postoperative cataract complications

Lecture 13
Liana Al-Labadi, O.D.
 Complications
Early P.O Complications Management
Transient Corneal Edema- secondary to minor surgical trauma to Control with topical steroids &/or hyperosmotics (Muro-128)
the corneal endothelium

Transient Anterior Iritis- i.e. Mild AC reaction Control with topical steroids

Transient Ocular Hypertension- due to residual lens material & Control with beta blockers or CAI or alpha adrenergic receptors
viscoelastic solution Consider paracentesis

Wound Leakage- Due to inadequate wound sealing, trauma or BCL + Antibiotic

eye rubbing. look for seidel’s sign; IOP usually low

FB sensation- exposed suture vs SPK Treat as dry eye

Lens remnant Uveitis- Causes severe uveitis & may result in Cylcoplegia BID & steroids Q2H; surgical intervention may be
secondary glaucoma required

Infectious Endophthalmitis- very poor prognosis (50% AB + Cycloplege + Steroids + (?IV AB)
blindness) (
Corneal Edema
Mild Uveitis
Seidel’s Sign
 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
ENDophthalmitis
 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

 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
 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
 PBK

http://emedicine.medscape.com/article/1193218-overview
http://www.doctorshangout.com/photo/bullous-keratopathy

http://flylib.com/books/en/3.283.1.8/1
descemet folds
 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)
 PCO

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

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

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

http://www.retinatexas.com/images/CSME.jpg
 CME

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

 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