After lens replacement surgery, a red spot. Complications of lens removal surgery

After surgery, the patient feels that he can finally breathe freely, because all the difficulties are already behind him. Unfortunately, this is not entirely true. Caring for yourself and following all medical recommendations in the postoperative period are no less important than the successful implementation of the intervention itself. Lens replacement surgery is no exception in this case. Recovery after lens replacement is not a very long process and is successful if the patient takes responsibility for himself and his health. The correct behavior after replacing the lens of the eye will be discussed in this article.

Patient behavior after eye lens replacement

As a rule, surgery to replace your own clouded lens with an intraocular lens is performed on an outpatient basis. This means that within a few hours after the intervention, when the doctor is convinced that there are no early postoperative complications, the patient can leave the ophthalmology clinic. The exception is for patients who received intravenous sedation during the procedure, in which case the patient may be asked to remain at the clinic for observation until the evening.

It is advisable that after replacing the lens, one of your relatives or friends will meet you and accompany you home. The fact is that a sterile bandage will be applied to the operated eye, and in the case of a low level of visual acuity in the second eye, it will be difficult to navigate in space. The dressing applied in the operating room can be removed the morning after the intervention. When going outside during the first week, it is advisable to use protective glasses or a sterile bandage, gluing it to the skin of the face with a plaster. The postoperative period may be accompanied by the following sensations:

• Minor painful sensations in the periorbital area and in the operated eye;
• Itching in the eyeball area;
• blurred vision;
• Sensation of a foreign body or sand in the eye where the intervention was performed;
• Minor headache.

All these symptoms disappear within the first week. If pain increases, you can take drugs based on ibuprofen or paracetamol. It is advisable to spend the first day after replacing the lens in a horizontal position, rest more, and also try not to strain the eye.

Restoring vision after lens replacement

Patients are always interested in how quickly their normal vision will return after lens replacement surgery. Immediately after surgery, your vision will be blurred. All structures of the eyeball need time to heal and recover after surgery. To speed up this process as much as possible, you should try not to put stress on the operated eye and spend the first day at rest. It is advisable to avoid significant visual stress for a week.

After the first week, patients will notice positive dynamics and a significant improvement in visual acuity. Maximum recovery is most often observed after 2-3 weeks. At first there may be increased photosensitivity.

However, complete healing after lens replacement occurs in the 4th postoperative week. Restoration of vision largely depends on the presence of concomitant ophthalmological pathology. For example, glaucoma or degenerative changes in the retina can affect the quality of vision. Colors may appear brighter after cataract surgery because the light rays will now pass through the new clear artificial lens.

The need to wear glasses after lens replacement largely depends on the other eye pathology and the type of intraocular lens implanted. Glasses may be needed because the artificial lens cannot focus on objects at different distances. Scientific studies have demonstrated that 95% of patients with monofocal lenses and 20% of patients with multifocal lenses require glasses after lens replacement. There are also accommodating artificial lenses. With their use, the likelihood of wearing glasses in the postoperative period is lower.

For advice on choosing the right artificial lens for you, you should only contact your surgeon or attending physician.

Treatment after lens replacement

Eye drops in the postoperative period are an integral aspect of rehabilitation. Such treatment is necessary for rapid healing of the postoperative wound, as well as for the prevention of infectious complications. The purpose and dosage regimen of eye drops is individual for each patient. All this is determined by the surgeon immediately after the operation, and then at each visit. Typically, the following groups of drugs are used:

• Antibacterial agents (drops containing ciprofloxacin, tobramycin).
• Anti-inflammatory drugs (non-steroidal drugs - diclofenac, indomethacin).
• Combined preparations containing hormonal and antibacterial agents).

As healing progresses, the frequency of use of drops decreases. However, all issues of dosing and the occurrence of adverse reactions must be discussed with your doctor. In order not to injure the eye during instillation, as well as to prevent infection, you must follow simple rules.

First of all, before using eye drops, you should wash your hands thoroughly with soap. Then tilt your head back or lie down on a horizontal surface. You need to pull the lower eyelid down with your finger, turn the bottle of drops over and press on the bottle or pipette. After instillation, close your eyes and apply a sterile gauze pad. If there are several drugs, a five-minute interval is considered the minimum. After use, eye drops must be tightly closed. To preserve the medicinal properties of the drug, it is recommended to observe the temperature regime of storage.

Recovery after lens replacement is not a very long process. Patients, as a rule, do not experience significant discomfort, and the restrictions are always temporary. Compliance with all medical recommendations and regimen guarantees the maximum possible restoration of visual acuity for each individual patient. It is best to discuss all questions and ambiguities that arise during the rehabilitation period with your doctor.

Limitations after lens replacement

Compliance with all restrictions will speed up the recovery period after lens replacement and will also reduce the risk of postoperative complications. Within a day after the intervention, the patient can take a shower, wash his hair and wash his face. It is important that during hygiene procedures, no soap, shampoo or other detergents get into the operated eye. Listed below are some restrictions after lens replacement surgery, which are strongly recommended to be adhered to during the first two weeks after surgery:

• Avoid intense physical activity and heavy lifting.
• Avoid tilting your head below the waist during the first month.
• It is not recommended to rub or press on the operated eye.
• It is not advisable to wear eye makeup for one week after lens replacement surgery.
• It is not advisable to visit a pool or swim in open water, as well as visit a sauna or bathhouse.
• You cannot stay in the bright sun for a long time without sunglasses.
• Doctors recommend not sleeping on the side of the eye that has undergone surgery.

