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Cataract surgery complications are rare with the procedure one of the most common and most successful surgical procedures performed. Most common complications are treatable and don’t have a long-term impact on your vision.
With cataract surgery your surgeon removes the cloudy natural lens of your eye (cataract) and replaces it with an intraocular lens (IOL). The clear thin membrane (the lens capsule) that surrounds the natural lens is kept intact during the surgery. Your surgeon places the IOL within this capsular pocket.
What To Expect After Cataract Surgery
Most cataract operations are done under local anaesthesia, which means that there is only a short stay in hospital required (2-3 hours). You will need to arrive 1 hour before your surgery time to have eyedrops to dilate your pupil. The cataract operation only takes 10-15 minutes to complete. You will stay in the hospital recovery area for observation for up to 1 hour after the surgery and information is given on how to care for your eye and the use of eye drops. Someone will need to drive you home after the procedure and you’ll be advised to bring a pair of sunglasses to wear to protect your eye from the bright light and glare. An eye pad will be placed over your eye and your surgeon will advise you on when you can remove this. Close follow up care is required after surgery to ensure that if you develop any post operative complications these are identified early and treated effectively.
When you first remove your eye pad don’t be alarmed if your vision appears cloudy, blurry or even wavy (for up to 4 hours) as it can take some time for your vision to adjust and the local anaesthetic to wear off. Your eye may be red or bloodshot and this should go within a few days as your eye heals. Follow your surgeon’s instructions on how to protect your eye and use the eye drops that have been prescribed – antibiotic eye drops will prevent infection and anti-inflammatory eye drops will help reduce any internal inflammation.
Your surgeon will check your eyes in the first couple of days after your surgery to make sure there are no complications.
If you experience any loss of vision, increasing pain or increasing redness after this post operative visit, you should contact your surgeon to let them know.
Other Complications
Lens Capsule Tear
When your cataract is removed, your surgeon is extremely careful to maintain the integrity of the lens capsule, however it is extremely thin and can sometimes rupture or break. When this occurs the overall cataract operation can take longer and the IOL may need to be repositioned, exchanged or removed. Most people with a capsule tear would still get the same visual result but it will take a bit longer to recover. A capsule tear can occur in 0.5-1% of cases.
Cystoid Macular Oedema
Sometimes the retina can become swollen in the first 1-4 weeks after cataract surgery 1-2%. This is called Cystoid Macular Oedema. It is treated with extra anti-inflammatory eyedrops, (steroids and NSAIDs) over 2-3 months.
Endophthalmitis
Internal infection (Endophthalmitis) is rare 0.1% but could result in loss of vision. It can occur in the first 2 weeks after cataract surgery. The symptoms are loss of vision, increasing pain or increasing redness of your eye. If you experience any of these you should urgently contact your surgeon to let them know. You will be given your surgeon's mobile number after surgery, please phone if you have any concerns.
Posterior Capsule Opacification (PCO) - Secondary Cataract
The main complication after cataract surgery is developing a condition called posterior capsule opacification. Sometimes the thin lens capsule becomes cloudy, causing frosty vision. This can occur any time in the first year or 10-20 years after cataract surgery. It is caused by the lens epithelial cells that remain after the cataract surgery growing over the back of the artificial lens onto the capsule. This can cause “cloudy vision” and is often referred to as a “secondary cataract” but it is not your cataract returning. Approximately 10% of people who have had cataract surgery will develop PCO.
Posterior Capsule Opacity can be treated safely and effectively
Fortunately PCO can be treated safely and effectively with laser eye surgery using a procedure called YAG laser capsulotomy. During this procedure, the cloudy part of the lens capsule is removed, leaving enough of the capsule pocket to still hold the artificial lens in place. This quick pain free procedure is done in the doctor’s clinic rooms, only takes a couple of minutes and as there is no discomfort after the procedure you can go about all your normal activities straight after it. Vision is restored within 24 hours and as it is a laser treatment, there is no surgical incision or stitches used.
