Complications after cataract surgery

The intraoperative complications following cataract surgery are as follows:

[1], [2]

Rupture of the posterior capsule

This is a rather serious complication, as it can be accompanied by loss of the vitreous, migration of lens masses back and less often - by expulsive bleeding. With inappropriate treatment for long-term consequences, the loss of the vitreous body is attributed to the upward-raised pupil, uveitis, vitreous humor, "wick" syndrome, secondary glaucoma, posterior artificial lens dislocation, retinal detachment and chronic cystic edema of the macula.

Signs of rupture of the posterior capsule

• Sudden deepening of the anterior chamber and instant dilatation of the pupil.
• The failure of the nucleus, the impossibility of pulling it to the tip of the probe.
• Probability of aspirating the vitreous.
• A torn capsule or vitreous body is clearly visible.

The tactics depend on the stage of the operation, on which the rupture occurred, and its magnitude and on the presence or absence of vitreous prolapse. The basic rules include:

• the introduction of viscoelasticity for nuclear masses with a view to removing them into the anterior chamber and preventing the hernia of the vitreous humor;
• the introduction of a special gland for the lens masses in order to close the defect in the capsule;
• removal of fragments of the lens by the introduction of viscoelastic or their removal with the help of phaco;
• complete removal of the vitreous from the anterior chamber and the section of the cut with vitreotome;
• the decision to implant an artificial lens should be made taking into account the following criteria:

If the lens masses are in large quantities in the vitreous cavity, the artificial lens should not be implanted, as it can interfere with the visualization of the fundus and the successful vitrectomy of the pars plana. Implantation of the artificial lens can be combined with vitrectomy.

With a small rupture of the posterior capsule, a careful implantation of the ZK-IOL into the capsular bag is possible.

With a large rupture and especially with intact anterior capsulorrexis, it is possible to fix the ZK-IOL in the ciliary groove with the placement of the optical part in the capsular bag.

Insufficient capsule support may necessitate ligation of the intraocular lens in the sulcus or implantation of the IOL by means of a glide. However, PC-IOL causes more complications, including bullous keratopathy, hyphema, iris folds and pupil irregularity.

Dislocation of fragments of the lens

The dislocation of lens fragments into the vitreous after the rupture of zonal fibers or the posterior capsule is a rare but dangerous phenomenon, since it can lead to glaucoma, chronic uveitis, retinal detachment and chronic wrist edema of the macula. These complications are more often associated with phaco than with EEC. Initially, treatment for uveitis and glaucoma should be performed, then the patient should be referred to a vitreoretinal surgeon for vitrectomy and removal of the lens fragments.

NB: There are cases when it is impossible to achieve the correct position even for the PC-IOL. Then it is more reliable to refuse implantation and to make a decision about correction of aphakia with a contact lens or secondary implantation of the intraocular lens at a later date.

The timing of the operation is contradictory. Some suggest removing residues within 1 week, since a later removal affects the restoration of visual functions. Others recommend postponing the operation for 2-3 weeks and to conduct a course of treatment for uveitis and increased intraocular pressure. Hydration and softening of lens masses during treatment facilitates their removal by vitreotome.

Surgical technique includes vitrectomy pars plana and removal of soft fragments by vitreotome. The denser fragments of the nucleus are joined by the introduction of viscous liquids (eg, perfluorocarbon) and further emulsification with a fragomatome at the center of the vitreous cavity, or through a corneal incision or scleral pocket. An alternative method of removing dense nuclear masses is their crushing with subsequent aspiration,

[3], [4], [5], [6], [7], [8], [9], [10],

Dislocation of ZK-IOL into the vitreous cavity

Dislocation of ZK-IOL into the vitreous cavity is a rare and complex phenomenon, which indicates incorrect implantation. The retention of the intraocular lens can lead to vitreal hemorrhage, retinal detachment, uveitis and chronic cystovidio edema of the macula. Treatment - vitrectomy with removal, reposition or replacement of the intraocular lens.

With adequate capsular support, it is possible to reposition the same intraocular lens in the ciliary furrow. With inadequate capsular support, the following options are possible: removal of the intraocular lens and aphakia, removal of the intraocular lens and replacement of it with a PC-IOL, scleral fixation of the same intraocular lens with a non-absorbable suture, implantation of iris lens clips.