There are practically no restrictions on diet after this intervention. Proper nutrition and sufficient fluid intake are recommended. If constipation occurs, it is advisable to take laxatives to avoid injury to the eye when straining.

All restrictions are temporary and are aimed at the fastest healing of the eyeball. By following these simple rules, you will achieve the fastest possible restoration of vision and reduce the risk of postoperative complications.

Rehabilitation after lens replacement

The rehabilitation period is an important and responsible time for the patient. Rehabilitation means a set of measures aimed at quickly restoring vision. Rehabilitation after eye lens replacement consists of the following activities:

• Visiting a doctor to examine and examine the operated eye. Timely visits will allow the specialist to monitor the progress of the recovery period, prescribe certain medications, and give recommendations on care and lifestyle. If for some reason you cannot visit the clinic on time, be sure to notify the administrator about this and select a new time for your visit.
• Mode. There are no strict restrictions on the regimen for patients during rehabilitation after eye lens replacement. On the first day after the intervention, it is advisable to remain in bed or semi-bed rest and not put any strain on yourself. Subsequently, you can lead a normal lifestyle, avoiding stress and taking all measures to protect your eyes outdoors, as well as protecting it from exposure to toxins and chemicals. Protection from various detergents during hygiene procedures has already been discussed above.
• Hygienic care. The operated eye does not require special care unless otherwise recommended by the attending physician. You can wash your face with water at room temperature. The use of eye drops for therapeutic and prophylactic purposes will be discussed in the appropriate section.
• Eye protection. The patient leaves the operating room after lens replacement with a special gauze bandage or curtain. At home, you are allowed to remove this bandage yourself, but not earlier than the next day after the intervention.

Doctors recommend avoiding driving a car at the initial stage of the postoperative period. In conditions of partial restoration of visual acuity, driving a vehicle may require intense work of the operated eye. And insufficient vision clarity can lead to unwanted accidents. It is advisable to discuss returning to driving with the operating surgeon.

Often, the rehabilitation period after replacing the lens of the eye proceeds smoothly, and vision is restored quite quickly if all recommendations are followed.

Complications after lens replacement

Fortunately, complications after lens replacement surgery are rare, and most are successfully treated if diagnosed early. The risk of complications increases in the presence of concomitant ophthalmological pathology. The attending physician always tells the patient about the risks of possible complications before surgery. After which, if everything is clear to the patient, he signs an informed consent to the intervention. The most common complications after lens replacement are:

• Bleeding in the early postoperative period;
• Infectious complications (endophthalmitis);
• Increase in intraocular pressure;
• Cystoid macular edema of the retina or retinal detachment;
• Dislocation of the intraocular lens;
• Secondary cataract or fibrosis of the lens capsule.

For timely recognition of complications, the patient is prescribed periodic preventive examinations in the postoperative period. If symptoms such as acute pain, a sharp decrease in the quality of vision against the background of previous positive dynamics, or flashes before the eyes appear, you should immediately consult a doctor.

However, if the patient follows all the necessary medical recommendations and restrictions after lens replacement, then the risk of developing postoperative complications is practically eliminated. Cataract surgery is one of the safest surgical procedures available today. Thanks to new ultrasound and laser technologies, the risk of intraoperative complications is 1/1000 percent, and patient reviews after lens replacement are mostly positive.

According to statistics from the American Society of Cataract and Refractive Surgeons, approximately 3 million operations to remove various types of cataracts with IOL implantation are performed annually in the United States. At the same time, the number of successful operations is at least 98 percent. Complications that arise during the postoperative process, in most cases, can be effectively treated with conservative or surgical methods.

So, in approximately 1% of cases, after cataract removal using phacoemulsification, cystoid macular edema or Irvine-Gass syndrome occurs. In the case of using the extracapsular technique, this complication can be detected in approximately 20% of patients. At the same time, the risk of complications especially increases in patients suffering from wet AMD, diabetes and uveitis. The incidence of macular edema, in addition, increases in the postoperative period of cataract extraction, complicated by rupture of the posterior capsule or loss of the vitreous. Corticosteroids, angiogenesis inhibitors, and NSAIDs are used to treat macular edema. If there are no results of conservative treatment, vitrectomy may be performed.

Corneal edema is a fairly common complication after cataract removal. Its cause may be a decrease in the pumping function of the endothelium due to mechanical or chemical damage during surgery, an inflammatory reaction, or concomitant ocular pathology. As a rule, corneal edema resolves spontaneously within a few days without treatment. In 0.1% of cases, pseudophakic bullous keratopathy develops, which is accompanied by the formation of bullae (bubbles) in the cornea. In this case, hypertonic solutions and ointments are used as treatment for the condition, medicinal contact lenses are recommended, and treatment for the pathology that caused this condition is prescribed. If there is no proper clinical effect, corneal transplantation may be performed.