Vision after Cataract Surgery
95% of people who choose a monofocal IOL for their cataract surgery will have their vision restored to how it was before they developed their cataract. The prescription of your glasses can be reduced with cataract surgery. In the majority of people who have no other eye problems their vision after cataract surgery would meet the standard for driving without glasses. New glasses after cataract surgery can give an extra 5-10% improvement. If you and your surgeon choose a premium IOL your visual result can be even better. The main indication for a premium IOL would be to treat astigmatism.
Some people aren’t good candidates for cataract surgery and this can be determined at your assessment appointment. People who have underlying eye disorders such as Glaucoma, Diabetic retinopathy or Age-Related Macular Degeneration or other eye conditions may benefit from either treating the underlying eye damage before making the decision to have cataract surgery, other procedures, or the use of low vision aids.
If you have cataracts in both eyes your surgeon will usually wait a week for your first eye to recover before performing the procedure on your other eye.
If you have cataracts and would like them assessed to restore your vision, please call Bowen Eye Clinic 0800 69 20 20 for an appointment.
Glossary
Age-Related Macular Degeneration (ARMD) is the most common cause of vision loss in adults aged 50 or over. Macular degeneration affects central vision rather than side vision. Vision loss may be a gradual process (dry ARMD) or a sudden one due to a leakage of blood vessels (wet ARMD). The macula is a small area at the centre of the retina - the light-sensitive inner lining of your eye. The macula contains the highest concentration of light-sensitive cells. These cells are responsible for detailed central and colour vision. Central vision is needed for seeing straight ahead, and is used in tasks such as reading and driving. In ARMD, central vision becomes distorted.
Astigmatism irregular defocus, or an eye that is ‘more rugby ball shaped than an equal spherical football shaped.’ The first number in your prescription for glasses describes the amount of long or short sight (-2.00/-1.00x180). The second number describes the amount of astigmatism and the angle (-2.00/-1.00x180). Most of us have at least some astigmatism, and a small amount can even help extend the range of activities you can do without reading glasses when you get older.
Cataract when the natural lens in your eye gets cloudy enough to make vision hazy it is called a cataract.
Cataract surgery is the surgery to replace the natural lens with a new intraocular lens (IOL). It is performed in patients who cannot see clearly despite using glasses or contact lenses with the main aim of restoring clear vision.
Diabetic Retinopathy is damage to the retina at the back of the eye caused by diabetes. Diabetes damages the small blood vessels that supply the retina of the human eye.
Glaucoma this is a condition in which the optic nerve is gradually damaged causing the visual field to contract. Left untreated, patients with glaucoma may develop ‘tunnel vision.’ Glaucoma is often associated with a higher than normal intraocular pressure, and treatment is centred on medication or surgery to lower the intraocular pressure.
Intraocular Lens (IOL) IOLs are small synthetic lens implants that are used to replace the natural lens in cataract surgery and refractive lens exchange. They can also reduce astigmatism.
Lens is made of transparent, flexible tissue and is located directly behind the iris and the pupil. It is the second part of your eye, after the cornea, that helps to focus light and images on your retina. When young the lens is flexible and elastic, it can change its curved shape to focus on objects and people that are either nearby or at a distance.
Posterior capsule opacification (PCO) in cataract surgery, the IOL is implanted within the capsule of the natural lens. This thin, clear membrane then shrink-wraps around the IOL and stabilises it in the natural position in the eye. As part of the healing process, the membrane can sometimes go misty, causing gradual loss of vision after surgery. This is called posterior capsule opacification (PCO). It can be treated successfully with a one-off minor laser procedure called YAG capsulotomy.
Retina the layer of light sensitive cells lining the back of the eye, which is sometimes described as “the film in the camera.” Images are focused on the retina by the cornea, the natural lens. Information from the retina is fed through the optic nerve to the visual areas of the brain.