Neuro-ophthalmologic complications of cataract surgery

Neuro-ophthalmologic complications from cataract surgery are uncommon and include central nervous system toxicity, binocular diplopia, traumatic optic neuropathy and ischemic optic neuropathy. Retrobulbar blocks may be accidentally injected into the subarachnoid space with diffusion to the brainstem. This leads to cardiovascular, respiratory, and mental status compromise. Most patients have complete recovery with adequate support. Post-operative, binocular diplopia may occur secondary to anisometropia or previously unrecognized misalignment. Periocular injection may cause paresis or fibrosis of extraocular muscles. Anterior or posterior ischemic optic neuropathy can occur in the first 6 weeks after cataract surgery with or without periocular injection. The risk to the other eye is high with subsequent contralateral cataract extraction. Post-operative vision loss associated with direct traumatic needle injury is recognized immediately. Therefore, an orbital MRI may be warranted for a patient with an optic neuropathy in the first 24 hours after cataract surgery using periocular anesthesia. If evidence of needle injury is present on neuroimaging, a trial of steroids should be considered.     

Corneal complications of cataract surgery

Recent advances in cataract surgery have reduced the incidence of corneal complications. Review of the current literature reveals a trend toward early visual rehabilitation and minimization of postoperative astigmatism by careful selection of incision type and location for small-incision cataract surgery. Since the introduction of intraocular lenses, endothelial cell loss has been a concern. Preservation of corneal endothelial cell function continues to be a major goal as cataract surgery continues to evolve. Recent studies have been undertaken to determine the effect of incision location and size on endothelial cell loss. Several reports on iatrogenically induced corneal decompensation are of interest as this complication can be avoided if proper precautions are taken. Although improvements in surgical technique have lead to a decreased incidence of Descemet's membrane detachments and of epithelial and fibrous downgrowth, early recognition and intervention are imperative.     

Retinal complications of cataract surgery

Main retinal complications of cataract extraction are retinal detachment and cystoid macular edema. The incidence of retinal detachment after ex traction is 1 %, and may increase after Nd: YAG laser capsulotomy to 4 %. Cystoid macular edema in aphakic or pseudophakic patients is unusually transient, with a decrease of visual acuity in about 3 % of cases; a long lasting cystoid macular edema with prolonged visual deficiency is described in only 1 % of cases. The incidence of photic macular injuries is estimated at between 7 and 28 % of cases; most photoretinal injuries are asymptomatic or minimally symptomatic because of their extrafoveolar location. Finally, the visual prognosis after cataract surgery is poor in diabetic patients, because of the frequency of cystoid macular edema and progression of diabetic retinopathy.     

Retinal complications of cataract surgery

Cataract surgery, like any surgical procedure, has associated complications. Acute retinal complications include globe perforation, dislocated lens fragments, hemorrhagic choroidal detachment, and endophthalmitis. Late retinal complications include retinal detachment, cystoid macular edema, and exacerbation of diabetic retinopathy and other retinal conditions. Proper and timely management of retinal complications from cataract surgery is crucial in maximizing visual outcomes. Many of the complications and current management strategies will be outlined in this review.     

Corneal complications of cataract surgery

Developments in cataract surgery have stimulated a greater interest in minimizing unwanted effects of cataract surgery on the cornea. The two main areas of concern are protection of the corneal endothelium and minimizing distortion of the anterior corneal surface. Endothelial cell loss is of particular importance where there is a preexisting significantly low cell count due to ocular trauma, surgery, or dystrophy, and in situations where cataract extraction is combined with other procedures that may be prolonged or require extensive manipulation. Recent availability of heavier molecular-weight viscoelastic substances are expected to help in minimizing endothelial cell trauma in these situations. In terms of postoperative corneal astigmatism the emphasis has changed for those who are regularly performing phacoemulsification from minimizing surgically induced astigmatism to planning the procedure so that it incorporates a correction of preexisting astigmatism. This emphasis may be more significant in cases of previous anterior segment surgery or trauma.     

Postoperative complications in cataract surgery

The paper is a statistical retrospective trial that evaluates the prevalence of postoperative complications of the cataract surgery in the IInd Department of Ophthalmology Timisoara. The parameters of interest were the type and the frequency of the postoperative complication encountered after the extracapsular cataract extraction (ECCE) followed by a PMMA intraocular lens (IOL) implantation. The most frequent early postoperative complications were endoepithelial comeal edema (20.8%), inflammatory complications (uveitis) (8.72%), hemorrhagic complications (4.02%), and postoperative rise of IOP (8.05%). Out of late complication, we encountered cystoid macular edema (1.34%), bullous keratopathy (1.34%), IOL malposition (0.67%) and secondary glaucoma (1%).     