One of the leading ophthalmological centers in Moscow where all modern methods of surgical treatment of cataracts are available. The latest equipment and recognized specialists are a guarantee of high results.

"MNTK named after Svyatoslav Fedorov"- a large ophthalmological complex "Eye Mycosurgery" with 10 branches in various cities of the Russian Federation, founded by Svyatoslav Nikolaevich Fedorov. Over the years of its work, more than 5 million people have received assistance.

"Helmholtz Institute of Eye Diseases"- the oldest research and medical state institution of ophthalmology. It employs more than 600 people who provide care to people with a wide range of diseases.

People who have had to deal with such an ophthalmological problem as lens opacity know that the only way to get rid of it is cataract surgery, that is, IOL implantation. In the United States, more than 3 million such operations are performed per year, and 98% of them are successful. In principle, this operation is simple, quick and safe, but it does not exclude the development of complications. What complications may arise after cataract surgery and how to correct them, we will find out by reading this article.

All complications that accompany IOL implantation can be divided into those that occurred directly during surgery or postoperatively. Postoperative complications include:

increase in intraocular pressure; uevitis, iridocyclitis - inflammatory ocular reactions; retinal detachment; hemorrhage in the anterior chamber; displacement of the artificial lens; secondary cataract.

Inflammatory eye reactions

Inflammatory responses almost always accompany cataract surgery. That is why, immediately after completion of the intervention, steroid drugs or broad-spectrum antibiotics are injected under the conjunctiva of the patient’s eye. In most cases, symptoms of the response will completely disappear after about 2-3 days.

Hemorrhage into the anterior chamber

This is a fairly rare complication that is associated with trauma or damage to the iris during surgery. Usually the blood resolves on its own within a few days. If this does not happen, doctors rinse the anterior chamber and, if necessary, additionally fix the lens of the eye.

Increase in intraocular pressure

This complication may occur due to clogging of the drainage system with highly elastic, viscous drugs that are used during surgery to protect the cornea and other intraocular structures. Usually, instilling drops that reduce intraocular pressure solves this problem. In exceptional cases, it becomes necessary to puncture the anterior chamber and thoroughly rinse it.

Retinal detachment

This complication is considered severe, and it occurs in the event of an eye injury after surgery. In addition, retinal detachment is most common in people with myopia. In this case, ophthalmologists most often decide to perform an operation, which consists of filling the sclera - vitrectomy. In the case of a small area of ​​detachment, restrictive laser coagulation of the retinal tear can be performed. Among other things, retinal detachment leads to another problem, namely lens displacement. Patients begin to complain about rapid eye fatigue, pain, and double vision when looking into the distance. These symptoms are not permanent and usually disappear after a short rest. When a significant displacement occurs (1 mm or more), the patient experiences constant visual discomfort. This problem requires repeated intervention.

Full Lens Shift

Dislocation of the implanted lens is considered the most severe complication, which requires unconditional surgical intervention. The operation involves lifting the lens and then fixing it in the correct position.

Secondary cataract

Another complication after cataract surgery is the formation of secondary cataracts. It occurs due to the proliferation of remaining epithelial cells from the damaged lens, which spread to the area of ​​the posterior capsule. The patient experiences deterioration in vision. To correct this problem, it is necessary to undergo a laser or surgical capsulotomy procedure. Take care of your eyes!

Posterior capsule rupture

This is a fairly serious complication, as it may be accompanied by loss of the vitreous body, posterior migration of the lens masses and, less commonly, expulsive bleeding. If not treated appropriately, long-term consequences of vitreous loss include a pulled-up pupil, uveitis, vitreous opacities, wick syndrome, secondary glaucoma, posterior dislocation of the artificial lens, retinal detachment, and chronic cystoid macular edema.

Signs of posterior capsule rupture

Sudden deepening of the anterior chamber and instantaneous dilatation of the pupil. Failure of the nucleus, inability to pull it to the tip of the probe. Possibility of vitreous aspiration. The ruptured capsule or vitreous body is clearly visible.

Tactics depend on the stage of the operation at which the rupture occurred, its size and the presence or absence of vitreous prolapse. The basic rules include:

introduction of viscoelastic behind the nuclear masses in order to bring them into the anterior chamber and prevent vitreous hernia; insertion of a special gland behind the lens masses to close the defect in the capsule; removal of lens fragments by introducing viscoelastic or removing them using phaco; complete removal of the vitreous from the anterior chamber and the incision area using a vitreotome; The decision to implant an artificial lens should be made taking into account the following criteria:

If large quantities of lens masses have entered the vitreous cavity, an artificial lens should not be implanted, as it may interfere with fundus visualization and successful pars plana vitrectomy. Artificial lens implantation can be combined with vitrectomy.

If there is a small tear in the posterior capsule, careful implantation of a CD-IOL into the capsular bag is possible.

In case of a large tear and especially with an intact anterior capsulorhexis, it is possible to fix the CB-IOL in the ciliary groove with the optical part placed in the capsular bag.

