Is cataract surgery safe?
Although cataract surgery is exceedingly safe, there is still a small risk of complications either at the time of surgery, or in the first week after surgery, or even some complications many months after surgery. It is important that you have a Consultant cataract surgeon who is trained to manage any surgical or post-surgical complications that could occur. I would like to take you through the three potential complications of cataract surgery, which are
- posterior capsule rupture (PCR) during surgery,
- postoperative endophthalmitis usually within a week of surgery, and
- posterior capsular lens opacity (PCLO), which is also known as the after cataract which can occur within the first six months of the operation.
Posterior capsule rupture is when the posterior capsule of your natural lens, which has to be preserved to hold and support the intraocular lens, develops a small rupture during the surgery. It is important during the phaco-cataract surgery when the surgeon is removing the contents of the capsule that they do not inadvertently cause a tear or rip in the posterior capsule. The posterior capsule lies between the clear vitreous gel behind and space where they will place the intraocular lens. Posterior capsule rupture or PCR can be of no consequence, or little effect, or can be accompanied by a vitreous prolapse or even a displacement of the lens nucleus (which is called nucleus loss) backwards into the vitreous cavity. PCR with lens fragment displacement can significantly impact on the visual outcome of surgery and will most likely require a vitrectomy to remove the residual lens fragments from the vitreous. However, the risk of poor visual outcome can be mitigated by prompt recognition by the surgeon of a posterior capsule rupture and its careful management during the surgery, minimising your potential side-effects. Miss Laura Crawley and Mr Jaheed Khan are well-trained and highly experienced cataract surgeons who can manage capsule rupture should it occur. They have to document and show their overall PCR rate as part of their yearly appraisal. The Royal College of Ophthalmologists audit of 55,000 cataract operations revealed that the overall PCR rate is 1.92%, but they also demonstrated the probability of PCR increases by a range of pre-operative factors related to the type of cataract and also other co-existing ocular conditions, or even the patient’s physical condition. Hence, the PCR rate can be much lower than 1.92% in some individuals or higher than 1.92% in others. For instance, if someone is very elderly with Parkinson’s disease, that comes under patient’s physical condition, and the PCR rate risk is higher than 1.92%. There are some unfavourable conditions, called complex or high-risk factors, which can result in a PCR risk of being even up to 50%, even for most highly experienced surgeons. Miss Laura Crawley and Mr Jaheed Khan will indicate to you how high risk your cataract surgery is. Remember most cataract surgery is low risk, but individual patients have a higher risk than average. The cataract surgeon will use their skills will help to identify whether you have higher risks for surgery because of your risk factors. Miss Laura Crawley and Mr Jaheed Khan compare their surgical outcomes with a large database of cataract surgical outcomes using the national ophthalmology database, and they are well within it. They have to audit their results of cataract surgery, particularly perioperative complications, the rate of infection and the final visual outcomes. Infective endophthalmitis is, unfortunately, one of the more severe continuing potential complications of cataract surgery. I will talk more about posterior capsular lens opacity (PCLO) and endophthalmitis in future blog posts.