cataract complication

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  • CATARACT SURGERYCOMPLICATIONS

    surjeet acharyaVMC

  • PRE-OPERATIVE

  • ANXIETYRx: DIAZEPAM 2-5mg at bed time

  • NAUSEA AND GASTRITISACETAZOLAMIDE

    Rx: ORAL ANTACIDS

  • ALLERGIC CONJUCTIVITIS

  • CORNEAL ABRASION

  • ANESTHESIACOMPLICATIONS

  • RETROBULBAR HEMORRHAGERx: 1 drop PILOCARPINE (2%) with pressure bandage

  • OCULOCARDIAC REFLEXBradycardia +/- Cardiac arrhythmiaRx; ATROPINE (iv)

    PERFORATION OF GLOBESUBCONJUCTIVAL HEMORRHAGEDISLOCATION OF LENS

  • OPERATIVE

  • POOR PRE-OPHYPOGLYCEMIA

    COUGH/SNEEZE, move head towards sides

    Excess Bleed if patient is on anticoagulants

  • POOR SURGICAL SKILL

  • Superior Rectus laceration/haematoma

    seen in ECCE/SICSno treatment required

  • Excess bleed

  • Incision relatedIrregular incision- in ECCE

    Button holing of anterior wall of tunnelPremature entry into anterior chamberScleral disinsertion

    MANUAL SICS & PHACO

  • Corneal Injury

    when A.C is entered with sharp instruments

  • CAPSULORRHEXIS COMPLICATIONSEscaping capsulorrhexisSmall capsulorrhexisEccentric capsulorrhexisVery large capsulorrhexis

  • POSTERIOR CAPSULAR RUPTUREFeared complication in all Cataract surgeriesOccurs due to-forceful hydrodissectiondirect injury by instrumentscortex aspiration (ACCIDENTAL PCR)

  • ZONULAR DEHISCENCEIn all ECCE and SICS

  • VITREOUS LOSS

  • To decrease vitreous volume- pre op mannitolTo decrease aqueous volume- pre op acetazolamideTo decrease orbital volume- ocular massage and compressionBetter ocular akinesia and anesthesiaMinimising external pressure- carefull handling, minimum pull on bridle suture

  • Posteriorsclerotomy + vitreous drain from pars plana- in case of high IOP and surgery cannot be postponed

  • if vitreous loss has occuredanterior vitrectomyclear vitreous from AC and Incision site

    This prevents post-op complication due to vitreous loss

  • NUCLEUS DROPmostly seen in PHACO

    Rx- refer case to VITRORETINAl surgeon

  • POSTERIOR LOSS OF LENS FRAGMENTSDue to PCR or ZD during PHACOCan lead to glaucoma, uveitis, RD

    Rx- refer to vitreoretinal surgeon (pars plana vitrectomy)

  • EXPULSIVE CHOROIDAL HEMORRHAGEseen in HT and arteriosclerosis changes patientsMOSTLY in ICCE, ECCELEAST in SICS and PHACO

    Ch: WOUND GAPING; LOSS OF LENS, VITREOUS, IRIS, RETINA, UVEA & finally gush of blood

    Rx- unsatisfactory EYE IS LOST so EVISCERATION IS DONE

  • POST-OP

  • Hyphaema

    Rx: usually gets absorbs by itselfDrain out blood (if not resolved in 1 week)Treat for raised IOP (acetazolamide)

  • IRIS PROLAPSECommon in ICCE and ECCE

  • STRIATE KERATOPATHYDue to endothelium damage (cornea)corneal edema with descement folds

    Rx: hypertonic saline drops + steroids

  • ENDOPTHALMITIS

    Causes- instruments, solutions, surgeon hand, patient own flora

    ocular pain, conjuctival congestion, corneal edema, exudates, diminished vision, hypopyon

    Rx: IntraVitreal Antibioticssteroidssupportivevitrectomy

  • CME

    Common in all cataract surgery but insignificantdevelops 1-3 months later

    EP: vitreous incarceration and iritis

    Rx: anterior vitrectomy+steroids+anti-PGs

    Prevention: preop and postop anti-PGs

  • CHRONIC POSTOP ENDOTHALMITIS

    AgentsRx: pars plana vitrectomy + Ab/Af therapy

  • PSEUDOBULLOUS KERATOPATHYContinued corneal edema

  • RD

    Aphakic>>>>phakicICCE >>> ECCER/F- vitreous loss, myopics

  • EPITHELIAL INGROWTHConjuctival epithelium enters AC and can block TM causing GlaucomaIn late stages, it can extend upto iris and anterior part of vitreous

  • FIBROUS DOWNGROWTHDue to abnormal apposition of cataract woundCan lead to secondary glaucoma, anterior segment disorganisation and finally, phthisis bulbi

  • AFTER CATARACTa.k.a SECONDARY CATARACT

    Generally after ECCECauses: - residual lens matter - proliferative cataract may develop from remains of anterior cells in capsular bag

  • Clinical TypesDense membranous: thickened PCORx: membranectomy

  • Soemmerings ring: thick ring behind iris enclosed between 2 layers of capsule

  • Elschnigs pearls: vacuolated subcapsular epithelial cells are clustered in posterior capsuleRx: YAG-laser capsulotomy

  • IOL RELATED COMPLICATIONS

  • Anterior chamber and Iris supported lens

    CME, uveitis, secondary glaucoma, UGH syndrome (uveitis, glaucoma, hyphema)

  • IOL malpossitionSunset syndrome- inferior subluxation of iol

    Sunrise syndrome- superior subluxation of iol

    Loss lens syndrome- dislocation into vitreous

    Windsheild-wiper syndrome

  • Pupillary capturePostop iritis or proliferation of lens fibre remnants

  • Toxic Anterior Segment SyndromeViolent inflammation of uveal tissueCauses: - ethylene gas (for sterlising IOL) - lens material

  • PRE-OPOPERATIVEPOST OPIOL relatedAnesthesia relatedSR lacerationHyphaemaMalposition of lensCorneal abrasionExcess bleedIris prolapsePupilary capture of lensConjuctivitisInjury to cornea, irisStriate keratophyTASSAnxietyPCRBullous keratopathyHypoglycemiaZonular dehisceneEndopthalmitisGastritisVitreous lossCME, RDNucleus drop into vitreous cavityEpithelial and fibrous growthExpulsive choroidal hemorrhageAfter cataract

  • THANK YOU