Cataract surgery is now the most common surgical procedure performed in India. Since the conversion from Small Incision Cataract Surgery (SICS) to phacoemulsification, the outcomes of cataract surgery have improved greatly, with the risk of complications falling down. Ninety-one percent of patients without any other ocular disease achieve a postoperative visual acuity of 6/12 or better, with 45.9 percent of all eyes achieving 6/6 or better.
Despite ongoing advances in cataract surgical technology, a small number of complications will always exist. This article explains about advances in surgery techniques, procedures and their possible complications.
According to WHO, Cataract is clouding of the lens of the eye which prevents clear vision. The only treatment option available is cataract surgery.
Cataract extraction surgery is done mainly in two techniques – Intracapsular and Extracapsular.1)Allen, David, and Abhay Vasavada. “Cataract and Surgery for Cataract.” BMJ: British Medical Journal 333.7559 (2006): 128–132.
Intracapsular extraction involves removal of the whole natural lens with its capsule from the eye.
Extracapsular extraction involves removal of almost entire lens material but the capsule is left intact to allow IOL implantation.
Phacoemulsification, modern extracapsular extraction procedure uses sophisticated machines to break the cataractous material inside the crystalline lens into small pieces then they sucked out. In this procedure, the incision can 2-3 mm small. Usually, the incision heals by itself without any stitches.
A small incision is made at the level of limbs where the cornea meets sclera (white part of the eye).
- A small surgical instrument called phaco-probe is inserted into the eye.
- With ultrasound waves, the cataract is broken down into smaller pieces. These pieces are then removed by the suction device.
- Finally, foldable foreign intraocular lens (IOL) is placed inside the eye.
Small Incision Cataract Surgery
In developing countries, Sutureless manual small incision cataract surgery (SICS) is done as a substitute to modern phacoemulsification procedure. Here the incision of about 6.0 mm is made outside the limbs. SICS are safer than earlier techniques, still, complications do occur.
In developing countries rather than foldable IOL’s, rigid IOL’s are used because of its low economic cost.
Complications of surgery
Modern cataract surgery is safe in more than 95 percent of patients. In the small number of cases where a serious complication occurs, the most common is a capsular rupture. This can lead to severe conditions like cystoid macular oedema (CME) or retinal detachment (RD). After surgery, patients can develop posterior capsular opacification (PCO). This is the most common post-operative complication. The most dangerous complication is endophthalmitis, the rate of which is now significantly decreased through the use of intracameral antibiotics.2)Chan, E., Mahroo, O. A. R. and Spalton, D. J. (2010), Complications of cataract surgery. Clinical and Experimental Optometry, 93: 379–389. doi:10.1111/j.1444-0938.2010.00516.x [PubMed]
Common complications are listed below,
- Rupture of the lens capsule.
- Opacification of the lens capsule.
- Endophthalmitis – Inflammation of the entire eye.
- Cystoid macular oedema – Swelling and fluid accumulation in the centre of the nerve layer.
- Corneal Oedema – Swelling of the cornea.
- Retinal Detachment – Detachment of nerve layer from the back of the eye.
- Increase pressure inside the eye leading to glaucoma.
- Refractive surprise – Sometimes patients without any refractive power have to wear glasses after cataract surgery because of induced refractive error.
References [ + ]
|1.||↑||Allen, David, and Abhay Vasavada. “Cataract and Surgery for Cataract.” BMJ: British Medical Journal 333.7559 (2006): 128–132.|
|2.||↑||Chan, E., Mahroo, O. A. R. and Spalton, D. J. (2010), Complications of cataract surgery. Clinical and Experimental Optometry, 93: 379–389. doi:10.1111/j.1444-0938.2010.00516.x [PubMed]|