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The Risks and Benefits of Cataract Surgery
What are the risks associated with cataract surgery?
- Cataract surgery is the most commonly performed type of eye surgery.
In the vast majority of cases, approximately 95% of the time, the
surgery is uncomplicated. Cataract surgery usually results in improved
vision and a well satisfied patient.
- However, cataract surgery should never be trivialized. In a small
percentage of patients, events occur which can lead to less than ideal
- Most of these events are known risks of the surgery itself and can
occur even if the operation is performed well by an experienced
surgeon. The occurrence of these events is often unpredictable.
- Patients should be aware of such possibilities when they decide to
proceed with surgery. Some of the most common risks are reviewed in
- Ophthalmic surgeons normally make great efforts at the time of
surgery to reduce the possibility of introacular infection, which is
- Patients usually receive topical antibiotic eye drops on the day of
surgery. The surface of the eye and the skin around the eye are
disinfected with antiseptic compounds, and the patient's face except
the eye is covered with sterile drapes.
- Sterile techniques are used for all instruments, similar to those
used for all modern surgeries. After the surgery is completed,
surgeons prescribe topical antibiotic eye drops.
- Nonetheless, even with these precautions, an intraocular infection,
called endophthalmitis, occurs in approximately one out of 3,000
cases. Symptoms and signs of endophthalmitis include excessive eye
redness, pain, light sensitivity, and worsening vision.
- In some cases, the patients may be fairly comfortable on the first
day or so after surgery, but then worsen in terms of pain, vision, and
light sensitivity several days later.
- Patients who undergo cataract surgery should be instructed to call
their ophthalmologist immediately if they worsen in these ways. If a
patient develops endophthalmitis, intraocular antibiotics are often
injected into the eye to minimize the spread of the infection.
- Sometimes an additional surgery (vitrectomy) is performed to remove
the jelly-like substance of the eye; this may help control the
Cystoid Macular Edema
- The retina is the neural tissue which lines the entire inside of the
back part the eye. The very center of the retina is called the macula,
which is responsible for central vision.
- After cataract surgery, inflammation can sometimes cause retinal
blood vessels to leak fluid which accumulates in the macula, causing
decreased central vision.
- This swelling is referred to as "cystoid macular edema".
When vision is affected by macular edema, the ophthalmologist may
recommend a specialized test, called a fluorescein angiogram, in order
to determine the extent of swelling.
- Ophthalmologists often treat macular edema with topical steroid eye
drops or non-steroidal anti-inflammatory eye drops which help quiet
the inflammation, often improving the situation over weeks or months.
- Sometimes injections of steroids behind the eye, or even
intra-ocular vitrectomy surgery are useful in improving the vision.
- A retinal detachment occurs when liquid vitreous fluid gets through
a fine tear in the retina, allowing it to separate abnormally from the
back wall of the eye. A retinal detachment may cause a curtain across
part or all of the vision of the eye.
- Retinal detachments can occur in patients who have not had any prior
eye surgery, especially in patients who are highly nearsighted.
However, cataract surgery increases the risk of retinal detachment.
- After cataract surgery, retinal detachments occur in approximately
1.5% of patients.
- You should contact your ophthalmologist immediately if you develop a
curtain blocking the vision, flashes of light like lightening streaks,
or new floating spots in your vision. These symptoms can sometimes
herald a retinal detachment.
Posteriorly Dislocated Lens Material
- In some instances, lens material can fall into the back cavity
(vitreous cavity) of the eye. Often small pieces of posteriorly
dislocated lens material are well tolerated by the eye without
- When larger pieces are dislocated, the ophthalmologist may recommend
a second surgery, called a vitrectomy, to remove the lens material.
This removal prevents excessive inflammation from developing.
- Infrequently and unpredictably during cataract surgery, acute
bleeding can occur in the choroid, which is the delicate pattern of
blood vessels underlying and nourishing the retina.
- Although this complication, called "choroidal hemorrhage"
is more common among elderly patients, it is truly unpredictable.
- In some cases of choroidal hemorrhage, the bleeding is localized,
and patients do well. In more severe cases of choroidal hemorrhage,
visual loss can be substantial.
How do I get more information about the risks associated with
- Before cataract surgery, ophthalmologists usually discuss the risks,
benefits and alternatives of the surgery.
- If unexpected events occur at the time of surgery, or develop after
the surgery, the ophthalmologic surgeon will discuss the particular
implications and help formulate a specific treatment plan.
Last Revised: August 17, 2010