Cataract Complications

Cataract surgery complications are relatively rare and most often treatable.

Cataract surgery is surgery and all surgery has potential complications, however 95.4%† of cataract patients have no cataract surgery induced complications. The vast majority of cataract surgery complications that do occur are resolved within three to six months after surgery.

A list of what can possibly go wrong during cataract surgery can be frightening, however it is valuable to consider the probability of something going wrong more than the possibility. A rate of occurrence for each potential complication has been provided when available.

Below are short descriptions of known cataract surgery complications with links to more detailed articles.

• Allergic Reaction

  Negative response to mediations used during and after cataract surgery. Prognosis excellent. Occurrence percent estimated under 1.0%.

  Many anti-bacterial, anti-inflammatory, and other medications are applied and prescribed for cataract surgery and recovery. Some may have agents that cause an allergic reaction in some patients. Many different types of agents that can provide the same benefits make changes for known allergies available.  Prognosis is excellent with proper identification of the allergen and change to a different agent.

  Intraocular lenses (IOLs) are made of benign materials. Allergic reaction or rejection of the IOL is virtually impossible.

• Astigmatism

  See Refractive Error

• Blood In Eye

  See Hyphema

• Choroidal Hemorrhage

  Bleeding of the choroid. Prognosis very poor to good. Occurrence is 0.07% †.

  The fine mesh of blood vessels that supply the retina is the choroid. These vessels may bleed during cataract surgery, causing pressure on the retina and possible retinal detachment.

  If the hemorrhage is confined to a small area of the choroid, patients often recover without significant visual loss. However, in the most severe cases of choroidal hemorrhage, patients can have complete and permanent visual loss. Treatment may be draining the blood buildup through a small port created in the eye. Prognosis is very poor if a large area of the retina is affected to good if a small area is affected and when appropriately diagnosed and treated.

• CME

  See Cystoid Macular Edema

• Corneal Edema

  Inflammation of the cornea. Recovery prognosis excellent. Occurrence is 5.18% †.

  Cataract surgery can be traumatic to the cornea (clear front of the eye) and a common response is inflammation. Symptoms may include induced refractive error, poor distance vision, improvement in near vision, sensitivity to light (photophobia), blurred vision. Treatment is commonly anti-inflammatory eye drops or tablets. Resolution prognosis is excellent when appropriately diagnosed and treated.

• Cystoid Macular Edema (CME)

  Inflammation of the part of the retina used for central vision. Prognosis excellent. Occurrence 1.62%.

  Inflammation of the part of the retina used for central vision due to accumulation of fluids. CME tends to be a caused by another disorder that must be diagnosed and treated. Symptoms include fluctuating poor central vision, and/or no pain.  Treatment for CME may be anti-inflammatory eye drops, injections, or tablet medication. Resolution prognosis is excellent when both CME and its underlying causes are appropriately diagnosed and treated.

• Decentered Intraocular Lens (IOL)

  IOL placement in eye is not centered to visual axis. Prognosis good. Occurrence is 0.22% †.

  The artificial intraocular lens (IOL) that replaces the defective natural crystalline lens during cataract surgery may become decentered due to placement issues, eye structure, or changes during healing.

  Decentration is especially problematic for multifocal IOLs and accommodating IOLs. Symptoms include poor vision, doubled vision in one eye, and/or glare. Treatment for a conventional or multifocal IOL is surgery to reposition the lens. Treatment for an accommodating IOL may be laser to disrupt the stressed area that is causing decentration. Prognosis is good  when appropriately diagnosed and treated.

• Descement's Folds

  Folds in the Descement's layer of the cornea. Prognosis excellent. Occurrence 2.57% †.

  Elevated intraocular pressure (IOP), or corneal edema may stress the cornea and cause folds in the Descement's layer. Symptoms may include no outward symptoms, sensitivity to light (photophobia), blurred vision, and/or eye pain. Treatment is commonly eye drops or tablets. Recovery prognosis excellent when appropriately diagnosed and treated.

• Dislocated Lens Material

  See Retained Lens Material

• Endophalmitis

  Bacterial infection within the eye after cataract surgery. Prognosis good to vision loss. Occurrence 0.25%††

  Endophalmitis is an infection that may appear as early as hours after cataract surgery or weeks to months to years after surgery. It is generally considered the most devastating potential adverse event following cataract surgery. The infection will destroy vision within days of presentation if not appropriately diagnosed and treated. To prevent endophalmitis, measures such as the use of antimicrobial eye drops are common.

  Symptoms include pain, red eye, and/or severe and rapid decrease of vision. Treatment is typically antibiotics but aggressive response may include vitrectomy.  Recovery prognosis is good when appropriately diagnosed early and aggressively treated, poor to very poor with vision loss if not appropriately diagnosed and treated in a timely manner.

