2020–2021 BCSC Basic and Clinical Science Course™
11 Lens and Cataract
Chapter 11: Postoperative Surgical Course and Complications
Introduction
In uncomplicated phacoemulsification, the postoperative course generally allows for rapid vision rehabilitation over several weeks:
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Symptoms: Foreign-body sensation and photosensitivity are common immediately after surgery. Fluctuations in vision may occur. Topical lubrication may alleviate these symptoms.
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Signs: The corneal incisions are typically Seidel-negative. There may be irregular epithelium or small epithelial defects at the incisions. Corneal edema is variable and may have a marked effect on visual acuity. Ideally, the anterior chamber is deep, with mild to moderate cellular reaction. Make sure the intraocular lens (IOL) is well positioned and stable. If present, ptosis is generally minimal (particularly if a block was used).
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Course: Typically, the patient’s vision stabilizes, and the pain and photosensitivity decrease over several days to weeks. Although further refractive changes may occur later, most patients are prescribed postoperative spectacles by 2‒6 weeks after uncomplicated cataract surgery.
Although the ophthalmologist strives to attain excellent results during both cataract surgery and the postoperative course, complications do occur, even in the best of hands. Therefore, recognizing and appropriately treating any complications are critical to a successful outcome.
Postoperative occurrences and complications of cataract surgery include the following:
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corneal edema (0.03%–5.18% of cases)
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retained lens fragments (0.45%–1.70% of cases)
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IOL dislocation (0.19%–1.10% of cases)
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posterior capsule opacification (common; increases with time after surgery)
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endophthalmitis (0.04%–0.20% of cases)
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clinically apparent cystoid macular edema (1.2%–3.5% of cases)
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retinal detachment (approximately 0.7% of cases in first postoperative year)
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.