• 1 ANXIETY : due to fear & apprehension of
operation. Anxiolytic drugs such as diazepam 2 to
5 mg at bed time usually alleviate such
• 2 NAUSEA & GASTRITIS : due to preoperative
medicines such as acetazolamide &/or glycerol.
• Oral antacids & omission of further dose of such
medicines usually relieve the symptoms
• It is irritative.
• It may occur in some patients due to
preoperative topical antibiotic drops.
• Postponing the operation for 2 days along
with withdrawal of such drugs required.
• due to inadvertent injury during schiotz
• Patching with antibiotic ointment for a day
and postponement of operation for 2 days is
COMPLICATION DUE TO LOCAL
• (1) Retrobulbar haemorrhage may occur due
to retrobulbar block.
• Immediate pressure bandage after instilling
one drop of 2% pilocarpine and postponement
of operation for a week is advised.
• (2) Oculocardiac reflex, which manifests as
bradycardia and/or cardiac arrhythmia, has also
been observed due to retrobulbar block.
• An intravenous injection of atropine is helpful.
• (3) Perforation of globe may also occur
• To prevent such catastrophy, gentle injection with
blunt-tipped needle is recommended. Further,
peribulbar anaesthesia may be preferred over
• (4) Subconjunctival haemorrhage is a minor
complication observed frequently, and does
not need much attention.
• (5) Spontaneous dislocation of lens in vitreous
has also been reported during vigorous ocular
massage after retrobulbar block.
• The operation should be postponed.
• SUPERIOR RECTUS MUSCLE LACERATION
• EXCESSIVE BLEEDING
• INCISION RELATED COMPLICATION
• INJURY TO THE CORNEA , IRIS & LENS
• ANTERIOR CAPSULORHEXIS
• POSTERIOR CAPSULAR RUPTURE
• VITREOUS LOSS
• ZONULAR DEHISCENE
• NUCLEAR DROP IN TO THE VITREOUS CAVITY
• POSTERIOR LOSS OF LENS FRAGMENT
• EXPULSIVE CHOROIDAL HAEMORRHAGE
• SUPRACHOROIDAL HAEMORRHAGE
(1) Superior rectus muscle laceration and/or
haematoma, may occur while applying the bridle
• Usually no treatment is required.
(2). Excessive bleeding may be encountered during
the preparation of conjunctival flap or during
incision into the anterior chamber. Bleeding
vessels may be gently cauterized.
• 3. Incision related complications depend upon
the type of cataract surgery being performed.
• i. In conventional ECCE there may occur irregular
• In manual SICS and phacoemulsification following
complications may occur while making the self-
sealing tunnel incision.
• Button holing of anterior wall of tunnel can occur
because of superficial dissection of the scleral
flap (Fig. 8.27B).
A, correct incision;
B, Buttonholing of anterior wall of the tunnel;
• Premature entry into the anterior chamber can
occur because of deep dissection (Fig. 8.27C).
• Once this is detected, dissection in that area
should be stopped and a new dissection
started at a lesser depth at the other end of
C, Premature entry into the anterior chamber
• Scleral disinsertion can occur due to very deep
• In it there occurs complete separation of
inferior sclera from the sclera superior to the
incision (Fig. 8.27D).
• Scleral disinsertion needs to be managed by
• 4. Injury to the cornea (Descement's
detachment), iris and lens may occur when
anterior chamber is entered with a sharp-tipped
instrument such as keratome or a piece of razor
• A gentle handling with proper hypotony reduces
the incidence of such inadvertent injuries.
• 5. Iris injury and iridodialysis (tear of iris from
root) may occur inadvertently during intraocular
• 6. Complications related to anterior capsulorhexis. Continuous curvilinear
capsulorhexis (CCC) is the preferred technique for opening the anterior capsule for
SICS and phacoemulsification. Following complications may occur:
• Escaping capsulorhexis i.e., capsulorhexis moves peripherally and may extend to
the equator or posterior capsule.
