When Cataract Surgery goes wrong!

[05/01/2014]

When Cataract Surgery goes wrong!

Happy 2014 everyone! It has been an absolute age since I last wrote anything and I have to apologise for my absence. Life has been hectic and this blog had unfortunately taken a back seat..... Well, it is a New Year and I have endeavoured to be more frequent with my writing this year!

I thought I'd start the year talking about the most common operation in the world - CATARACT SURGERY! Cataract is an age related clouding of the lens and us mere mortals, will be inevitably stricken by this disease as we grow older! The common symptoms which have been described are hazy or smoky vision or just plain blurred vision!(see below) Surgery is the only available treatment and the techniques of surgery have become so refined that it is a relatively quick procedure performed under local anaesthesia with excellent visual outcomes!



Modern cataract surgery is called phacoemulsification whereby ultrasound energy is used to break up the cataract into little pieces and removed. This is done through a small wound (less than 3mm) and no stitches are required. The common misconception is that laser is used and there are newer more expensive femtosecond lasers being used to perform certain parts of the procedure but the results have not been shown to be better than conventional phacoemulsification. 

When things go wrong?

Cataract surgery is a very safe operation but never forget that any form of surgery has its associated risks and complications! A retinal surgeon is often involved in the management of the complications of cataract surgery and as a retinal surgeon myself, I have seen my fair share and will talk about 3 of them today.

Dropped nucleus / dislocated cataract

The cataract is situated inside a "capsule" and during surgery, the front portion of the capsule is opened and the cataract removed. The back portion of the capsule has to be left intact so that a new lens can be implanted. This back portion of the capsule can sometimes be damaged during surgery and as a consequence, the cataract could fall to the back of the eye. When this occurs, the pieces of cataract which fall to the back have to be removed by a procedure called a vitrectomy. This second procedure has to be done by a retinal surgeon and could be done at the same sitting or several days later. If referred quickly to a retinal surgeon, this complication does not spell disaster for the patient and in actual fact, many patients still get good vision despite this complication.

Retinal Detachment

This complication is rare and can even occur years after cataract surgery. It is more common if the capsule is damaged during surgery or in patients who are highly short sighted and undergo cataract surgery.

The retina (or nerve layer of the eye) can become detached from the wall of the eye and this is a blinding condition which has to be treated urgently. The symptoms include seeing floaters, flashing lights or partial loss of vision.

Again, the retinal surgeon has an integral role in the management of retinal detachment which includes surgical procedures such as vitrectomy or scleral buckle. If treated early, the patient will still be able to see well.

Endophthalmitis

This is the most dreaded complication of cataract surgery and is exceedingly rare. This is when infection develops inside the eye after cataract surgery. It is therefore, imperative that patients maintain good hygiene and remember to use their postoperative antibiotic eyedrops to minimise the risk of infection.

When this occurs, the eye can become very inflamed and painful and vision can become very poor. In severe cases, the retinal surgeon has to perform a vitrectomy in an attempt to remove the source of infection and infuse antibiotics directly into the eye. 

Despite all I've said, cataract surgery is arguably the most successful operation in terms of "curing a disease" and restoring function! Hundreds and thousands of cataract operations are performed each year throughout the world. Nevertheless, be aware of what you are going in for when you have to undergo cataract surgery. I leave you with a short clip of one of my cataract operations.

Happy New Year once more!!

 

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