Detecting and managing complications in cataract patients

Even if these are all in place, problems can arise with a patient who can’t keep still in theatre, an eye that is deep-set and difficult to access, a small pupil, weak lens zonules (whether due to pseudo-exfoliation or subluxation) or a hyper-mature cataract that requires a high degree of surgical skill. If the posterior capsule is ruptured and there is vitreous loss, there is a higher risk of postoperative complications such as endophthalmitis, retinal detachment or macular oedema. Poor vision postoperatively can be caused by uncorrected refractive error, particularly if no intraocular lens (IOL) was used or the wrong power IOL was inserted. Things can also go wrong in the postoperative period if postoperative complications are missed, or if perioperative complications are not managed well. It is therefore important that all eye health workers who come into contact with the patient postoperatively know the basics of what the operation entails and what is normal so that they are alert to any signs or symptoms that might require action. They must know how to recognise an early or late complication and how to manage it effectively to prevent loss of sight – which we will cover in more detail in this article. Complications are rare and in most cases can be treated effectively. In a small proportion of cases, further surgery may be needed. Very rarely, some complications can result in blindness. Some complications may arise despite a good initial surgical outcome but in most settings they can be avoided through effective communication between the eye team and the patients. Good rapport is needed with an honest discussion about expectations right from the start. As a general rule, worsening sight, increasing pain, redness, swelling and discharge are all symptoms or signs that should trigger a referral. What follows is a list of complications and advice on how to manage them in order to minimise the risk of a poor outcome.