• Small capsulorhexis. It predisposes to posterior capsular tear and nuclear drop
• It also predisposes to occurrence of zonular deshiscence. Therefore, a small sized
capsulorhexis should always be enlarged by 2 or 3 relaxing incisions before
• Very large capsulorhexis may cause problems for in the bag placement of IOL.
• Eccentric capsulorhexis can lead to IOL decentration at a later stage.
• 7. Posterior capsular rupture (PCR).
• It is a dreaded complication during extra capsular
• In manual SICS and phacoemulsification PCR is even
more feared because it can lead to nuclear drop into
• The PCR can occur in following situations:
• During forceful hydrodissection,
• By direct injury with some instrument such as
• Sinskey's hook, chopper or phacotip, and
• During cortex aspiration
• (8) Zonular dehiscence- during nucleus
prolapse into the anterior chamber in manual
• (9) Vitreous loss.- occur following accidental
rupture of post. Capsule during any technique
• To decrease vitreous volume: Preoperative use of
hyperosmotic agents like 20 percent mannitol or oral
glycerol is suggested.
• To decrease aqueous volume: Preoperatively
acetazolamide 500 mg orally should be used and
adequate ocular massage should be carried out
digitally after injecting local anaesthesia.
• To decrease orbital volume adequate ocular massage
and orbital compression by use of superpinky, Honan's
ball, or 30 mm of Hg pressure by paediatric
sphygmomanometer should be carried out.
• Better ocular akinesia and anaesthesia decrease
the chances of pressure from eye muscle.
• Minimizing the external pressure on eyeball by
not using eye speculum, reducing pull on bridle
suture and overall gentle handling during surgery.
• Use of Flieringa ring to prevent collapse of sclera
especially in myopic patients decreases the
incidence of vitreous loss.
• When IOP is high in spite of all above
measures and operation cannot be
postponed, in that situation a planned
posterior-sclerotomy with drainage of vitreous
from pars plana will prevent rupture of the
anterior hyaloid face and vitreous loss.
• (10) Nuclear drop into the vitreous cavity. – it
occurs phacoemulsification , less frequently
with manual SICS.
• It is a dreadful complication which occur due
to sudden & large PCR.
Management.- ant. Vitrectomy & cortical
• (11) Post. Loss of lens fragments- into the
vitreous cavity may occur after PCR or zonular
dehiscence during phaco.
- Result in glaucoma, chronic, uveitis, chronic
- Management.- pars plana Vitrectomy &
removal of nuclear fragment.
• (12) Expulsive choroidal haemorrhage.-
• It is one of the most dramatic and serious complications of
• It usually occurs in hypertensive and patients with
• It may occur during operation or during immediate
• Its incidence was high in ICCE and conventional ECCE but
has decreased markedly with valvular incision of manual
SICS and phaco emulsification technique.
- Characterized by spontaneous gaping of the wound followed
by expulsion of the lens, vitreous, retina, uvea, & finally a gush
of bright red blood.
• (1) Hyphaema – collection of blood in ant.
Chamber may occur from conjunctival or
scleral vessels due to minor ocular trauma.
• Treatment. Most Hyphaema absorb
spontaneously and thus need no treatment.
Sometimes hyphaema may be large and
associated with rise in IOP.
Early / Late
Early: Immediate postoperative period
Origin: Incision / Iris
Mild resolves spontaneously
Mixed with blood / viscoelastic – resolution
Late: Months / years after surgery
Origin: wound vascularization / erosion of
vascular tissue by lens implant
• (2) Iris prolapse – by inadequate suturing of the
incision after ICCE & conventional ECCE.
• This complication is not known with manual SICS
and phacoemulsification technique.
• Management: A small prolapse of less than 24
hours duration may be reposited back and wound
• A large prolapse of long duration needs
abscission and suturing of wound.
• (3) Striate keratopathy.- by mild corneal oedema
with descement's fold is a common complication
observed during immediate postoperative period.