• Nearsighted

  See Refractive Error

• Floppy Iris Syndrome (FIS)

  Poorly toned iris. Prognosis excellent. Occurrence estimated less than 0.5%.

  When the iris is flaccid it will move in and out with aqueous flow or changes in interchamber intraocular pressure, making cataract surgery more difficult and sometimes causing Iris Prolapse and uncontrolled pupil constriction. FIS is often associated with patient's use of Flomax® (tamsulosin), a medication commonly used for prostate conditions, but may be associated with other causes. Symptoms are pain, slow vision recovery, lower vision quality. Treatment is primarily preventative with removal of medications contributing to FIS and the use of devices to control iris constriction. Recovery prognosis is excellent if FIS is anticipated and surgeon is prepared for a complicated surgery.

• Halo

  Fuzzy halos around objects, especially light sources at night.

• Hyperopia

  See Refractive Error

• Hyphema

  Blood in the anterior chamber of the eye. Prognosis excellent. Occurrence 0.07% †.

  The anterior chamber (AC) is located behind the front of the eye. Trauma during cataract surgery may cause bleeding and the blood may travel into the AC. Symptoms include dramatic decrease in vision, pain, nausea, red eye. Treatment is commonly shielding the eye, bed rest with the head elevated 45°, avoidance of blood thinners including aspirin and nonsteroidal anti-inflammatory drugs like Advil, medications to stabilize blood clot formation may be administered. Recovery prognosis excellent when appropriately diagnosed and treated, however the direct cause of the bleeding may present a different prognosis.

• Incision Leak

  See Wound Leak

• Intraocular Lens (IOL) Decentration

  See Decentered Intraocular Lens

• Intraocular Pressure Elevation

  Pressure within the eye becomes elevated. Prognosis excellent. Occurrence 2.57% †.

  Elevated intraocular pressure (IOP) may stress the optic nerve. Symptoms may include no outward symptoms, sensitivity to light (photophobia), blurred vision, and/or eye pain. Treated with eye drops or tablets. Recovery prognosis excellent when appropriately diagnosed and treated.

• Intraoperative Floppy Iris Syndrome

  See Floppy Iris Syndrome.

• Iris Prolapse

  A portion of the iris moves toward and/or exits through the corneal incision. Prognosis good. Occurrence 0.16% †.

  During cataract surgery an incision is made at the edge of the cornea to allow access to the defective natural crystalline lens within the eye. An iris that is not stable or a lack of pressure equalization inside and outside the eye may allow a portion of the iris to travel toward, into, or through the incision. Related to Floppy Iris Syndrome. Treatment is repositioning the iris within the eye during surgery. Prognosis is good, however damage may occur to the delicate iris.

• Macular Edema

  See Cystoid Macular Edema

• Myopia

  See Refractive Error

• Nearsighted

  See Refractive Error

• Overcorrection

  See Refractive Error

• PCO

  See Posterior Capsule Opacification

• Posterior Capsule Opacification

  The membrane that surrounds the lens becomes cloudy. Prognosis excellent. Occurrence 1.22% †.

  To help position the intraocular lens (IOL) the outermost layer of the natural crystalline lens is left largely intact. This capsule may become cloudy. Symptoms include blurred vision, hazy vision. Treatment is opening a hole in the capsule with a laser. Recovery prognosis excellent when appropriately diagnosed and treated.

  Approximately 50% of cataract surgery patients will eventually have posterior capsule opacification over a greater period of time.

• Posterior Capsule Rupture

  A hole forms in the back of the outermost layer of the natural lens.

• Posterior Vitreous Detachment

  See Vitreous Detachment

• Refractive Error

  Vision after cataract surgery not 20/20, requiring correction with glasses or contacts. Prognosis excellent. Occurrence is 54.1%†

  Refractive error includes myopia (nearsighted, shortsighted) vision, hyperopia (farsighted, longsighted) vision, and astigmatism (cornea is not spherical like top of a ball, but is elliptical like the back of a spoon).

  Intraocular lens (IOL) power is calculated to provide the best uncorrected vision possible, however preoperative measurements, intraoperative placement of the IOL, and postoperative conditions may cause refractive error and provide vision that is not 20/20 (6/6).

  Treatment is commonly glasses, contact lenses, or laser vision correction surgery like Lasik. If refractive error is great, then IOL exchange, piggy back lens implantation, or phakic intraocular lens (PIOL) may be recommended.

• Retained Lens Material

  Fragments of the natural crystalline lens remain within the eye. Prognosis fair. Occurrence 0.45% †.

