Complications of Cataract Surgery

For most patients, cataract surgery is a low risk event.  It is likely that you will have minimal to no discomfort during surgery, minimal discomfort after surgery, and rapid emergence of excellent vision within several days or even sooner.  Minor issues come up relatively infrequently.  

 

More rarely, major issues can come up.  Complications are listed below in approximate order of frequency. This is not a comprehensive list. The likelihood and consequences of any given event may be different for different people.  Before surgery, your surgeon should discuss with you the risks and benefits in your particular case.  If you are worried, err on the side of caution.  When in doubt, call your doctor.

If you recently had cataract surgery and just want to know if your symptoms are normal, click here.

 

Minor Complications

 

1. Cornea abrasion (10%): On the day of surgery you may feel like you scratched your eye.  You may tear a lot and the pain might be pretty significant for a few hours.   This does not affect your prognosis and usually goes away quickly.  Often it is gone by the time you wake up the next morning.   In some cases it can persist for several days.

2. High postoperative pressure (5%).  Pressure can vary widely on the first postoperative day. This usually resolves on its own.  A mild increase in pressure does not cause symptoms.  If pressure gets high enough, you might feel an ache around your eye.  

 

Pressure can also rise slowly over the course of the first several weeks. Your surgeon will be watching for this.  This is usually not high enough for you to feel.  Your surgeon may recommend adding some eyedrops temporarily to treat high pressure.

3. Corneal edema (5%).  This can cause blurred and foggy/misty vision for a few days.   It is often worse in the mornings. Your surgeon will discuss how quickly you can expect this to resolve.

4. Tearing (5%).  You may notice more tearing during the first few weeks after cataract surgery.  Tearing often resolves after a month or two, so it is best not to do anything about it right away.  If it persists, explore options for treating it with your surgeon.

5. Rebound inflammation (5%).  After surgery, you will probably be given eyedrops to keep inflammation down.  These are usually tapered off during the first month. Occasionally inflammation returns.  You might notice that the eye becomes uncomfortable and more light sensitive a day or two after stopping eye drops.  Sometimes you just need to be on your eyedrops for a little longer.   Do not stop your eyedrops- or restart them- unless your doctor tells you to do so.

6. Dry eye (5%):  Cataract surgery can make dry eye worse.  There are several reasons for this, including the side effects of postoperative eye drops, and the surgical incisions.  You may notice some extra dry eye for up to 2 months after surgery.

7. Unexpected refractive outcome (1-2%):  About 1-2% of the time, your eye after surgery may focus differently than you expected, enough for you to notice.  Your focus may be inside your goal (nearsighted), outside the goal (farsighted), or you may have unexpected astigmatism. This can occur in the hands of the very best surgeons.  If this happens, there are options for treating it including glasses, contact lenses, corneal refractive surgery, and exchange of the intraocular lens. 

 Major Complications

1. Macular Edema after surgery  (1 in 200):

The retina can become swollen due to inflammation. The most likely time for this to occur is about a month after surgery.  If this happens, you will notice that your vision gets a little blurry at all distances. This swelling, called cystoid macular edema, usually gets better all by itself.  Your surgeon will probably prescribe eyedrops to make the swelling better more quickly.  Diabetics are at increased risk of developing this issue.

2. Vitreous loss during surgery (1 in 300): 

The vitreous is the substance behind the lens. It has the consistency of jelly, which is very different from the liquid in front of the lens and iris.  The two substances are separated by an extremely thin, clear membane.  This membrane, called the posterior capsule, remains intact during and after cataract surgery.  If the posterior capsule is torn during surgery, some of the vitreous can come forward into the front of the eye, and pieces of the cataract can fall into the back of the eye.  The term for this is vitreous loss. 

 

The most common symptom is floaters. These may persist for months.   Many other issues can come up surrounding vitreous loss, including high pressure, malpositioned intraocular lens, retained debris, retinal detachment, macular edema, prolonged inflammation, and infection.  The many potential consequences of vitreous loss are beyond the scope of this website.  If vitreous loss occurs during your surgery, the first thing to do is have a discussion with your surgeon regarding the specific concerns they have for your eye, and what their management plan is.   

3. Infection after surgery (1 in 5,000-10,000)

Infection can occur as early as one or two days after cataract surgery.   It is more likely to happen if there was a complication during the initial surgery, however it can occur even in the setting of straightforward cataract surgery.  Infection is a rare, serious, and rapidly progressive event.  Symptoms include moderate to profound drop in vision, red eye, light sensitivity, pain, and ache.  If you think this may be happening to you, call your doctor, day or night. 

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