Insufficient capsule support may necessitate sulcus suturing of the intraocular lens or implantation of a glide-assisted PC IOL. However, PC IOLs are associated with more complications, including bullous keratopathy, hyphema, iris folds, and pupil irregularity.

Dislocation of lens fragments

Dislocation of lens fragments into the vitreous body after rupture of the zonular fibers or posterior capsule is a rare but dangerous phenomenon, as it can lead to glaucoma, chronic uveitis, retinal detachment and chronic cystoid macular edema. These complications are more often associated with phaco than with EEC. Initially, treatment for uveitis and glaucoma must be carried out, then the patient should be referred to a vitreoretinal surgeon for vitrectomy and removal of lens fragments.

NB: There may be cases where it is not possible to achieve the correct position even for a PC IOL. Then it is safer to refuse implantation and decide to correct aphakia with a contact lens or secondary implantation of an intraocular lens at a later date.

The timing of the operation is controversial. Some suggest removing residues within 1 week, since later removal affects the restoration of visual function. Others recommend delaying surgery for 2-3 weeks and undergoing treatment for uveitis and increased intraocular pressure. Hydration and softening of the lens masses during treatment facilitates their removal using a vitreotome.

Surgical techniques include pars plana vitrectomy and removal of soft fragments with a vitreotome. More dense fragments of the nucleus are connected by the introduction of viscous liquids (for example, perfluorocarbon) and further emulsification with a phragmatome in the center of the vitreous cavity or removal through a corneal incision or scleral pocket. An alternative method for removing dense nuclear masses is their crushing followed by aspiration,

Dislocation of the GK-IOL into the vitreous cavity

Dislocation of the GC IOL into the vitreous cavity is a rare and complex phenomenon, indicating improper implantation. Leaving an intraocular lens in place can lead to vitreal hemorrhage, retinal detachment, uveitis, and chronic cystoid macular edema. Treatment is vitrectomy with removal, reposition or replacement of the intraocular lens.

With adequate capsular support, repositioning of the same intraocular lens into the ciliary sulcus is possible. With inadequate capsular support, the following options are possible: removal of the intraocular lens and aphakia, removal of the intraocular lens and replacing it with a PC-IOL, scleral fixation of the same intraocular lens with a non-absorbable suture, implantation of iris-clip lenses.

Hemorrhage into the suprachoroidal space

Hemorrhage into the suprachoroidal space may be a consequence of expulsive bleeding, sometimes accompanied by prolapse of the contents of the eyeball. This is a serious but rare complication and is unlikely to occur with phacoemulsification. The source of hemorrhage is a rupture of the long or posterior short ciliary arteries. Contributing factors include advanced age, glaucoma, anterior-posterior enlargement, cardiovascular disease, and vitreous loss, although the exact cause of bleeding is not known.

Signs of suprachoroidal hemorrhage

Increasing fragmentation of the anterior chamber, increased intraocular pressure, iris prolapse. Leakage of the vitreous body, disappearance of the reflex and the appearance of a dark tubercle in the pupil area. In acute cases, the entire contents of the eyeball may leak through the incision area.

Immediate actions include closing the incision. Posterior sclerotomy, although recommended, may increase bleeding and lead to loss of the eye. After surgery, the patient is prescribed local and systemic steroids to relieve intraocular inflammation.

Follow-up tactics

Ultrasound examination is used to assess the severity of changes that have occurred; surgery is indicated 7-14 days after blood clots have liquefied. The blood is drained and vitrectomy is performed with air/fluid exchange. Despite the unfavorable prognosis for vision, in some cases it is possible to preserve residual vision.

Edema

The swelling is usually reversible and is most often caused by the operation itself and injury to the endothelium during contact with instruments and the intraocular lens. Patients with Fuchs endothelial dystrophy pose an increased risk. Other causes of edema are the use of excessive power during phacoemulsification, complicated or prolonged surgery, and postoperative hypertension.

Iris prolapse

Iris prolapse is a rare complication of small incision surgery but can occur with EEC.

Causes of iris loss

The incision for phacoemulsification is closer to the periphery. Moisture leaking through the cut. Poor suture placement after EEC. Patient-related factors (cough or other strain).

Symptoms of iris loss

On the surface of the eyeball in the area of ​​the incision, prolapsed iris tissue is detected. The anterior chamber at the incision site may be shallow.

Complications: uneven wound scarring, severe astigmatism, epithelial ingrowth, chronic anterior uveitis, macular edema and endophthalmitis.

Treatment depends on the interval between surgery and detection of prolapse. If the iris falls out within the first 2 days and there is no infection, its reposition with repeated suturing is indicated. If the prolapse occurred a long time ago, the area of ​​the prolapsed iris is excised due to the high risk of infection.

Intraocular lens displacement

Displacement of the intraocular lens is rare, but can be accompanied by both optical defects and disturbances in the structures of the eye. When the edge of the intraocular lens is displaced into the pupil area, patients are bothered by visual aberrations, glare and monocular diplopia.

