Complications and side effects | Cataract surgery

Complications and side effects

Cataract surgery is one of the safest and – with 7000 operations per year in Germany alone – one of the most frequently performed routine operations worldwide and the side effects and complications are extremely low. 97 to 99 percent of all cataract operations performed are completely free of complications. Nevertheless, like any surgical intervention, the procedure, in principle, bears some risks.

For example, a tear of the posterior capsule wall can occur during the operation. Behind the lens is the vitreous body in the human eye, which consists of a gellike, transparent liquid and fills almost the entire eye. It presses with its mass on the retina at the back of the eye, holding it firmly pressed against its substrate.

If some of the vitreous fluid escapes in a ruptured capsule, the vitreous loses volume and can no longer press on the retina properly. Under certain circumstances, the retina detaches from the substrate, which is then called retinal detachment. The risk of capsule rupture is approximately six to eight percent with intracapsular cataract extraction, while capsule rupture is virtually never a problem with extracapsular cataract extraction.

Also very rare, but theoretically possible, is the penetration of bacteria into the interior of the eye, where they can lead to inflammation (endophthalmitis). In the worst case, the affected eye can even go blind if the inflammation is not treated. There may also be an increase in pressure inside the eye during the procedure, which can cause small blood vessels in the back of the eye to burst.

The escaping blood can accumulate both in the eye (intraocular) and in the lens capsule (intracapsular). However, with less than 1% probability, this complication is extremely rare. For this reason, macular edema can be an extremely rare consequence.

In this case a fluid accumulation in the area of the sharpest vision, the “yellow spot“, is formed, which can lead to considerable visual problems. Due to the incision into the cornea and its subsequent healing, the cornea may be slightly more curved for some time after the operation than before. However, this usually disappears within a few weeks.

However, if there is a severe deterioration in vision, unusually severe redness or even severe pain after the operation, an ophthalmologist should definitely be consulted, as this is an ophthalmological emergency. A widespread consequence of cataract surgery is the so-called “after-star” (also known as cataracta secundaria). Depending on the surgical method, it occurs in about 20 to 30 percent of patients.

Younger people are generally more frequently affected than older people. In this case, the posterior parts of the lens capsule still remaining in the eye become cloudy and worsen the vision, just like the actual cataract before it. However, the removal of this clouding is very simple: With the help of a laser or another surgical procedure, the lens capsule parts are removed quickly and without risk and vision is immediately restored.