sources of infection are contaminated solutions,
instruments, surgeon'shands, patient's own flora from conjunctiva,
eyelids and air-borne bacteria.

13. Ocular pain, diminished vision, lid
oedema, conjunctival chemosis
and marked circumciliary
congestion, corneal oedema,
exudates in pupillary area,
hypopyon and diminished or
absent red pupillary glow.

14. [D] Late postoperative complications
These complications may occur after
weeks, months
or years of cataract surgery.
1. Cystoid macular oedema (CME).
Collection of
fluid in the form of cystic loculi in the
Henle’s layer of
macula is a frequent complication of
cataract surgery.

15. 2. Delayed chronic postoperative endophthalmitis
is caused when an organism of low virulence (Propionibacterium acne)
becomes trapped within the capsular bag.
3. Pseudophakic bullous keratopathy (PBK) is
usually a continuation of postoperative corneal
oedema produced by surgical or chemical insult to a
healthy or compromised corneal endothelium.

16. 4. Retinal detachment (RD). Incidence of retinal detachment is higher in
aphakic patients as compared to phakics. It has been noted that retinal
detachment is more common after ICCE than after ECCE. Other risk factors
for aphakic retinal detachment include vitreous loss during operation,
associated myopia and lattice degeneration of the retina.
5. Epithelial ingrowth.
6. Fibrous downgrowth into the anterior chamber

17. 7.After cataract. It is also known as ‘secondary cataract’. It
is the opacity which persists or develops after
extracapsular lens extraction.
Causes.
(i) Residual opaque lens matter may persist as after cataract
when it is imprisoned between the remains of the
anterior and posterior capsule,
(ii) Proliferative type of after cataract may develop from the
left-out anterior epithelial cells.

18. Clinical type
Soemmering’s ring
Elschnig’s pearls
Dense membranous
Treatment is as follows :
i. YAG-laser capsulotomy
ii. ii. Dense membranous after cataract needs surgical membranectomy.
7. Glaucoma-in-aphakia and pseudophakia

19. [E] IOL-related complications
1. Complications like
cystoid macular oedema, corneal endothelial damage, uveitis and secondary
glaucoma are seen more frequently with IOL implantation.
UGH syndrome refers to concurrent occurrence of uveitis, glaucoma and
hyphaema.

20. 2. Malpositions of IOL
. decentration, subluxation and
dislocation.
Sun-set syndrome (Inferior subluxation
of IOL).
Sun-rise syndrome (Superior
subluxation of IOL).
Lost lens syndrome refers to complete
dislocation of an IOL into the
vitreous cavity.
Windshield wiper syndrome. It results
when a very small IOL is placed
vertically in the sulcus. In it the
superior loop moves to the left and
right with movements of the head.

21. 3. Pupillary capture of the IOL may occur following
postoperative iritis or proliferation of the remains of lens
fibres.
4. Toxic lens syndrome. It is the uveal inflammation excited
by either the ethylene gas used for sterilising IOLs (in
early cases) or by the lens material (in late cases).