DEPARTMENT OF INPATIENT POST OPERATIVE COMPLICATION

AIM The MLOP shall identify the early post operative complications in the ward and shall help in the effective management of the same.

Objectives The MLOP shall Develop wide range of basic knowledge of immediate post surgical complications In early identification of post operative complications Helping doctors in prompt remedial measures In explaining and reassuring patients in a proper way about their complications.

Theory The ocular post surgical complications can broadly be divided into Anterior segment complications Posterior segment complications Early post operative complications Late post operative complications

Early Post - Operative Anterior segment complications Lid - Oedema; ptosis Conjunctiva - Chemosis, Subconjunctival haemorrhage Cornea - Oedema, Striate Keratopathy, Epi. defect Ant. Chamber - Shallow, Cortex, Hyphaema, Hypopyon Cont…

Iris - Iritis, Iris prolapse Pupil - Fibrin Membrane , Pupilary capture Lens - Decentred IOL, Haptic in AC, Panophthalmitis

Late post-operative Ant. segment complications Bullous Keratopathy Vitreous touch syndrome Vitreous wick syndrome Secondary Glaucoma - Angle closure Severe iritis, Pupillary block, Irisbombe, Peripheral anterior synechiae Cont…

Cortex Suture infiltration Iris Prolapse Uveitis Open Angle Cortex Cells Blood Suture infiltration Iris Prolapse Uveitis Late post – op endophthalmitis

POSTERIOR SEGMENT COMPLICATIONS Cystoid macular edema (CME) Pseudophakic R.D PCO ( Posterior capsule opacifications) Dislocated IOL/ Decentered IOL Vitreous Haemorrhage Endophthalmitis

Swelling of the Lid Lid edema Causes : Treatment : Injury with instruments Inflammation ( Iritis) Allergy to medications Treatment : Anti - Inflammatory drugs Steroids Anti histamines in case of allergy

Chemosis Congestion and collection of fluid Causes : Allergy Subconjunctival Injections Iritis Endophthalmitis Treatment : Observation Anti Inflammatory drug

Subconjunctival Haemorrhage Collection of blood beneath the conjunctiva Causes : Injury Retrobulbar Haemorrhage Hypertension Bleeding disorders Treatment : Observation Absorbs spontaneously – 2 -3 wks

Corneal Oedema Corneal Oedema Increase in corneal thickness epithelial edema Causes: Increased IOP – 40 mmHg and more Iritis Descemets membrane stripping Endothelial damage Treatment: Timolol eyedrops Tab. Diamox Oral glycerol Injection Mannitol 20% Hypertonic Saline drops

Striate Keratitis Causes : Severe endothelium damage Tight suture Treatment : Steroid eye drops Timolol eye drops Cycloplegic eye drops

Descemets Membrane Stripping The stroma and thus allowing easy separation from stroma Causes: Entry in to the globe Faulty instrumentation Fluid is injected between the descemet’s membrane and stroma If small – Air Bubble left in anterior chamber If larger – Needs surgical repair

Epithelial defect Epithelial defect Rupture of epithelium Predisposing Factors : Injury (Instrument, Pad / Cotton ) During anaesthesia eye is open Treatment : Only antibiotic ointment pad / bandage.

A.C Shallow Shallow Anterior Chamber Causes : Wound leak Pupilary block Choroidal detachment Malignant glaucoma

Wound leak : Treatment : Size of the section is larger than the normal Loose suture wound gape Trauma Inadequate and improper suturing of the wound Treatment : Pressure pad / bandage / mydriatic If AC does not form within 24 – 48 hrs Needs AC reforming / resuturing

Pupilary Block Causes : AC IOL without PI Severe Iritis – 360 deg PS Vitreous touching the PUPIL IOL capture Treatment : Inj. mannitol 20% Tab. diamox 1st Laser PI. If not possible Needs surgical PI.

Fibrin Membrane Appear as a dense fibrin net in pupillary area Causes: Prolonged Irrigation with balance – salt solution Unsterile IOL Treatment: Antibiotic drops hourly Steriods drops hourly Cycloplegic drops TDS If needed oral steriods to be given (1mg /1kg)

Cortex Residual cortex Predisposing Conditions : Treatment : Small pupil Pseudo exfoliation Diabetic mellitus Positive pressure during surgery PC rent Treatment : Small piece of loose cortex will get absorbed – steroids E/D Large clumps of cortex not getting absorbed – needs AC wash.

Bed rest, bandage both eyes. Treatment : Bed rest, bandage both eyes. Steroid eye drops. Cycloplegic eye drops. Timolol eye drops. Tab. Diamox. Tab. Vit C. Observation for 2 days. If not responding needs AC wash.

Hypopyon Predisposing conditions : Complicated cat Phacolytic / Phacomorphic glaucoma Infection. Treatment : Antibiotic Steroids Cycloplegic.

SYMPTOMS Pain , Redness , Defective vision. Lid edema , conjunctival chemosis Corneal edema, corneal Infiltration AC cells, Hypopyon Infiltrate in suture / section Wound gape or weak wound.

TREATMENT: No steroids Topical antibiotics AC tap. Vit-tap Intravitreal antibiotics

IRITIS Inflammation of the iris. Flare and cells Fibrin membrane. Treatment : Antibiotic drops hourly Steroids drops hourly Cycloplegic drops TDS If needed oral steroids to be given (1mg/1kg)

Iris Prolapse IRIS PROLAPSE Causes : Loose suture Wound gape Injury Positive pressure. Treatment : Hourly antibiotic drops Iris prolapse excision and resuturing < 24 hrs – Reposition > 24 hrs – Excision.

HAPTIC IN AC : One Haptic in AC Treatment : IOL reposition ( or ) Redialing

(Dreadful complication, follows infection ) ENDOPHALMITIS (Dreadful complication, follows infection ) Sources: Contamination in O.T (Staffs & Instruments) Patients Lids and conjunctival poor hygiene.

TREATMENT: No steroids Topical antibiotics AC tap. Vit - tap Intravitreal antibiotics Anti inflammatory drug

RISK FACTOR : Poor hygiene Immune suppressed patient Debilatet patient - (diabetic, cancer & weak ) Suture abscess or suture removal

ORGANISMS : Bacteria Fungal Staphylococcus Aspergillus Staphylococcus Candida Streptococcus Fusarium Pseudomonas

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