- Due to endothelial damage during surgery.
• Management : Mild striate keratopathy usually
disappears spontaneously within a week.
Moderate to severe keratopathy may be treated
by instillation of hypertonic saline drops (5%
sodium chloride) along with steroids.
It Is associated with hypotony.
It is diagnosed by Seidel's test.
• In this test, a drop of fluorescein is instilled into the lower
fornix and patient is asked to blink to spread the dye
• The incision is then examined with slit lamp using cobalt-
• At the site of leakage, fluorescein will be diluted by
aqueous. In most cases wound leak is cured within 4 days
with pressure bandage and oral acetazolamide.
• If the condition persists, injection of air in the anterior
chamber and resuturing of the leaking wound should be
• CILIOCHOROIDAL DETACHMENT : It may or
may not be associated with wound leak.
• In most cases choroidal detachment is cured
within 4 days with pressure bandage and use
of oral acetazolamide.
• PUPIL BLOCK : Pupil block due to vitreous
bulge after ICCE leads to formation of iris
bombe and shallowing of anterior chamber.
• (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.
• Management includes more aggressive use of
topical steroids, cycloplegics.
• Bacterial endophthalmitis- dreadful
complication with an incidence 0.2 to 0.5%.
- Sorce of infection- contaminated solution,
instruments, surgeon’s hands, pt’s own flora
from conjunctiva, eyelids, & air-borne
- Sign & symptom : ocular pain , diminished of
vision , corneal oedema
Signs of mild endophthalmitis
• Mild pain and visual loss
• Anterior chamber cells
• Small hypopyon
• Fundus visible with indirect
• CME- collection of fluid in the form of cystic
loculi in the henle’s layer of macula is a
frequent complication of cataract Surgery.
- On fundoscopy it gives a honeycomb
- On FA- typical flower petal patterns due to
leakage of dye from perifoveal capillaries.
• Delayed chronic postoperative
endophthalmitis is caused when an organism
of low virulence becomes trapped within the
• It has an onset ranging from 4 weeks to years
(mean 9 months) postoperatively.
• Pseudophakic bullous keratopathy(PBK)-
postoperative corneal oedema produced by
surgical or chemical insult to a healthy or
compromised corneal endothelium.
• This serious postoperative complication is,
fortunately, rare but is more common in
myopic (shortsighted) patients after intra
• Epithelial ingrowth- rarely conjunctival
epithelial cells may invade the ant. Chamber
through a defect in the incision.
• Fibrous down growth- into the ant. Chamber
may occur very rarely when the cataract
wound apposition is not perfect.
- May cause secondary glaucoma, phthisis
• After cataract- (secondary cataract)
• “It is the opacity persists or develop after ECCE.”
• TYPES : Present as thickened post. Capsule or
dense membranous after cataract.
• Soemmering’s ring –thick ring of after cataract
formed behind the iris, enclosed between the
two layers of capsule.
• Elshning’s pearls- vasculated sub capsular
epithelial cells are clustered like soap bubbles
along the post. Capsule.
A, dense membranous; B, Soemmering's ring; C, Elschnig's pearls.
Capsule or dense membranous Elshning’s pearls-
ILO RELATED COMPLICATION
MALPOSITION OF IOL
OF THE IOL
• Complications like-
• CME, corneal endothelial damage, uveitis, secondary
glaucoma are seen.
• UGH syndrome- uveitis, glaucoma. Hyphema. Occur
with rigid ACIOL.
• Pupillary capture of the IOL - postoperative iritis
• Toxic lens syndrome- uveal inflammation excited by
either ethylene gas used for sterilising IOLs or by the
• Malposotion of IOL – decentration,
subluxation, & dislocation.
• Sun-set syndrome- infer. Subluxation of IOL
• Sun- rise syndrome-sup. Subluxation of IOL
• Lost lens syndrome- IOL into the vitreous
• Windshield wiper syndrome- IOL is places
vertically in the sulcus.