Complications of lens removal surgery

 

Lens removal complications Since the introduction of phacoemulsification technology, a little more than 30 years have passed and this operation, almost devoid of complications and injuries, has become especially popular and popular. This also happened because it is now impossible to imagine it without self-sealing micro-incisions, as well as folding lenses or viscoelastics, which are protection for intraocular structures. Today, there is no need to wait for any particularly suitable moment to perform the operation – it can be done immediately.

By the way, the “maturation” of the lens required earlier for the operation leads to its strong compaction. And this, in turn, leads to an increase in the time of surgical intervention and increases the risk of complications. That is why cataracts should be removed immediately, as soon as it becomes a hindrance to the usual way of life.

Phacoemulsification is the most modern, effective and practically safe method of cataract treatment. However, like any operation, it has a certain risk of some complications.
Possible complications
Secondary cataract

The most common complication of lens replacement surgery. Secondary cataract is expressed in turbidity of the posterior capsule. It is revealed that the frequency of its development depends on the material from which the artificial lens is made. For example, polyacrylic IOLs cause it in 10% of cases, and silicone lenses-already in almost 40%, there are lenses made of polymethyl methacrylate (PMMA), the frequency of this complication for them is 56%. The causes that provoke the occurrence of secondary cataracts, as well as effective methods of its prevention, are still not fully understood.

It is generally believed that this complication is due to the migration of the lens epithelium into the space between the lens and the posterior capsule. The epithelium of the lens is the cells remaining after its removal, which contribute to the formation of deposits that significantly degrade the image quality. Another possible cause is fibrosis of the lens capsule. The elimination of such a defect is carried out using an YAG laser, which forms a hole in the center of the zone of the clouded posterior lens capsule.
Increase in IOP

This is a complication of the early postoperative period. It can be caused by incomplete leaching of viscoelastic – a gel-like special drug that is injected into the anterior chamber to protect the structures of the eye from surgical damage. In addition, the cause may be the development of pupillary block, if there was a shift of the IOL to the iris. Elimination of this complication does not take much time, in most cases it is enough to drop anti-glaucoma drops for several days.
Cystic macular edema (Irwin-Gass syndrome)

A similar complication occurs after cataract phacoemulsification in about 1% of cases. While the extracapsular method of lens removal makes it possible to develop this complication in almost 20% of operated patients. People with diabetes, uveitis, or wet AMD are most at risk. In addition, the incidence of macular edema increases after cataract extraction, which is complicated by rupture of the posterior capsule or loss of the vitreous body. Treatment is carried out with the help of corticosteroids, NSAIDs, angiogenesis inhibitors. If conservative treatment is ineffective, vitreoectomy may sometimes be prescribed.
Corneal edema

A fairly common complication of cataract removal. The reasons are a change in the pumping function of the endothelium, which occurred due to mechanical or chemical damage during surgery, an inflammatory reaction or concomitant eye pathology. As a rule, the swelling goes away in a few days, without prescribing treatment. In 0.1% of cases, pseudofacial bullous keratopathy may develop, accompanied by the formation of bullae (vesicles) in the cornea. In such cases, hypertonic solutions or ointments are prescribed, therapeutic contact lenses are used, and the pathology that caused this condition is treated. The lack of treatment effect may lead to the appointment of corneal transplantation.
Postoperative astigmatism

A very common complication of IOL implantation, which leads to a deterioration in the result of the operation. At the same time, the magnitude of induced astigmatism is directly related to the method of cataract extraction, the length of the incision, its localization, the presence of sutures, and the occurrence of any complications during the operation. Correction of small degrees of astigmatism is carried out by eyeglass correction or with the help of contact lenses, with pronounced astigmatism, refractive operations can be performed.
Displacement (dislocation) of the IOL

Quite a rare complication, compared to the above. Retrospective studies revealed that the risks of IOL dislocation in operated patients 5, 10, 15, 20 and 25 years after implantation were 0.1, 0.2, 0.7 and 1.7%, respectively. It was also found that pseudoexfoliative syndrome and weakness of the cinnae ligaments can increase the probability of lens displacement.
Video of a cataract specialist about the complications of surgery
Video Complications of lens removal surgery
Other complications

IOL implantation increases the risk of regmatogenic retinal detachment. As a rule, this risk is exposed to patients with complications that occurred during the operation, injured the eye in the period after surgery, having myopic refraction, diabetics. In 50% of cases, such a detachment occurs in the first year after surgery. It occurs most often after intracapsular cataract extraction (in 5.7% of cases), less often after extracapsular cataract extraction (in 0.41 – 1.7% of cases) and phacoemulsification (in 0.25-0.57% of cases). All patients with implanted IOLs should continue to be monitored by an ophthalmologist so that the detection of this complication occurs as early as possible. The principle of treatment of this complication is the same as for detachments of a different etiology.

Very rarely, during cataract surgery, choroidal (expulsive) bleeding occurs – an acute condition that is absolutely impossible to predict in advance. When it develops bleeding from the affected vessels of the choroid, which lie under the retina, feeding it. Risk factors for the development of such conditions are arterial hypertension, sudden rise in IOP, atherosclerosis, aphakia, glaucoma, axial myopia, or, conversely, small anteroposterior size of the eyeball, taking anticoagulants, inflammation, old age.

Often, it is stopped on its own, practically without affecting the visual functions, but sometimes its consequences can even lead to the loss of the eye. The main treatment is complex therapy, including the use of local and systemic corticosteroids, drugs with cycloplegic and mydriatic effects, and anti-glaucoma agents. In some cases, surgical intervention is indicated.

Endophthalmitis is also a fairly rare complication in cataract surgery, which can lead to a significant decrease in vision, up to its complete loss. The frequency of its occurrence can be 0.13 – 0.7%.

The risk of developing endophthalmitis may increase if the patient has blepharitis, conjunctivitis, canaliculitis, obstruction of the nasolacrimal ducts, entropion, when using contact lenses, a prosthetic pair of eyes, after immunosuppressive therapy.

Signs of intraocular infection can be: pronounced redness of the eye, increased photosensitivity, pain, decreased vision. Prevention of endophthalmitis – instillation of 5% povidone-iodine before surgery, introduction of antibacterial agents into the chamber or subconjunctivally, sanitization of possible foci of infection. Especially important is the use of disposable or thorough disinfection of reusable surgical instruments.
The benefits of treatment of cataract in CIM

Almost all of the above complications of cataract surgery are poorly predicted and are often associated with circumstances beyond the surgeon’s skill. Therefore, it is necessary to treat the resulting complication as an inevitable risk that is inherent in any surgical intervention. The main thing in such circumstances is to get the necessary help and adequate treatment.

surgery to remove the lens of the eye

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