1. postoperative cataract complications
Lecture 13
Liana Al-Labadi, O.D.

2. Early P.O Complications
Management
Transient Corneal Edema- secondary to minor surgical trauma to the corneal endothelium
Control with topical steroids &/or hyperosmotics (Muro-128)
Transient Anterior Iritis- i.e. Mild AC reaction
Control with topical steroids
Transient Ocular Hypertension- due to residual lens material & viscoelastic solution
Control with beta blockers or CAI or alpha adrenergic receptors
Consider paracentesis
Wound Leakage- Due to inadequate wound sealing, trauma or eye rubbing. look for seidel’s sign; IOP usually low
BCL + Antibiotic
FB sensation- exposed suture vs SPK
Treat as dry eye
Lens remnant Uveitis- Causes severe uveitis & may result in secondary glaucoma
Cylcoplegia BID & steroids Q2H; surgical intervention may be required
Infectious Endophthalmitis- very poor prognosis (50% blindness)
AB + Cycloplege + Steroids + (?IV AB) (

3. Corneal Edema

4. Mild Uveitis

5. Seidel’s Sign

6. Endophthalmitis Rarely occurs after modern cataract surgery
Visually threatening condition
Carries very poor prognosis- 50% blindness if treatment is delayed
Can present as an acute form or chronic form
Symptoms:
Mild to severe pain
Redness
Loss of vision
Floaters
Photophobia
Signs:
The hallmark of endophthalmitis is vitreous inflammation
Eyelid & periorbital edema
Chemosis
Corneal edema
AC reaction
Hypopyon
Etiology:
Toxic material introduced to the eye
Poor sterlization- materials, injection needle, surgeon, nurses
Management:
Culture- must identify organism type
IV AB & hospitalization

7. ENDophthalmitis

8. Complications Late P.O Complications Management
Persistent Corneal Edema & Bullous Keratopathy
Control with topical steroids &/or hyperosmotics (Muro-128); PK may be required
Posterior Capsule Opacification (PCO)
YAG Laser
Cystoid Macular Edema
NSAIDs
Retinal Detachments
RD repair

9. Pseudophakic Bullous Keratopathy (PBK)
PBK is a post-op condition that can occur as a complication following PE PCIOL
May present early or it may not present for many years
Symptoms:
Decreased vision
Pain
FBS & tearing
Photophobia
red eye
Signs:
Mild to marked persistent stromal edema in an eye in which the native lens has been removed
Increased K thickness
Bullous formation in severe cases--> these rupture & cause pain
Descemet folds
K vascularization
CME may be present

10. Pseudophakic Bullous Keratopathy (PBK)
Etiology: Due to compromised endothelial cell function
Both intraoperative insult to the endothelium and long-term cell damage as a result of the lens implant can lead to PBK
Proposed mechanism to endothelial cell loss include:
Direct trauma during surgery
Prolonged irrigation
Toxic medications
Persistent inflammation
Increased IOP
AC IOL- associated with more endothelial cell loss than PC IOL
“Intermittent touch” between IOL & K
Chronic low-grade inflammation caused by IOL haptics or footplates
May disrupt the normal flow of aqueous in the AC which affects the nutrient flow to endothelial cells
Management:
Mild PBK
Hypertonic saline drops (Muro 128-5% sodium chloride)
Steroids
BCL
PK or DSAEK
Prevention:
Use of preoperative endothelial cell counts in high risk cases
Use of viscoelastic solution during the surgery

11. PBK http://emedicine.medscape.com/article/1193218-overview

12. descemet folds

13. Posterior Capsular opacification (PCO)
Aproliferation of lens epithelial cPosterior capsule becomes opacified as a result of continued proliferation of lens cells from the residual anterior lens epithelium or from residual fibrosis that could not be removed at the time of surgery
ells can lead to posterior capsule opacificationfter ECCE & PE,
Occurs in 50% of patients within 5 years after ECCE surgery
Occurs in 1/5 people who undergo PE PCIOL
Symptoms: decreased vision & FBS & pain if bullae present
Signs:
Blurry vision
Glare “secondary cataracts”
Asymptomatic
Management:
YAG laser capsulotomy
Done when the patient is symptomatic
Follow up in 1 week then 1 month s/p YAG
Complications:
Increased IOP
Damage to IOL
IOL dislocation
Inflammatory reaction
CME
RD- especially in myopic patients (1-3% of patients)

14. PCO http://flylib.com/books/en/3.283.1.8/1/

15. PCO

16. YAG

17. Cystoid macular edema (CME)
A condition in which fluid accumulates within the sensory retina in the macular area
May occur after intraocular surgery
Cataract
Filtration procedures
RD surgery
Associated with other systemic & ocular conditions including:
Diabetes
Peripheral uveitis RP
May occur in as high as 20% of cataract surgeries, but only persists in 1-2%
Onset: 6-10 wks s/p CE
Symptoms: decreased hazy vision
Signs:
Hyperopic shift in RE
Macular haze
Petaloid appearance on FA is the hallmark of CME (or flower petal)
Evidence suggests inflammation plays a role
Management:
May improve without treatment if no other surgical complications
70% of post-CE CME resolves spontaneously within 6 months
NSAIDs
CME may be recurrent
CME secondary to CE is AKA Irvin-Grass Syndrome

18. CME http://dro.hs.columbia.edu/pco2.htm

19. CME

20. Complications Late P.O Complications Management
Persistent Corneal Edema & Bullous Keratopathy
Control with topical steroids &/or hyperosmotics (Muro-128); PK may be required
Posterior Capsule Opacification (PCO)
YAG Laser
Cystoid Macular Edema
NSAIDs
Retinal Detachments
RD repair

21. Bye Bye Cataract- conclusion
Approach cases in a conservative manner
Correlate VA with anterior segment appearance
Maintain communication with surgeon and family physicians
Make referrals to experienced modern surgeons