Potential Complications After Surgery

Complications from cataract surgery occur in only a tiny percentage of patients. The risks are almost nil in the hands of an excellent surgeon. When rare complications do occur, however, a few can be serious and might require immediate medical attention.

Be sure to ask your doctor what you should do-both during and after office hours-if you have symptoms of potentially serious complications.

Infection

Fewer than one-tenth of 1 percent (0.1%) of cataract-surgery patients get endophthalmitis, a bacterial (or occasionally fungal) infection of the inner eye. Symptoms can include pain, loss of vision, and excessive redness. If not treated immediately, the condition might damage the vision. The usual treatment is injection of antibiotics into the eye. Rarely, vitrectomy-removal of the vitreous-is necessary to control the infection.

Retinal Detachment

In about one-half of 1 percent (0.5%) of patients, vitreous fluid seeps through a tear in the retina after cataract surgery, separating the retina from the back of the eye. Extremely nearsighted patients are at greater-than-normal risk for retinal detachment.

Symptoms include a shower of new floaters, much like a swarm of bees, in the vision, or extensive flashes of light, akin to fireworks. The most distinctive symptom is complete or partial loss of vision in the affected eye. Patients report feeling as if a curtain is moving across their field of vision.

Like infection, retinal detachment is a medical emergency. If you have symptoms of either, you should seek treatment immediately, day or night.

Inflammation

Slight inflammation within the eye is normal for a day or two after surgery. Very unusual is prolonged inflammation of eye membranes (uveitis) or the macula (cystoid macular edema, caused by accumulation of fluid in the retina). These can usually be managed using anti-inflammatory eye drops. Corneal edema, an inflammation of the cornea, may in extreme cases require a cornea transplant. Report any eye pain, tenderness, or swelling to your ophthalmologist immediately.

Lens Shifting

Rarely, the implanted lens shifts or rotates within the eye. It can be replaced surgically, although wearing thin eyeglasses usually solves the problem.

Incorrect Prescription

A capable, experienced eye surgeon will carefully formulate the prescription for your lens using measurements of the cornea and the length of the eye. This formulation is more difficult if you are extremely farsighted or nearsighted or if you've had LASIK or another type of refractive surgery-all of which underscores the importance of finding the best ophthalmologist available, ideally one who specializes in cataract surgery. If it turns out that the lens is too strong or too weak, the solution is to perform additional surgery to improve the focusing or rarely to replace it surgically.

After-Cataract (Secondary Cataract)

When the clouded natural lens is removed and a synthetic lens implanted, it's impossible for cataracts to "come back." Sometimes, however, the natural lens capsule, part of which remains in the eye to hold the implanted lens in place, becomes clouded or thickened. This posterior capsule opacity-which can develop months or years after your surgery-is also called an after-cataract or secondary cataract. It is quite common and affects younger patients more often than older patients.

Fortunately, the problem can be quickly and safely repaired with a five-minute outpatient procedure called YAG laser capsulotomy. Your eye surgeon will use an yttrium aluminum garnet (YAG) laser to make a small hole in the back of the lens capsule, allowing light through. The procedure is painless, requiring no incision or sutures.