Intraocular lens displacement mainly occurs during surgery. It can be caused by dialysis of the ligament of Zinn, capsule rupture, and can also occur after conventional phacoemulsification, when one haptic part is placed in the capsular bag and the second in the ciliary groove. Postoperative causes include trauma, irritation of the eyeball and contraction of the capsule.

Treatment with miotics is beneficial for minor displacement. Significant displacement of the intraocular lens may require replacement.

Rheumatogenous retinal detachment

Rheumatogenous retinal detachment, although rare after EEC or phacoemulsification, may be associated with the following risk factors.

Before surgery

Lattice degeneration or retinal breaks require pretreatment before cataract extraction or laser capsulotomy if ophthalmoscopy is possible (or immediately after it becomes possible). High myopia.

During surgery

Vitreous loss, especially if subsequent management was incorrect, and the risk of detachment is about 7%. If myopia is >6 diopters, the risk increases to 1.5%.

After operation

Performing YAG laser capsulotomy in the early stages (within a year after surgery).

Cystoid retinal edema

Most often it develops after a complicated operation, which was accompanied by rupture of the posterior capsule and prolapse, and sometimes strangulation of the vitreous, although it can also be observed during a successfully performed operation. Usually appears 2-6 months after surgery.

Cataract is clouding of the lens of the eye. In most cases, the disease is caused by the natural aging process of the body, but it is also observed in people who have sustained an eye injury, have diabetes, and can also be a consequence of radiation therapy.

Cataract surgery is safe and quick in most cases, especially when performed by a highly qualified specialist. However, there are cases when complications arise during, and more often after, surgery.

Types of complications

Complications after cataract removal are divided into 2 types:

In turn, each type includes different types of complications. So they attribute to the early ones:

• inflammatory reactions. These include uveitis (inflammation of the vascular system of the eye) and iridocyclitis (inflammation of the iris and ciliary body of the eye). This reaction is a completely normal response of the body to the injury that occurred during the operation. If the postoperative period proceeds without complications, then the inflammatory process will go away on its own in a couple of days and the eye will return to its original state.
• rise in intraocular pressure. Associated with clogged drainage system of the eye. Most often it is eliminated by prescribing drops to the patient; in some cases it is treated with punctures.
• hemorrhage in the anterior chamber. It occurs extremely rarely if the iris of the eye is affected.
• retinal disinsertion. Most often observed with myopia or surgical injuries, it is treated with repeated intervention.
• displacement of the artificial lens. The displacement is caused by improper attachment in the capsular bag or incompatibility of the bag with the lens. Corrected by repeated surgery.

Late complications after cataract removal are:

• secondary cataract. A frequently observed late complication that occurs after surgery. It occurs due to the fact that incompletely removed epithelial cells continue their development further, transforming into lens fibers. After they move to the central optical zone, clouding occurs, reducing vision. It can be treated with simple surgery or laser.
• swelling of the macular region of the retina. The second name is Irvine-Gass syndrome. It is an accumulation of fluid in the macula of the eye (macula), leading to decreased central vision. It is treated with laser or conventional surgery, as well as a course of medication.

Possible complications after cataract surgery

More than 98% of patients have improved vision after surgery. if there were no concomitant eye diseases. Recovery is proceeding smoothly. Moderate or severe complications are extremely rare but require immediate medical attention.

Eye infections after cataract surgery are very rare - one case in several thousand. But if the infection develops inside the eye, you can lose your vision and even your eye.

Most ophthalmologists use antibiotics before, during, and after cataract surgery to minimize the risk. External inflammation or infections usually respond well to medication. However, infection can develop in the eye very quickly, even within a day after surgery, and in such cases immediate treatment is required.

Intraocular inflammation (swelling at the incision site) that occurs in response to surgery is usually a minor reaction in the postoperative period.

Small discharge from a cut on the cornea is rare, but can create a high risk of intraocular infection and other unpleasant consequences. If this occurs, your doctor may recommend using a contact lens or apply a pressure bandage to the eye to promote healing. But sometimes additional stitches are needed to close the wound.

Some people may develop severe astigmatism, an abnormal curvature of the cornea that causes blurred vision, after surgery due to tissue inflammation or too tight sutures. But when the eye heals after surgery, the swelling goes down and the stitches are removed, the astigmatism usually corrects itself. In some cases, cataract removal can reduce pre-existing astigmatism because the incisions can change the shape of the cornea.

Bleeding inside the eye is another possible complication. It occurs quite rarely, since small incisions are made in the eye exclusively on the cornea and do not affect the blood vessels inside the eye. By the way, even bleeding caused by large incisions can stop on its own without causing any harm. Bleeding from the uvea - the thin membrane in the middle layer of the eye, between the sclera and the retina - is a rare but serious complication that can cause complete loss of vision.

Another possible complication after cataract surgery is secondary glaucoma - increased intraocular pressure. It is usually temporary and can be caused by inflammation, bleeding, adhesions, or other factors that increase intraocular (in the eyeball) pressure. Drug treatment for glaucoma usually helps regulate blood pressure, but sometimes laser treatment or surgery is required. Retinal detachment is a serious condition in which the retina separates from the back wall of the eye. Although this does not happen often, it requires surgery.

