1. DEPARTMENT OF INPATIENT
POST OPERATIVE COMPLICATION

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

3. 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.

4. 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

5. 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…

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

7. 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…

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

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

10. 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

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

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

13. 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

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

15. 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

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

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

18. 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

19. 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.

20. 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)

21. 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.

22. 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.

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

24. 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.

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

26. 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)

27. 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.

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

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

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

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

32. ORGANISMS :
Bacteria Fungal
Staphylococcus Aspergillus
Staphylococcus Candida
Streptococcus Fusarium
Pseudomonas

33. THANK YOU