儿童白内障手术并发症的研究进展

儿童白内障手术步骤较多,儿童眼的解剖学特点及白内障的不同状态常常需要变更手术操作技术,术中、术后并发症较成人多,术后随访观察须严密,视力重建需要家长的长期配合与付出,这些都使儿童白内障的治疗具有挑战性.近年来,儿童白内障手术并发症的研究领域有了以下更新:23G及25G玻璃体切割机用于儿童白内障手术,使儿童白内障摘出术实现无缝线;多中心、前瞻性随机对照研究——美国婴儿无晶状体眼的治疗项目(IATS)的近期、中期研究结果已经逐步报道;大样本、远期观察的回顾性研究对儿童白内障术后眼内出血、眼内炎、青光眼相关不良事件、视轴再混浊、视网膜脱离等并发症及其结局都有了新的认识.本文回顾近年相关文献,就儿童白内障术中、术后并发症进行综述,帮助临床医师进一步理解和重视儿童白内障手术并发症及其防范、随访及处理.     

The vitreoretinal complications of cataract surgery

The paper reports a retrospective study performed between January 1996 and January 1999 which comprised 423 patients who underwent eye cataract surgery. Vitreoretinal complications (retinal detachment, cystoid macular edema, choroidal detachment, endophthalmitis, luxation of the lens into the vitreous body) were related to age, sex, other general and local diseases and surgical complications, like disruption of the posterior capsule. The study presents also vitreoretinal complications after Nd:YAG laser posterior capsulotomy. The outcomes of the study show that 18 cases (4.25%) had retinal detachment, 11 (2.60%) had cystoid macular edema, 2 cases had endophthalmitis, while choroidal detachment and luxation of the lens into the vitreous body were reported each in 1 case. Retinal detachment following Neodymium:YAG laser capsulotomy (performed in 109 cases) was found in 2 cases. All of those vitreoretinal complications were reported with a higher incidence in patients with vascular diseases (diabetes mellitus, arterial hypertension, angiosclerosis) and also in patients who had axial lengths of 25 mm or greater.     

Managing intraoperative complications in cataract surgery

PURPOSE OF REVIEW: This article surveys the literature from 2002 and 2003 and addresses a variety of complications that may arise during cataract surgery. Modern surgical techniques and technology contribute to the decreased incidence of complications. Surgeon experience, early recognition of potential complications, and optimal handling of events lead to better outcomes. RECENT FINDINGS: Recognizing eyes preoperatively that are particularly at risk for having dysgenesis of the capsular bag, cortical-capsular adhesions, low endothelial cell reserve, dropped nucleus, and bag-lens dislocation will allow for contingency planning and appropriate tailoring of techniques.Capsular tension rings are indispensable for achieving in-the-bag implantation in the presence of weak zonules and zonulolysis. Viscolevitation to rescue sinking implants, avoidance of foldable lens complications, and proper lens placement with an open capsule are discussed. High-frequency ultrasound biomicroscopy is a useful diagnostic tool. Noninjection sub-Tenon anesthesia is not benign. Complications have been documented that include traumatic optic neuropathy. Immediate diagnosis and a trial of corticosteroids could be vision saving. Mastering topical anesthesia is a worthy goal. In some cases, faulty instruments result in complications. Routine inspection of reusable instruments, or the use of disposable instruments is warranted. Though there is no FDA-recognized use, at the time of this writing, for trypan blue dye, it has become the world standard for intraocular staining because of its safety and efficacy. Clear corneal self-sealing incisions are increasingly mainstream and, when properly constructed, are extremely secure.The most significant trend for successful management of intraoperative complications this year is the increasing use of pars plana anterior vitrectomy. The ability to identify prolapsed vitreous by intracameral Kenalog staining is an invaluable tool. Surgeons depend on a team of nurses and technicians for optimal outcomes. SUMMARY: With new technology and techniques highlighted by capsular tension rings, Kenalog vitreous identification, and fourth-generation fluoroquinolones, even complicated cataract surgery can result in optimal outcomes.     