Sometimes 1-3 months after cataract surgery, the macular tissue of the retina becomes inflamed. This condition is called cystoid macula edema. characterized by blurred central vision. Using a special analysis, an ophthalmologist can make a diagnosis and administer medication. In rare cases, the implant may move. If this happens, you may experience blurred vision, intense double vision, or blurred vision. If this interferes with your vision, your ophthalmologist may replace or replace the implant.

In 30-50% of all cases, the residual membrane (the capsule left in the eye to support the implant) becomes cloudy some time after surgery, causing blurred vision. It is often called secondary, or post-cataract, but this does not mean that the cataract has formed again; this is only a clouding of the membrane surface. If this condition interferes with clear vision, it can be corrected with a procedure called YAG (yttrium aluminum garnet) capsulotomy. During this procedure, the ophthalmologist uses a laser to create holes in the center of the cloudy membrane to allow light to pass through. This can be done quickly and painlessly, without incisions.

Complications After Cataract Surgery

People who have had to deal with such an ophthalmological problem as lens opacity know that the only way to get rid of it is cataract surgery, that is, IOL implantation. In the United States, more than 3 million such operations are performed per year, and 98% of them are successful. In principle, this operation is simple, quick and safe, but it does not exclude the development of complications. What complications may arise after cataract surgery and how to correct them, we will find out by reading this article.

Types of complications

All complications that accompany IOL implantation can be divided into those that occurred directly during surgery or postoperatively. Postoperative complications include:

• increase in intraocular pressure;
• uevitis, iridocyclitis – inflammatory eye reactions;
• retinal disinsertion;
• hemorrhage in the anterior chamber;
• displacement of the artificial lens;
• secondary cataract.

Inflammatory eye reactions

Inflammatory responses almost always accompany cataract surgery. That is why, immediately after completion of the intervention, steroid drugs or broad-spectrum antibiotics are injected under the conjunctiva of the patient’s eye. In most cases, symptoms of the response will completely disappear after about 2-3 days.

Hemorrhage into the anterior chamber

This is a fairly rare complication that is associated with trauma or damage to the iris during surgery. Usually the blood resolves on its own within a few days. If this does not happen, doctors rinse the anterior chamber and, if necessary, additionally fix the lens of the eye.

Increase in intraocular pressure

This complication may occur due to clogging of the drainage system with highly elastic, viscous drugs that are used during surgery to protect the cornea and other intraocular structures. Usually, instilling drops that reduce intraocular pressure solves this problem. In exceptional cases, it becomes necessary to puncture the anterior chamber and thoroughly rinse it.

Retinal detachment

This complication is considered severe, and it occurs in the event of an eye injury after surgery. In addition, retinal detachment is most common in people with myopia. In this case, ophthalmologists most often decide to perform an operation, which consists of filling the sclera - vitrectomy. In the case of a small area of ​​detachment, restrictive laser coagulation of the retinal tear can be performed. Among other things, retinal detachment leads to another problem, namely lens displacement. Patients begin to complain about rapid eye fatigue, pain, and double vision when looking into the distance. These symptoms are not permanent and usually disappear after a short rest. When a significant displacement occurs (1 mm or more), the patient experiences constant visual discomfort. This problem requires repeated intervention.

Full Lens Shift

Dislocation of the implanted lens is considered the most severe complication, which requires unconditional surgical intervention. The operation involves lifting the lens and then fixing it in the correct position.

Secondary cataract

Another complication after cataract surgery is the formation of secondary cataracts. It occurs due to the proliferation of remaining epithelial cells from the damaged lens, which spread to the area of ​​the posterior capsule. The patient experiences deterioration in vision. To correct this problem, it is necessary to undergo a laser or surgical capsulotomy procedure. Take care of your eyes!

Possible complications

Secondary cataract

The most common complication of lens replacement surgery. Secondary cataract is expressed as opacification of the posterior capsule. It was 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 - in almost 40%; there are also 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 for its prevention, are still not fully understood.

It is generally accepted that this complication is caused by migration of the lens epithelium into the space between the lens and the posterior capsule. Lens epithelium is the cells remaining after lens removal that contribute to the formation of deposits that significantly degrade image quality. Another possible cause is fibrosis of the lens capsule. Elimination of such a defect is carried out using a YAG laser, which is used to create a hole in the center of the area of ​​the clouded posterior lens capsule.

Increased IOP

This is a complication of the early postoperative period. It may be caused by incomplete washout of viscoelastic, a special gel-like 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 is a displacement of the IOL towards the iris. Elimination of this complication does not take much time; in most cases, taking antiglaucoma drops for several days is enough.

Cystoid macular edema (Irvine-Gass syndrome)

A similar complication occurs after phacoemulsification of cataracts in approximately 1% of cases. While the extracapsular method of lens removal makes it possible for the development of 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. Treatment is carried out with corticosteroids, NSAIDs, angiogenesis inhibitors. If conservative treatment is ineffective, vitrectomy 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 ocular pathology. As a rule, swelling goes away within a few days, without treatment. In 0.1% of cases, pseudophakic bullous keratopathy may develop, accompanied by the formation of bullae (vesicles) in the cornea. In such cases, hypertonic solutions or ointments are prescribed, medicinal contact lenses are used, and therapy is carried out for the pathology that caused this condition. Lack of treatment effect may lead to corneal transplantation.

