The Risks and Benefits of Cataract Surgery

Vincent J. Patalano II, MD
Massachusetts Eye and Ear Infirmary, Massachusetts Eye and Ear Somerville Eye Center
October 15, 2002

What are the risks associated with cataract surgery?
Cataract surgery is the most commonly performed type of eye surgery. In the vast majority of cases, approximately 95% of the time, the surgery is uncomplicated. Cataract surgery usually results in improved vision and a well satisfied patient. However, cataract surgery should never be trivialized. In a small percentage of patients, events occur which can lead to less than ideal results. Most of these events are known risks of the surgery itself and can occur even if the operation is performed well by an experienced surgeon. The occurrence of these events is often unpredictable. Patients should be aware of such possibilities when they decide to proceed with surgery. Some of the most common risks are reviewed in this article.

Ophthalmic surgeons normally make great efforts at the time of surgery to reduce the possibility of introacular infection, which is called "endophthalmitis". Patients usually receive topical antibiotic eye drops on the day of surgery. The surface of the eye and the skin around the eye are disinfected with antiseptic compounds, and the patient's face except the eye is covered with sterile drapes. Sterile techniques are used for all instruments, similar to those used for all modern surgeries. After the surgery is completed, surgeons prescribe topical antibiotic eye drops. Nonetheless, even with these precautions, an intraocular infection, called endophthalmitis, occurs in approximately one out of 3,000 cases. Symptoms and signs of endophthalmitis include excessive eye redness, pain, light sensitivity, and worsening vision.

In some cases, the patients may be fairly comfortable on the first day or so after surgery, but then worsen in terms of pain, vision, and light sensitivity several days later. Patients who undergo cataract surgery should be instructed to call their ophthalmologist immediately if they worsen in these ways. If a patient develops endophthalmitis, intraocular antibiotics are often injected INTO the eye to minimize the spread of the infection. Sometimes an additional surgery (vitrectomy) is performed to remove the jelly-like substance of the eye; this may help control the infection.

Cystoid Macular Edema
The retina is the neural tissue which lines the entire inside of the back part the eye. The very center of the retina is called the macula, which is responsible for central vision. After cataract surgery, inflammation can sometimes cause retinal blood vessels to leak fluid which accumulates in the macula, causing decreased central vision. This swelling is referred to as "cystoid macular edema". When vision is affected by macular edema, the ophthalmologist may recommend a specialized test, called a fluorescein angiogram, in ORDER to determine the extent of swelling. Ophthalmologists often treat macular edema with topical steroid eye drops or non-steroidal anti-inflammatory eye drops which help quiet the inflammation, often improving the situation over weeks or months. Sometimes injections of steroids behind the eye, or even intra-ocular vitrectomy surgery are useful in improving the vision.

Retinal Detachment
A retinal detachment occurs when liquid vitreous fluid gets through a fine tear in the retina, allowing it to separate abnormally FROM the back wall of the eye. A retinal detachment may cause a curtain across part or all of the vision of the eye. Retinal detachments can occur in patients who have not had any prior eye surgery, especially in patients who are highly nearsighted. However, cataract surgery increases the risk of retinal detachment. After cataract surgery, retinal detachments occur in approximately 1.5% of patients. You should contact your ophthalmologist immediately if you develop a curtain blocking the vision, flashes of light like lightening streaks, or new floating spots in your vision. These symptoms can sometimes herald a retinal detachment.

Posteriorly Dislocated Lens Material
In some instances, lens material can fall INTO the back cavity (vitreous cavity) of the eye. Often small pieces of posteriorly dislocated lens material are well tolerated by the eye without problems. When larger pieces are dislocated, the ophthalmologist may recommend a second surgery, called a vitrectomy, to remove the lens material. This removal prevents excessive inflammation FROM developing.

Choroidal Hemorrhage
Infrequently and unpredictably during cataract surgery, acute bleeding can occur in the choroid, which is the delicate pattern of blood vessels underlying and nourishing the retina. Although this complication, called "choroidal hemorrhage" is more common among elderly patients, it is truly unpredictable. In some cases of choroidal hemorrhage, the bleeding is localized, and patients do well. In more severe cases of choroidal hemorrhage, visual loss can be substantial.

How do I get more information about the risks associated with cataract surgery?
Before cataract surgery, ophthalmologists usually discuss the risks, benefits and alternatives of the surgery. If unexpected events occur at the time of surgery, or develop after the surgery, the ophthalmologic surgeon will discuss the particular implications and help formulate a specific treatment plan. If you live in the New England area and would like to be examined by an ophthalmologist at the Massachusetts Eye and Ear Infirmary, please call the Cataract Consultation & General Eye Service (Boston, MA) at (617) 573-3202 or the Massachusetts Eye & Ear Somerville Eye Center (Somerville, MA) at (617) 623-0030 for an appointment.

The information and recommendations appearing on these pages are informational only and is not intended to be a basis for diagnosis, treatment or any other clinical application. For specific information concerning your personal medical condition, the DJO suggests that you consult your physician.