Cataract surgery complications are continuing to decrease. General anesthesia, which includes a rare risk of stroke and death, is rarely needed for cataract surgery. Peribulbar anesthesia, where a needle is used to inject anesthesia behind the eye and even Subtenons anesthesia, where we use a cannula placed under the conjunctiva (clear covering of the white part of the eye) to inject surgery is also rarely needed. Peribulbar and Subtenons anesthesia carry a rare risk of optic nerve injury, retro-orbital hemorrhage (bleeding) and subsequent loss of vision.
Thus most surgeries are done with local anesthesia: just anesthetic eye drops.
Most patients do still get intravenous sedation but in some patients this is also not needed.
Currently the below are the most common risks in order of most common with approximate % risk if widely known. This not meant to include every possible risk published but are the key risks.
1. The most common “risk” after surgery is the need for glasses for reading, computer, and distance even if a patient has purchased Advance Technology Premium Intraocular Lenses which try to help patients be as close to glasses-free as possible.
2. Complaint of Poor Quality of Vision due to Uncorrected Astigmatism (the front surface of the eye, the Cornea, still has the shape of a football instead of a basketball) either due to natural astigmatism or from a Poor Quality Tear or Dry Eye Syndrome: This risk decreases with the warm compress routine and using steps on the “Step Ladder for Dry Eye” prior to cataract surgery eye measurements and after cataract surgery:
This risk, believe it or not, has been observed to be partly associated with a patient’s personality: physicians have noted that patients with “easy going” personalities tend to not notice these slight imperfections in vision compared to “perfectionists.” The risks thus partly varies according to personality and profession: physicians have frequently noted that patients who are “perfectionists” and in particular professions (ie, engineers, mathematicians, physicists, lawyers) may notice these types of imperfections more than others, though this has not been published as a proven fact.
4. Posterior Capsular Opacification (PCO): the back part of the capsule of the Lens can get hazy in between 20-30% of patients
5. Dry eye symptoms can worsen in some patients after surgery due to the incisions we make in the cornea. Usually most patients return to their status prior to cataract surgery.
6. Risk of vitreous loss: the lens is covered by a capsule. The Posterior Capsule is 3.5 micrometers and can break open during cataract surgery. This can occur even in the best cataract surgeons in the world. Vitreous Loss can increase the risk of needing another surgery, risk of retinal detachment, risk of needing a corneal transplant, risk of infection which remains low in most cases.
7. Rare risks:
a. Risk of needing another surgery: (ie, part of cataract [nucleus or cortex (part around nucleus of cataract] was not able to be removed; iris damage; Implant moves or dislocates; risk of wrong implant placed}
b. Risk of retinal hole or detachment
c. Risk of infection
d. Risk of loss of vision
e. Risk of having a blind painful eye
f. Risk of loss of the eye
8. Very rare risks: increases minimally with general anesthesia
a. having a heart attack during or immediately after surgery
b. having a stroke during or immediately after surgery
c. death from any cause during or immediately after surgery
Below is a recent review of risks in the United Kingdom as a comparison.