[11], [12], [13], [14], [15], [16], [17]

Hemorrhage in the suprachoroidal space

Hemorrhage in the suprachoroidal space may be a consequence of the expulsive bleeding, sometimes accompanied by loss of the contents of the eyeball. This is a formidable, but rare complication, unlikely with phacoemulsification. The source of hemorrhage is the rupture of long or posterior short ciliary arteries. The contributing factors are elderly age, glaucoma, anterior-posterior segment, cardiovascular disease and loss of vitreous humor, although the exact cause of bleeding is not known.

Symptoms of suprachoroidal hemorrhage

• Increasing chopping of the anterior chamber, increased intraocular pressure, prolapse of the iris.
• The flow of the vitreous body, the disappearance of the reflex and the appearance of a dark tubercle in the pupil area.
• In acute cases, the entire contents of the eyeball may flow out through the incision area.

Immediate actions include closing the cut. Posterior sclerotomy, although recommended in this case, can increase bleeding and cause loss of the eye. After the operation, the patient is prescribed local and systemic steroids for relief of intraocular inflammation.

Follow-up tactics

• Ultrasound is used to assess the degree of manifestation of the changes;
• the operation is shown 7-14 days after the blood clots are diluted. The blood is drained, vitrectomy is performed with air / fluid replacement. Despite the unfavorable vision forecast, in some cases it is possible to preserve residual vision.

Edema

Edema is usually reversible and is most often due to the operation itself and endothelial trauma in contact with instruments and the intraocular lens. Patients with endothelial dystrophy Fuchs represent an increased risk. Other causes of edema are the use of excessive power during phacoemulsification, a complicated or prolonged operation and postoperative hypertension.

[18], [19], [20], [21], [22], [23]

Iris Dropout

Iris prolapse is a rare complication in operations with small incisions, but it can occur with EEC.

Causes of loss of the iris

• The incision at phacoemulsification is closer to the periphery.
• The percolation of moisture through the incision.
• Poor seam imposition after EEC.
• Factors associated with the patient (cough or other stress).

Symptoms of an iris

• On the surface of the eyeball in the region of the incision is determined the fallen tissue of the iris.
• The front camera in the cut can be shallow.

Complications: uneven scarring of the wound, pronounced astigmatism, ingrowth of the epithelium, chronic anterior uveitis, macular edema of the macula and endophthalmitis.

Treatment depends on the interval between the operation and the detection of prolapse. When the iris falls for the first 2 days and there is no infection, its reposition with repeated suturing is shown. If the prolapse has occurred long ago, the excision of the iris is performed because of the high risk of infection.

Displacement of intraocular lens

Displacement of the intraocular lens is rare, but can be accompanied by both optical defects and disturbances in the structure of the eye. When the edge of the intraocular lens is shifted to the pupil area of the patients, visual aberrations, glare and monocular diplopia disturb.

Causes

• The displacement of the intraocular lens mainly occurs during surgery. It can be caused by dialysis of the zinn ligament, rupture of the capsule, and also can occur after the usual phacoemulsification, when one haptic part is placed in the capsular bag, and the second - in the ciliaria furrow.
• Postoperative causes include trauma, eyeball irritation and capsule contraction.

Treatment with miotics is beneficial with a slight bias. A significant displacement of the intraocular lens may require replacement.

[24], [25], [26], [27], [28], [29]

Rheumatogenic retinal detachment

Rheumatogenic retinal detachment, despite its rare occurrence after EEC or phacoemulsification, may be associated with the following risk factors.

Before surgery

• Latticular degeneration or retinal fractures require prior treatment before cataract extraction or laser capsulotomy if ophthalmoscopy is possible (or immediately after it becomes possible).
• Myopia of a high degree.

During the operation

• The loss of the vitreous humor, especially if the subsequent tactics was wrong, and the risk of detachment is about 7%. If there is a myopia> 6 D, the risk increases to 1.5%.

After operation

• Conducting YAG laser capsulotomy at an early date (within a year after surgery).

Brush retina swelling

Most often it develops after a complicated operation, which was accompanied by rupture of the posterior capsule and loss of, and sometimes infringement of the vitreous, although it can also be observed with a successfully performed operation. Usually appears 2-6 months after the operation.

[30]