This question was asked by an anonymous patient on Healthtap. Here is an expanded answer.
Complications are rare after cataract surgery but still happen even in the best surgeon’s hands. During my time at Harvard Medical School, we saw many of other surgeon’s complications but no surgeon is immune from complications. In fact the best surgeons may have a slightly higher complication rate because they are referred the toughest of cases. This was true at Harvard and is true around the world.
The biggest risks for issues/complications during cataract surgery are as follows:
1. Dense cataracts
2. Pseudoexfoliation,
3. Small pupil (after dilation)
4. Previous trauma causing weak zonules
5. Lens anomolies (posterior polar cataract, abnormally shaped lens, dislocated lens, Marfans syndrome with lens anomoly.
6. Excessive movement of patient during surgery (ie, coughing, snoring excessively).
Issues & Complications are rare but include (in order of most common to least):
1. Delayed vision recovery (can be due to any of below).
2. Dry eye new or worsening: lid glands can get clogged as we “pamper the eye” before & after surgery so recommend cleaning lids with warm compresses, diluted baby shampoo or tea tree oil before surgery & starting again 5 days after surgery if eyeMD says ok to re-start.
3. PVD: posterior vitreous detachment: very common issue. The vitreous is the gel behind the lens. PVDs are usually of minimal concern. One might notice more floaters after surgery (likely from a combination of being able to see better and possible vitreous protein change after surgery). Rarely will a new PVD, or one developing after surgery, cause the vitreous to pull part of the retina off and cause a retinal hole or tear. All myopes are at increased risk. Tell your doctor of any increased flashes/floaters in vision after eye surgery.
4. PCO: posterior capsular opacification: common issue which requires a Yag laser to open posterior capsule behind implanted lens to remove haze that can develop after surgery NORMALLY in 20+% of patients.
5. Swollen cornea: not uncommon: Muro 128 drops & ointment can help this heal faster in some cases. Guttae & Fuchs dystrophy increase the risk of having the cornea swollen for sometimes 1-3 months after surgery.
6. Rebound iritis: not uncommon. There is a normal inflammatory response in the eye after surgery that the surgeon sees after cataract surgery. Steroids decrease this but as the steroids are decreased/tapered, the inflammation (iritis) can come back. We restart the steroids to calm down this inflammation again.
7. High eye pressure: not uncommon. There is a normal inflammatory response in the eye after surgery that the surgeon sees after cataract surgery. This can clog up the drain of the eye & cause high eye pressure. The surgeon sometimes has to give pressure lowering drops or pills and rarely, open the wound “burp the wound” to decrease the pressure. Complications from this are extremely rare. There is 1 case at Harvard of a loss of vision after “burping the wound” by a resident out of millions of cases. Uncontrolled high pressure, though is more risky as it can cause permanent optic nerve damage. Steroids over the long term can also cause high eye pressure (steroid response glaucoma) which is treated with either discontinuing the steroid or eye pressure lowering drops.
8. CME: cystoid macular edema: swelling of macula. Not uncommon. We use non-steroidal drops once per day for a few weeks or months (depending on patient) to try to prevent this.
These are much less common:
9. Need for repeat intraocular surgery: either because patient is unhappy with the implant choice, “refractive surprise” where the power of the implant needs to be changed, implant has moved position and needs to be re-positioned (not uncommon in Toric implants to correct astigmatism), need for vitreous removal, need to remove remaining cataract cortex/nucleus, need to have a corneal transplant for PBK (pseudophakic bullous keratopathy) where the cornea swelling does not improve.
9. Retinal hole/detachment: rare. All myopes are at increased risk. Tell your doctor of any increased flashes/floaters in vision after eye surgery.
10. Retinal Vein or Artery Occlusion: rare. More common in patients with a history of high blood pressure, on oral contraceptives, take illegal drugs or have uncontrolled high eye pressure. Any vision loss or “blacking out of vision”: see help immediately.
12. Endophthalmitis: severe eye infection that is very rare. Needs fortified drops immediately and many times re-peat intraocular surgery to save the eye.
13. Expulsive Hemmorhage: very rare event where inner contents of eye come out during surgery. High blood pressure increases risk.