Cataract Surgery Complications

Cataract Surgery Complications
SYMPTOMS Symptoms vary depending on complication: Posterior capsular opacification (PCO) - blurry vision | Posterior lens dislocation - blurry vision | Cystoid macular edema (CME) - blurry vision, metamorphopsia | Endophthalmitis - pain, blurry vision, photophobia
SIGNS Signs vary depending on complication: Posterior capsular opacification (PCO) - clouding of the posterior capsule | Posterior lens dislocation - zonular dehiscence, dislocated IOL | Cystoid macular edema (CME) - retinal thickening, intraretinal cystoid spaces via OCT, early phase leakage and/or “petalloid” pattern via FA | Endophthalmitis - hypopyon, injection, marked inflammation (vitritis)
WORK-UP Thorough history. Slit lamp examination
TREATMENT PCO is treated with Nd:YAG laser capsulotomy | Posterior lens dislocation is addressed with the placement of an anterior chamber IOL or scleral fixation sutures | CME can be treated off-label with topical NSAIDs (Voltaren 1 gtt qid). Topical steroids may be less effective than topical NSAIDs. Rarely, oral carbonic anhydrase inhibitors may be used | Endophthalmitis requires urgent treatment, including a vitreous tap/cultures and intravitreal and/or intravenous antibiotics/antifungals
FOLLOW-UP Frequent follow-up for CME and endophthalmitis
ADDITIONAL LAB | TESTS OCT macula and fluorescein angiography for CME
ETIOLOGY Cataract surgery
NOTES Pseudophakic CME is also referred to as Irvine-Gass syndrome and may spontaneously resolve | Endophthalmitis usually involves staphylococcus epidermidis