This document summarizes potential complications from cataract surgery, grouped into those occurring at surgery, within a week, and longer term. Complications at surgery include posterior capsule rupture, dropped nucleus, and small pupil. Within a week, potential issues are infection, high eye pressure, corneal swelling, and inflammation. Longer term risks include cystoid macular edema, retinal detachment, and unexpected conditions found on postoperative exam. The document provides examples and treatment approaches for several common complications.

1. B Y D N Y A N E S H W A R B P O T F O D E
Complications of Cataract Surgery

2. Time of onset of complication
1 At the time of surgery
2 Within one week of surgery
3 Longer term

3. Surgery Anaesthesia
 Rupture of the posterior capsule
with vitreous loss
 Dropped nucleus
 Zonule dehiscence
 Iris prolapse / phako damage to
iris
 Small pupil
 Expulsive choroidal haemorrhage
 Wrong intraocular lens implant
power
 Wrong concentration of
antibiotic in AC
Retrobulbar
haemorrhage
Globe perforation
Diplopia
1 Complication at the time of surgery

4. 1 Posterior capsule rupture (PCR)

5. 1 Dropped lens nucleus or fragments

6. Zonule dehiscence Iris prolapse
1 More complications at the time of surgery

7. 1 Iris hooks for small pupil

8. Surgery Anaesthesia
 Rupture of the posterior capsule
with vitreous loss
 Dropped nucleus
 Zonule dehiscence
 Iris prolapse / phako damage to
iris
 Small pupil
 Expulsive choroidal haemorrhage
 Wrong intraocular lens implant
power
 Wrong concentration of
antibiotic in AC
 Retrobulbar haemorrhage
 Globe perforation
 Diplopia
1 Complications at the time of surgery
THESE PROBLEMS SHOULD HAVE BEEN MANAGED BY THE SURGEON

9. 2 Complications within one week of surgery
 Infection
 Postoperative raised intraocular pressure
 Corneal endothelial decompensation
 Refractive imbalance
 Allergy to drops

10. Infection - endophthalmitis
Red eye.
Painful.
Blurred.
Hypopyon.
Urgent
treatment.
Intravitreal
Antibiotic.
Sample
vitreous
if possible.

11. Raised intraocular pressure
Pain
Blurred vision
Corneal oedema, hazy fundus view
Hypopyon
Treat with eye drops:
latanoprost,
brinzolamide
timolol
aproclonidine
and intravenous acetazolamide.

12. Corneal oedema Specular microscopy
Corneal endothelial decompensation

13. 3 Longer term complications
 Cystoid macular oedema
 Retinal detachment
 IOL subluxation
 Persistent non-infective uveitis/inflammation/discomfort
 Unexpected astigmatism
 Other ocular conditions not found preoperatively
eg. age-related macula degeneration

14. 3 Cystoid macula oedema (CMO)

15. Flat retinal tear
Retinal detachment and
tear
3 Retinal tears and retinal detachment

16. Subluxation of IOL

17. Persistent non-infective uveitis
AC cells,
protein flare
& KP

18. 3 Longer term complications
 Cystoid macular oedema
 Retinal detachment
 IOL subluxation
 Persistent non-infective uveitis/inflammation/discomfort
 Unexpected astigmatism
 Other ocular conditions not found preoperatively
eg. age-related macula degeneration

19. Examination of postoperative patient
History
Visual acuity (with pinhole if needed)
Intraocular pressure
Check anterior segment with loupe and light
Dilate the pupil for fundus check
Refraction

20. Management of complications
The urgent conditions requiring immediate
treatment are:
endophthalmitis
postoperative raised intraocular
pressure/glaucoma
retinal tears/retinal detachment
All other conditions are less urgent and should be
referred back to the operating surgeon