COMPLICATIONS OF CATARACT.pptx

undergraduate teaching ppt for complications of cataract surgery

1. COMPLICATIONS OF CATARACT

2. Complications PREOPERATIVE COMPLICATIONS INTRAOPERATIVE COMPLICATIONS EARLY POSTOPERATIVE COMPLICATIONS DELAYED(LATE) POSTOPERATIVE COMPLICATIONS IOL- related COMPLICATIONS

3. PREOPERATIVE COMPLICATIONS Anxiety Nausea and Gastritis Irritative or Allergic conjunctivitis Corneal abrasion Complications during local anesthesia Retrobulbar Hemorrhage Oculocardiac Reflex Perforation of globe Subconjunctival hemorrhage Spontaneous dislocation of lens

4. OPERATIVE COMPLICATIONS Superior rectus muscle laceration Excessive bleeding Incision related complications In manual SICS and phacoemulsification: ----Button holing of anterior wall of tunnel ----Premature entry into anterior chamber ---- Scleral disinsertion

5. Injury to the Cornea, Iris and Lens Iris injury and Iridodialysis (tear of iris from root) Complications related to anterior capsulorhexis Escaping capsulorhexis Small capsulorhexis Very large capsulorhexis Eccentric capsulorhexis

6. Posterior capsular rupture During forceful hydrodissection By direct injury with some instrument like Sinkey hook, chopper or phacotip During cortex aspiration 8. Zonular dehiscence

7. Vitreous loss-adequate measures should be taken to prevent this like: To decrease vitreous volume To decrease aqueous volume To decrease orbital volume Better ocular akinesia and anaesthesia Minimising external pressure on the eye Use of flieringa ring to prevent collapse of sclera

8. Nucleus drop into the vitreous cavity Posterior loss of lens fragment Expulsive choroidal hemorrhage

9. [C] Early postoperative complications Hyphaema . Treatment. Most hyphaemas absorb spontaneously and need no treatment. hyphaema may be large and associated with rise in IOP. In such cases, IOP should be lowered by acetazolamide and hyperosmotic agents.

10. 2. Iris prolapse . It is usually caused by inadequate suturing of the incision 3. Striate keratopathy. corneal oedema with Descemet’s folds due to endothelial damage during surgery.

11. 4. Flat (shallow or nonformed ) anterior chamber. wound leak, ciliochoroidal detachment or pupil block 5. Postoperative anterior uveitis can be induced by instrumental trauma, undue handling of uveal tissue, reaction to residual cortex or chemical reaction induced by viscoelastics , pilocarpine etc.

12. 6. Bacterial endophthalmitis . This is one of the most dreaded complications with an incidence of 0.2 to 0.5 percent. The principal sources of infection are contaminated solutions, instruments, surgeon'shands , patient's own flora from conjunctiva, eyelids and air-borne bacteria.

13. Ocular pain, diminished vision, lid oedema, conjunctival chemosis and marked circumciliary congestion, corneal oedema, exudates in pupillary area, hypopyon and diminished or absent red pupillary glow.

14. [D] Late postoperative complications These complications may occur after weeks, months or years of cataract surgery. 1. Cystoid macular oedema (CME). Collection of fluid in the form of cystic loculi in the Henle’s layer of macula is a frequent complication of cataract surgery.

15. 2. Delayed chronic postoperative endophthalmitis is caused when an organism of low virulence (Propionibacterium acne) becomes trapped within the capsular bag. 3. Pseudophakic bullous keratopathy (PBK) is usually a continuation of postoperative corneal oedema produced by surgical or chemical insult to a healthy or compromised corneal endothelium.

16. 4. Retinal detachment (RD). Incidence of retinal detachment is higher in aphakic patients as compared to phakics . It has been noted that retinal detachment is more common after ICCE than after ECCE. Other risk factors for aphakic retinal detachment include vitreous loss during operation, associated myopia and lattice degeneration of the retina. 5. Epithelial ingrowth . 6. Fibrous downgrowth into the anterior chamber

17. 7.After cataract. It is also known as ‘secondary cataract’. It is the opacity which persists or develops after extracapsular lens extraction. Causes. ( i ) Residual opaque lens matter may persist as after cataract when it is imprisoned between the remains of the anterior and posterior capsule, (ii) Proliferative type of after cataract may develop from the left-out anterior epithelial cells.

18. Clinical type Soemmering’s ring Elschnig’s pearls Dense membranous Treatment is as follows : YAG-laser capsulotomy ii. Dense membranous after cataract needs surgical membranectomy . 7. Glaucoma-in- aphakia and pseudophakia

19. [E] IOL-related complications Complications like cystoid macular oedema, corneal endothelial damage, uveitis and secondary glaucoma are seen more frequently with IOL implantation. UGH syndrome refers to concurrent occurrence of uveitis, glaucoma and hyphaema .

20. 2. Malpositions of IOL . decentration, subluxation and dislocation. Sun-set syndrome (Inferior subluxation of IOL). Sun-rise syndrome (Superior subluxation of IOL). Lost lens syndrome refers to complete dislocation of an IOL into the vitreous cavity. Windshield wiper syndrome. It results when a very small IOL is placed vertically in the sulcus. In it the superior loop moves to the left and right with movements of the head.

21. 3. Pupillary capture of the IOL may occur following postoperative iritis or proliferation of the remains of lens fibres . 4. Toxic lens syndrome. It is the uveal inflammation excited by either the ethylene gas used for sterilising IOLs (in early cases) or by the lens material (in late cases).