Postoperative astigmatism

A very common complication of IOL implantation, leading to a deterioration in the outcome of the operation. Moreover, the amount of induced astigmatism is directly related to the method of cataract extraction, the length of the incision, its location, the presence of sutures, and the occurrence of any complications during the operation. Correction of small degrees of astigmatism is carried out with spectacle correction or using contact lenses; with severe astigmatism, refractive surgery is possible.

Displacement (dislocation) of the IOL

A rather rare complication compared to those described above. Retrospective studies have found that the risks of IOL dislocation in operated patients 5, 10, 15, 20 and 25 years after implantation are 0.1, 0.2, 0.7 and 1.7%, respectively. It has also been found that pseudoexfoliation syndrome and laxity of the zonules of Zinn can increase the likelihood of lens displacement.

Other complications

IOL implantation increases the risk of rhegmatogenous retinal detachment. As a rule, patients with complications that arose during surgery, those who injured the eye during the period after surgery, those with myopic refraction, and diabetics are exposed to this risk. In 50% of cases, such a detachment occurs in the first year after surgery. Most often it occurs after intracapsular cataract extraction surgery (in 5.7% of cases), least often after extracapsular cataract extraction surgery (in 0.41-1.7% of cases) and phacoemulsification (in 0.25-0.57% of cases). cases). All patients with implanted IOLs should continue to be followed by an ophthalmologist to ensure that this complication is detected as early as possible. The principle of treatment for this complication is the same as for detachments of other etiologies.

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

Often it stops on its own, with virtually no effect on visual functions, but sometimes its consequences can even lead to the loss of an eye. The main treatment is complex therapy, including the use of local and systemic corticosteroids, drugs with cycloplegic and mydriatic effects, and antiglaucoma drugs. In some cases, surgery 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 prosthesis of the fellow eye, or after immunosuppressive therapy. Signs of an intraocular infection may include: severe redness of the eye, increased sensitivity to light, pain, and decreased vision. Prevention of endophthalmitis - instillation of 5% povidone-iodine before surgery, administration of antibacterial agents inside the chamber or subconjunctivally, sanitation of possible foci of infection. It is especially important to use disposable or thoroughly treat reusable surgical instruments with disinfectants.

Advantages of treatment at MGK

Almost all of the above complications of cataract surgical treatment are poorly predictable and are often associated with circumstances beyond the skill of the surgeon. Therefore, it is necessary to treat the complication that has arisen 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.

By using the services of specialists from the Moscow Eye Clinic, you can be sure that you will receive all the necessary assistance in full, regardless of the location of the operation that caused the complication. Our patients have the latest diagnostic and surgical equipment, the best ophthalmologists and ophthalmic surgeons in Moscow, and attentive medical staff at their disposal. The clinic’s specialists have accumulated sufficient experience in effectively treating complications of cataract surgery. The clinic has a comfortable 24-hour hospital. We work for you all week, seven days a week, from 9.00 to 21.00 Moscow time.

Share a link to the material on social networks and blogs:

An increase in intraocular pressure in the postoperative period may occur due to: the development of pupillary block, or clogging of the drainage system with special viscous preparations - highly elastic, used at all stages of the operation to protect intraocular structures and, especially, the cornea of ​​the eye, if they are incompletely washed out of the eye In this case, when intraocular pressure rises, drops are prescribed, and this is usually sufficient. Only in rare cases, when intraocular pressure increases in the early postoperative period, an additional operation is performed - puncture (puncture) of the anterior chamber and its thorough washing. Retinal detachment occurs with the following predisposing factors:

• myopia,

Phacoemulsification minimizes the risk of complications after lens replacement. Therefore, this operation is in great demand among ophthalmologists and patients. Phacoemulsification uses self-sealing incisions.

A reduction in the number of complications is caused by folding lenses or viscoelastics, which well protect the internal structures of the eye. With this procedure, it became possible to carry out the operation at any time. There is no need to wait for more favorable conditions.

Before the introduction of this technology, complications after cataract surgery occurred more frequently. This happened because it was necessary to wait for the lens to fully mature.

In this state, it became denser, which complicated the process. Therefore, ophthalmologists believe that cataracts must be eliminated immediately. This factor contributed to the invention of phacoemulsification.

This is a new and safe method that has maximum effect in the treatment of cataracts. But any operation has its own certain risks of complications. More often noticed. The first sign of this complication is a cloudy appearance of the posterior capsule.

Most often, secondary cataracts occur when using lenses made of polymethyl methacrylate. The reasons for its appearance, as well as preventive measures, are still unknown. Scientists are trying to figure out how this effect occurs after lens replacement. This is known to occur due to the movement of epithelial tissues into the space that lies between the lenses and the posterior capsule.

Epithelium is the cells that remain when the lens is completely removed. They can form deposits that make the patient's vision blurry. It is believed that fibrosis of the lens capsule leads to the occurrence of secondary cataracts. In this case, the complication is eliminated using a YAG laser. They make a hole (in the center of the clouded area).

