What are the risks and complications of cataract surgery?
Cataract surgery is one of the most successful procedures in modern medicine.
More than 99% of patients experience an improvement in their vision. However, even in the best hands complications may still occur.
Tears of the posterior lens capsule
The lens capsule is the transparent bag, which surrounds the lens. During cataract surgery a circular hole is torn in the front surface of the capsular bag so the surgeon can then remove the cloudy lens material. Every effort is made to preserve the remainder of the capsular bag so that the implant lens can be placed in this bag once the cataract has been removed. Tears in the back (posterior) of the capsular bag occur in approximately 2% of cases (National Cataract Audit of over 55,000 cases). Although the complication rate for surgery carried out by a Consultant Ophthalmologist is often closer to 0.5%.
Should this complication arise it is usually still possible to place an intraocular lens on top of the remaining capsule. The eye may take longer to settle down but majority of patients still achieve good outcome if this complication is managed well.
Very occasionally a small piece of lens material falls into the vitreous jelly, if this happens a second operation may be necessary to remove this lens material.
Bleeding within the layer of blood vessels that nourish the retina is a very rare and unpredictable complication of cataract surgery. If the bleeding is localised the eye may recover but in more severe cases permanent, severe visual loss may occur.
Endophthalmitis (infection inside the eye)
This is potentially the most serious complication of cataract surgery, but fortunately it is also the least common (approximately between 1 in 1,000 to 1 in 1,500 operations). Every precaution before, during and after surgery is taken to prevent the development of endophthalmitis. The first signs and symptoms are of increasing pain, redness and deteriorating vision in the first 5-7 days after surgery. If these symptoms occur you should contact your surgeon immediately.
Posterior vitreous detachment and retinal detachment
Cataract surgery slightly increases the risk of posterior vitreous detachment and subsequent retinal detachment.
Myopic patients and those who suffer a posterior capsule rupture during surgery are at greater risk that normal sighted patients or those who have uncomplicated surgery. New floaters in your field of vision and flashes of light are warning signs and if they occur you should contact your surgeon immediately.
Cystoid macular oedema (CMO)
The centre of the retina that serves detailed central vision is called the macula. After routine cataract surgery inflammation may cause swelling in this area of the retina, which is referred to as cystoid macular oedema. This condition results in blurred central vision 3-6 weeks after surgery and in the majority of cases resolves without treatment after 2-3 months. Occasionally anti-inflammatory drops or tablets may be prescribed to speed up recovery.
Post-operative refractive error
During cataract surgery the strength of the intraocular lens implant is chosen to help correct any previous long or short sightedness. The aim of surgery in most cases is to provide good distance vision with no glasses, or just a weak spectacle correction, but reading glasses will be needed for close work. Although the equipment used to calculate the strength of the implant is very accurate there is still the possibility that small errors can occur, especially in very long or shortsighted eyes. This may mean that following surgery you may be slightly more long or short sighted than your surgeon had planned. In very rare cases a second operation may be needed to replace the implant with one of a different strength. If there is significant pre operative astigmatism (i.e. the shape of the eye ball is not like a football but like a rugby ball) then glasses may still be needed to correct this afterwards.
Posterior Capsule Opacification (PCO)
Thickening of the posterior lens capsule occurs in approximately 1 in 10 patients following cataract surgery. If you notice a gradual decline in vision 1-2 years after cataract surgery this is the most common cause. PCO is often detected by your optician who will then refer you back to the clinic for laser treatment. This is carried out using a laser mounted on a slit lamp. Treatment only takes 2-3 minutes to carry out and is painless.
Click here to download a leaflet on YAG laser posterior capsulotomy to treat.
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I had cataract surgery to both eyes. I also had upgraded trifocal lenses in both eyes. I am very happy as the cataract symptoms have now gone and I do not need glasses at all. I sit at a computer 90% of my working day. Before the surgery I could not see the screen without glasses and now I do not need them at all.
I am writing to thank you for the care and attention you afforded me recently to remedy the cataracts in both eyes and the astigmatism in my right eye. Throughout you explained clearly your thoughts and proposals for my treatment and set clear expectations about the outcome from the two operations. The expectations you set for long distance and short sight distance have not only been met but been exceeded. I am delighted with the outcome. The two operations were painless and I would recommend anyone who has to undergo such treatment not to be concerned. At all times you provided excellent patient care. As you know I am engaged in the IT industry and in my view the two most important facets to success is the technical solution provided and working closely with my clients. Clearly you have immense technical knowledge and in addition managed to make me feel at ease, comfortable and consequently I gained complete confidence with you. I have been wearing glasses and / or contact lenses for over 50 years and to be able see normally without either is a fantastic feeling. Mr Goyal thank you again for the excellent care you provided to me. If ever the opportunity arises I would be happy to recommend you.
I recently underwent surgery for a cataract in my R eye following a very frightening experience where I had developed complete loss of vision in my R eye over a period of 2 hours. Mr Goyal provided not only incredible expertise but kindness and a sense of humour throughout,I cannot recommend him highly enough.
It was a pleasure to be treated by Mr. Goyal. I was completely relaxed throughout both of my cataract operations performed by him. All went well and true to his word he telephoned me the next morning the ensure that all was well.
Saurabh Goyal is a charming man and an excellent surgeon who exudes quiet confidence in his undoubted abilities. When he successfully carried out bilateral laser iridotomy on my eyes I decided that he was the only surgeon I would choose to perform my cataract surgery. His attention to detail throughout has been meticulous and nothing has been too much trouble for him on my behalf. He is, in short, an immense credit to his Profession.T.D.Ireland B.Sc.,C.Eng.,F.I.Mech.E.