飞秒激光辅助白内障超声乳化术中并发症

飞秒激光辅助白内障超声乳化手术系统在手术中有四个关键步骤: 晶状体前囊膜切开、 预劈核、角膜切口和角膜弧形切口。这种新技术相对于传统白内障手术有许多优点,但也不可忽视其术中并发症,如负压吸引环脱落、结膜充血或结膜下出血,囊袋阻滞综合征（capsular blockage syndrome,CBS）、后囊破裂、前囊裂开及瞳孔缩小等。其中前五项可以通过加强术前宣教与术中引导、手术技术的熟练度增加和设备的更新来减少甚至避免,而瞳孔缩小发生的具体机制尚不明确,还需要进一步研究。     

Results and complications of surgery of congenital cataract

Results of surgery for congenital cataract were studied according to age of implantation, type and polarity. Each forms combined, visual acuity in logMAR is divided by a median of 0.45 (5/10) in bilateral cataracts and 0.7 (2/10) in the unilateral. The precocity of the surgery allows a better prognosis, but exposes to more complications, especially glaucoma. Complications as inflammatory diseases, glaucoma, capsular opacification, refractive error, residual myopic shift, and retinal complications are discussed.     

Techniques for managing common complications of cataract surgery

Cataract surgery has evolved dramatically over the last two decades, largely as a result of technological advances. As a result, visual outcomes and patient convalescence have improved significantly. A second consequence of increased instrumentation and technology, however, is increased complexity of cataract surgery and the advent of complications unique to these advances. Cataract surgeons must be aware and capable of managing the many possible adverse events that can occur during cataract surgery. This review identifies many of the common complications of cataract surgery, describes methods to avoid these complications and discusses techniques to address complications that do occur. It is the ability to avoid, quickly identify, and properly manage complications that defines the accomplished cataract surgeon.     

Refractive complications of cataract surgery after radial keratotomy

Four patients underwent cataract extraction with posterior chamber lens implantation several years after radial keratotomy. All four patients experienced an initial hyperopic shift caused by an early postoperative corneal flattening of greater than or equal to 1 diopter. This flattening partially regressed, leaving the patients with a mean of 0.42 diopter of persistent corneal flattening. We found the Binkhorst and the Holladay intraocular lens calculation formulas to be more accurate than the SRK II for these patients. Corneal curvature measured with the keratometer was less accurate for intraocular lens calculations than was a value derived by subtracting the refractive change induced by the radial keratotomy from the patients' keratometric measurements obtained before radial keratotomy.     

手法小切口白内障摘出术中并发症分析

目的:探讨手法小切口白内障摘出术中常见并发症的发生原因与防治措施。方法:施行152例183眼手法小切口白内障摘出术,记录术中并发症并加以分析。结果:术中悬韧带离断8例(4.4%),后囊膜破裂4例(2.2%),晶状体核脱出囊袋困难11例(6.0%),虹膜脱出3例(1.6%),术中前房维持不良10例(5.5%),术毕上方切口渗漏7例(3.8%),角膜水肿8例(4.4%)。结论:手法小切口白内障摘出术中可能发生各种并发症,良好的手术操作和熟练的技巧可减少并发症发生。     

Postoperative complications after simultaneous vitrectomy and cataract surgery

OBJECTIVE: We reviewed postoperative complications after simultaneous vitrectomy, phacoemulsification, aspiration, and acryl lens insertion. PATIENTS AND METHODS: Combined surgery was performed in 316 eyes of 279 patients between 1995 and 1997. Postoperative observation was continued in all of them for more than 6 months. The diagnoses that led to vitrectomy included diabetic retinopathy in 155 eyes, rhegmatogenous retinal detachment in 64 eyes, macular hole in 43 eyes, and other diseases in 93 eyes. The rate of postoperative complications that needed any reoperation was investigated. RESULTS: Reoperations were needed for intravitreal hemorrhage in 23 eyes (7.3%), retinal detachment in 15 eyes (4.7%), rubeotic glaucoma in 6 eyes (1.9%), and other conditions in 4 eyes (1.3%). Among them, reoperations were performed on 13 eyes (4.1%) twice and more. A removal of an intraocular lens was needed in 16 eyes (5.1%) for treatment of vitreoretinal disease. In patients with diabetic retinopathy, reoperations were needed for intravitreal hemorrhage in 21 eyes (13.5%), rubeotic glaucoma in 6 eyes (3.9%), other diseases in 4 eyes (2.6%), and a removal of an intraocular lens was needed in 10 eyes (6.5%) at a higher rate than the other disease. CONCLUSION: This combined surgery is considered advantageous for removing peripheral vitreous, while preventing these complications is important for preserving visual function.