The document outlines various complications associated with cataract surgeries, including pre-operative anxiety, anesthesia risks, and multiple potential post-operative issues such as vitreous loss, endophthalmitis, and secondary cataract. It discusses treatment approaches for these complications and emphasizes the importance of careful surgical technique to minimize risks. Specific causes, symptoms, and appropriate management strategies for each complication are also detailed.

1. CATARACT SURGERY
COMPLICATIONS
surjeet acharya
VMC

3. PRE-OPERATIVE

4. ANXIETY
Rx: DIAZEPAM 2-5mg at bed time

5. NAUSEA AND GASTRITIS
ACETAZOLAMIDE
Rx: ORAL ANTACIDS

6. ALLERGIC CONJUCTIVITIS

7. CORNEAL ABRASION

8. ANESTHESIA
COMPLICATIONS

9. RETROBULBAR
HEMORRHAGE
Rx: 1 drop PILOCARPINE (2%) with
pressure bandage

10. OCULOCARDIAC REFLEX
Bradycardia +/- Cardiac arrhythmia
Rx; ATROPINE (iv)
PERFORATION OF GLOBE
SUBCONJUCTIVAL HEMORRHAGE
DISLOCATION OF LENS

11. OPERATIVE

12. POOR PRE-OP
HYPOGLYCEMIA
COUGH/SNEEZE, move head towards
sides
Excess Bleed if patient is on anticoagulants

13. POOR SURGICAL SKILL

14. Superior Rectus
laceration/haematoma
seen in ECCE/SICS
no treatment required

15. Excess bleed

16. Incision related
Irregular incision- in ECCE
Button holing of anterior wall of tunnel
Premature entry into anterior chamber
Scleral disinsertion
MANUAL
SICS &
PHACO

17. Corneal Injury
when A.C is entered with sharp
instruments

19. CAPSULORRHEXIS
COMPLICATIONS
Escaping capsulorrhexis
Small capsulorrhexis
Eccentric capsulorrhexis
Very large capsulorrhexis

20. POSTERIOR CAPSULAR
RUPTURE
Feared complication in all Cataract
surgeries
Occurs due to-
forceful hydrodissection
direct injury by instruments
cortex aspiration (ACCIDENTAL PCR)

21. ZONULAR DEHISCENCE
In all ECCE and SICS

22. VITREOUS LOSS

23. • To decrease vitreous volume- pre op
mannitol
• To decrease aqueous volume- pre op
acetazolamide
• To decrease orbital volume- ocular
massage and compression
• Better ocular akinesia and anesthesia
• Minimising external pressure- carefull
handling, minimum pull on bridle suture

24. • Posteriorsclerotomy + vitreous drain from
pars plana- in case of high IOP and
surgery cannot be postponed

25. if vitreous loss has occured
anterior vitrectomy
clear vitreous from AC and Incision site
This prevents post-op complication due to
vitreous loss

26. NUCLEUS DROP
mostly seen in PHACO
Rx- refer case to
VITRORETINAl surgeon

27. POSTERIOR LOSS OF LENS FRAGMENTS
Due to PCR or ZD during PHACO
Can lead to glaucoma, uveitis, RD
Rx- refer to vitreoretinal surgeon (pars plana
vitrectomy)

28. EXPULSIVE CHOROIDAL HEMORRHAGE
seen in HT and arteriosclerosis changes patients
MOSTLY in ICCE, ECCE
LEAST in SICS and PHACO
Ch: WOUND GAPING; LOSS OF LENS,
VITREOUS, IRIS, RETINA, UVEA & finally gush
of blood
Rx- unsatisfactory
EYE IS LOST so EVISCERATION IS DONE

29. POST-OP

30. Hyphaema
Rx: usually gets absorbs by
itself
Drain out blood (if not resolved
in 1 week)
Treat for raised IOP
(acetazolamide)

31. IRIS PROLAPSE
Common in ICCE and ECCE

32. STRIATE KERATOPATHY
Due to endothelium damage (cornea)
corneal edema with descement folds
Rx: hypertonic saline drops + steroids

33. ENDOPTHALMITIS
Causes- instruments, solutions, surgeon hand,
patient own flora
ocular pain, conjuctival congestion, corneal
edema, exudates, diminished vision, hypopyon
Rx: IntraVitreal Antibiotics
steroids
supportive
vitrectomy

34. CME
Common in all cataract surgery but insignificant
develops 1-3 months later
EP: vitreous incarceration and iritis
Rx: anterior vitrectomy+steroids+anti-PGs
Prevention: preop and postop anti-PGs

35. CHRONIC POSTOP
ENDOTHALMITIS
Agents
Rx: pars plana vitrectomy + Ab/Af therapy

36. PSEUDOBULLOUS
KERATOPATHY
Continued corneal edema

37. RD
Aphakic>>>>phakic
ICCE >>> ECCE
R/F- vitreous loss, myopics

38. EPITHELIAL INGROWTH
Conjuctival epithelium enters AC and can
block TM causing Glaucoma
In late stages, it can extend upto iris and
anterior part of vitreous

39. FIBROUS DOWNGROWTH
Due to abnormal apposition of cataract
wound
Can lead to secondary glaucoma, anterior
segment disorganisation and finally,
phthisis bulbi

40. AFTER CATARACT
a.k.a SECONDARY CATARACT
Generally after ECCE
Causes: - residual lens matter
- proliferative cataract may develop
from remains of anterior cells in
capsular bag

41. Clinical Types
Dense membranous: thickened PCO
Rx: membranectomy

42. Soemmering’s ring: thick ring behind iris
enclosed between
2 layers of capsule

43. Elschnig’s pearls: vacuolated subcapsular
epithelial cells are
clustered in posterior
capsule
Rx: YAG-laser capsulotomy

44. IOL RELATED
COMPLICATIONS

45. Anterior chamber and Iris supported lens
CME, uveitis, secondary glaucoma, UGH
syndrome (uveitis, glaucoma, hyphema)

46. IOL malpossition
Sunset syndrome- inferior subluxation of iol
Sunrise syndrome- superior subluxation of
iol
Loss lens syndrome- dislocation into vitreous
Windsheild-wiper syndrome

47. Pupillary capture
Postop iritis or proliferation of lens fibre
remnants

48. Toxic Anterior Segment
Syndrome
Violent inflammation of uveal tissue
Causes: - ethylene gas (for sterlising IOL)
- lens material

49. PRE-OP OPERATIVE POST OP IOL related
Anesthesia
related
SR laceration Hyphaema Malposition of lens
Corneal
abrasion
Excess bleed Iris prolapse Pupilary capture of
lens
Conjuctivitis Injury to cornea, iris Striate keratophy TASS
Anxiety PCR Bullous keratopathy
Hypoglycemia Zonular dehiscene Endopthalmitis
Gastritis Vitreous loss CME, RD
Nucleus drop into vitreous
cavity
Epithelial and
fibrous growth
Expulsive choroidal
hemorrhage
After cataract

50. THANK YOU