  During modern cataract surgery ultrasonic energy is used to break up the central portion of the natural crystalline lens into fragments, which are then removed from the eye through gentle vacuum. Fragments may move to areas within the eye where they cannot be reached by vacuum. Symptoms may include blurry vision, dark spots within the visual field. Treatment is commonly to allow fragments to remain, however in severe cases surgery to remove the fragments may be appropriate. Prognosis is fair when appropriately diagnosed and treated.

• Retinal Detachment

  Retina becomes detached from the back of the eye. Prognosis poor to very poor with vision loss. Occurrence 0.75 to1.65%†††

  The retina is a light sensitive membrane that transfers light energy into nerve signals sent to the brain. Trauma to the eye causing fluid to build and inflammation may cause retinal detachment. Probability of retinal detachment is much greater for a person who is highly myopic (nearsighted, shortsighted).

  Symptoms include a dense shadow that starts in the peripheral vision and slowly progresses toward central vision, appearing like a veil or curtain drawn over the field of vision, straight lines (edge of the wall, road, etc.) suddenly appear curved, and/or central visual loss. Treatment may include pneumatic retinopexy, which is the introduction of an expandable gas into the eye to provide pressure to reattach the retina, scleral buckling, which is attaching a small band to the outside of the eye that changes the stress to the retina on the opposite side of the buckle, and/or vitrectomy which is removing the vitreous and replacing it with a solution that provides appropriate intraocular pressure (IOP). 

• Secondary Cataract

  See Posterior Capsule Opacification

• Starburst

  Rays of fuzzy light appear to emit from light sources, especially at night.

• TASS

  See Toxic Anterior Segment Syndrome

• Toxic Anterior Segment Syndrome

  Acute, noninfectious inflammation of the anterior segment of the eye. Prognosis good to very poor. Occurrence estimated less than 0.25%.

  Various contaminants, usually from surgical equipment or supplies, have been implicated as causes of TASS. The syndrome typically develops within 24 hours after surgery. Symptoms include increased myopia, poor vision quality. Treatment is commonly topical steroids and/or nonsteroidal anti-inflammatory eye drops. Recovery prognosis is good to very poor as inflammatory response may cause serious damage to intraocular tissues, resulting in vision loss, if not properly diagnosed and promptly treated.

• Undercorrection

  See Refractive Error

• Uveitis

  Inflammation of the middle layer of the eye. Recovery prognosis excellent. Occurrence 3.29% †.

  In common usage uveitis may refer to any inflammatory process involving the interior of the eye. Symptoms may include redness of the eye, blurred vision, sensitivity to light (photophobia), dark floating spots within the visual field, and/or eye pain. Treated with anti-inflammatory eye drops or tablets. Recovery prognosis excellent when appropriately diagnosed and treated.

• Vitreous Detachment

  Detachment of the vitreous from the inner walls of the eye. Prognosis excellent. Occurrence N/A.

  Most of the eye's interior is filled with vitreous, a clear gel-like substance that helps the eye maintain a round shape. There are millions of fine fibers intertwined within the vitreous that are attached to the surface of the retina, the eye's light-sensitive tissue. With age the vitreous slowly shrinks, and these fine fibers pull on the retinal surface. Usually the fibers break, allowing the vitreous to separate and shrink from the retina.

  The vitreous is normally not disrupted by cataract surgery, however trauma through surgery may lead to detachment. In most cases a vitreous detachment is not sight-threatening and requires no treatment.

• Vitreous Loss

  Movement of a portion of the vitreous into the anterior chamber of the eye. Prognosis good.  Occurrence 0.17% †.

  The vitreous is the clear jelly like substance that fills the main body of the eye. During cataract surgery a portion of the vitreous may seep into the anterior chamber of the eye in front of the natural crystalline lens. Symptoms may include light flashes. Treatment is commonly removal of the vitreous during surgery. Recovery prognosis good when appropriately diagnosed and treated.

• Wound Leak

  Internal fluids of the eye leak through incision. Prognosis is excellent.  Occurrence 0.14% †.

  Most modern cataract surgery utilizes very small incisions in the cornea that do not require stitches. On occasion these incision will leak eye fluids, causing fluid loss and loss of intraocular pressure (IOL). Treatment may be to suture the incision. Recovery prognosis excellent when appropriately diagnosed and treated.

†Eye, 2007 Nov 23. Jaycock, et al, The Cataract National Dataset electronic multi-centre audit of 55,567 operations: updating benchmark standards of care in the United Kingdom and internationally. Link to abstract.

††Ophthalmology, 2005 Sep;34(9):1460-7, West et al, . Link to abstract

†††Seminars in Ophthalmology, 2002 17 (3-4): 206–13, Kruger et al, "Biostatistical analysis of pseudophakic and aphakic retinal detachments" Link to abstract

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