CATARACT SURGERY- COMPLICATIONS

A i.e. Endopthalmitis; C i.e. Retinal detachment

– Painful red eye with diminution of vision along with eye lid swelling, chemosis, conjunctival injection, corneal haze (edema), aqueous flare & hypopyon in anterior chamber, posterior synechae, RAPD, with severe vitritis causing impaired view of fundus and loss of red reflex (lit grey white / grey yellow papillary reflex) in a diabetic within a week of ocular surgery indicate infectious inflammation of anterior & posterior segment concurrent with partial thickness involvement of ocular wall (i.e postoperative acute infective endophthalmitis).

In this diabetic patient, pain, redness, watering, diminution of vision, circumcorneal congestion, aqueous cells (+4), anterior chamber hypopyon and posterior synecheae on 3^rd postop day indicate infection and may be b/o anterior uveitis (iridocyclitis). But grayish -yellow papillary reflex indicate involvement of posterior segment and vitreous also, so the diagnosis is endophthalmitis.

D i.e. Propionobacterium Aenes

Delayed (late) onset endophthalmitis following cataract surgery (or glucoma filtering surgery) is caused most frequently by Propionibacterium acnesQ and occasionally S. epidermidis, Corynebacterium spp, or Candida parapsilosis (fungi).

A i.e. Endopthalmitis

Endopthalmitis is an early complication of cataract surgery, usually seen after 48-72 hours of surgery. It presents with ocular pain, diminished vision Q, lid edema, conjunctival chemosis, marked ciliary congestion, corneal oedema, exudates in pupillary area, hypopyon, and absent pupillary glow.

A i.e. Antibiotics eye drop; C i.e. Intraoperative antibiotics

They normally improve with time and with application of anti-inflammatory drops.
Infections after cataract surgery are rare, but if you have one, you’ll get a shot of antibiotics & Intraoperative antibiotics into your eye.

B i.e. Retinal detachment 

B i.e. After surgery for cataract or glaucoma 

• Ciliary block glaucoma is also called as malignant glaucoma/inverse glaucoma.

Ciliary Block Glaucoma/ Malignant Glaucoma

• Ciliary block glaucoma, or aqueous misdirection (formerly known as malignant glaucoma ), results from the posterior misdirection of aqueous into the vitreous body. 
• This posterior diversion of aqueous into the vitreous body after ocular surgery can elevate the IOP despite the presence of a patent iridectomy or iridotomy. 
• This misdirection displaces the lens–iris diaphragm anteriorly,causing the central and peripheral portions of the anterior chamber to become very shallow, and leads to a secondary elevation of IOP as a consequence of angle obstruction. 
• This condition occurs most commonly after intraocular surgery in eyes with prior angle-closure glaucoma, but it can also occur after cataract surgery or various laser procedures in eyes with open angles. Ciliary block glaucoma is characterized by a shallow anterior chamber and elevated IOP. 
• It must be differentiated from the pupillary block, suprachoroidal hemorrhage, and choroidal detachment.

Treatment

•  Atropine (malignant glaucoma also called inverse glaucoma since atropine is used), timolol, acetazolamide
•  Nd: Yag laser hyaloidotomy: making an opening in the anterior hyaloid membrane
•  Pars plana vitrectomy.

Ans. Posterior vitreous detachment

Ans. After cataract

Ans. Opacification of posterior capsule

Opacification of the posterior capsule caused by proliferation of cells in capsular bag remains the most frequent complication of ECCE and IOL surgery.

Ans. All

Ans. Fabry’s disease

Ans. Cystoid macular edema