This causes another complication - an increase in intraocular pressure (IOP). It occurs immediately after the intervention. It may occur due to incomplete washout of the viscoelastic. This is a substance that protects the internal structures of the eye. The cause of increased IOP after cataract removal may be a shift of the IOL towards the iris. But this phenomenon can be easily eliminated if you use glaucoma drops for 2-3 days.

Other negative phenomena

Irvine-Gass syndrome, or cystoid macular edema, occurs in 1% of cases. But when using the extracapsular technique, the likelihood of pathology occurring increases to 20%. There is a risk group for this complication that includes diabetics, people with uveitis and wet AMD.

The likelihood of occurrence increases if the posterior capsule ruptures during cataract extraction. After the lens is removed, a complication may arise in the event of vitreous loss. You can get rid of the pathology with the help of corticosteroids, non-steroidal anti-inflammatory drugs, angiogenesis inhibitors. If conservative treatment does not give the desired effect, vitrectomy is prescribed.

The eye may swell after lens replacement. This complication is called ocular edema. It occurs when the pumping function of the endothelium is damaged during surgery. Damage can be either chemical or mechanical in nature.

During swelling of the eye, a person sees blurred. But with a favorable outcome, the complication goes away on its own.

But the development of pseudophakic bullous keratopathy can also occur. This process is characterized by the presence of bubbles in the cornea. To eliminate them, hypertonic solutions and ointments are prescribed. It is possible to use therapeutic contact lenses. If therapy does not help, the cornea will need to be replaced.

Foggy eyes can also appear with astigmatism. The postoperative form of the disease occurs after IOL implantation. The complexity of astigmatism directly depends on the method used to eliminate the cataract. The severity is influenced by the length of the incision, its location, the presence of sutures and problems encountered during the operation.

If the degree of astigmatism is small, then it can be corrected with glasses or lenses. But when the eye is watery and the degree of astigmatism is high, it is necessary to perform refractive surgery.

In rare cases, a complication such as IOL displacement occurs. According to statistics, the percentage of manifestation of this complication is very small even several years after the operation. Contributing factors are:

• weakness of the cyanogen ligaments;
• pseudoexfoliation syndrome.

Other pathologies

- A common occurrence during IOL implantation. Its occurrence is associated with various problems discovered during surgery. The appearance of pathology is facilitated by the presence of diabetes mellitus, myopic refraction, and previous surgical intervention.

In most cases, this disease is caused by intracapsular cataract extraction. Less commonly, the cause is extracapsular cataract extraction. But the smallest percentage of cases of such a complication is observed during phacoemulsification. To detect this complication early after surgery, it is necessary to periodically visit an ophthalmologist. This condition is treated in the same way as other detachments.

During the operation, unforeseen complications may occur, which include choroidal hemorrhage. Blood pours out from the nutrient vessels of the retina. This condition is observed with hypertension, a sudden increase in IOP, atherosclerosis, and aphakia. The cause of the disease may be an eyeball that is too small, old age, or an inflammatory process.

The bleeding may stop on its own. But there are cases when it led to complex consequences, as a result of which patients lost an eye. It is necessary to apply complex therapy to eliminate bleeding. Additionally, corticosteroids, cycloplegic and mydriatic drugs, and antiglaucoma drugs are prescribed. Sometimes surgery is indicated.

If cataract surgery is performed, complications may present in the form of endophthalmitis. They can cause, which leads to its absolute loss. According to statistics, the frequency of occurrence is 0.13-0.7%

Factors contributing to the occurrence of pathology are wearing contact lenses, a prosthetic fellow eye, and the use of immunosuppressive therapy. If an infectious process has begun in the organ, it is manifested by severe redness of the eye, increased photosensitivity, painful sensations and deterioration of vision.

For prophylaxis, preoperative administration of 5% povidone-iodine is indicated. Additionally, an antibacterial agent is injected into the eye. The quality of disinfection of the instrument used for surgery plays an important role.

Reasons for the development of negative phenomena

Many patients are interested in why, despite the high level of safety, complications appear. This is explained by the fact that any interference in the activity and integrity of the body is stressful for the patient. Moreover, each complication has its own mechanism of occurrence.

Swelling of the eye can appear not only in the postoperative period, but also before the procedure. More often it is caused by weakness of the cornea. If swelling appears after surgery, a reaction to ultrasound may occur. If you have to treat already advanced cataracts, it is necessary to use stronger sound waves. This also causes an increased effect on the eyeball.

If the operation is performed without stitches, swelling is minor and does not require any treatment. Once the shape of the eye is restored and the swelling disappears, vision will be restored. It is possible that there will be a burning sensation and pain in the eye. To alleviate this condition, you must follow your doctor’s recommendations:

• You can’t lower your head (until the doctor’s permission);
• avoid driving;
• while sleeping, lie on the side of your healthy eye;
• avoid physical overexertion;
• prevent water from entering while taking a bath;
• protect the eye from mechanical damage.

Lens replacement surgery is a fairly safe intervention, the postoperative period of which goes quite smoothly if you follow all the doctor’s recommendations

Video