Archive October 2014 XV, No. 10

5 Cataract Complications to Avoid

Tips, techniques and technology to ensure eye cases go as planned.

Daniel Cook

Daniel Cook, Executive Editor

BIO

ensuring surgery goes as planned IN GOOD HANDS Surgeon skill is important, but it's not the only factor in ensuring surgery goes as planned.

Nine times out of 10, cataract cases go off as planned, but your surgeons need to react to unexpected developments to ensure one of surgery's most routine procedures remains just that. Here's what 3 leading eye docs have to say about managing the rare, but potentially devastating, mishaps that can occur before, during and after surgery.

1Capsular tear
It's not overly difficult to tear the capsular bag, says Paul Rosenblum, MD, a cataract surgeon in Jupiter, Fla. He says capsular tear occurs in less than 1% of his cases, but it's involved in most of the complications he faces. When it occurs, the cataract drops into the back of the eye where it can't be reached with ordinary anterior segment techniques. A retinal surgeon must perform corrective surgery at a later date.

"If the complication is managed well, you can still achieve good outcomes," says Dr. Rosenblum. "But if not, secondary complications can occur, including retinal tears or detachments, infection and retinal swelling — although these complications are extraordinary rare."

Robert F. Melendez, MD, a cataract and refractive surgeon at Eye Associates of New Mexico in Albuquerque, says history of eye disease or past trauma are red flags of a loose capsular bag. Even in expected routine cases, he'll know something is amiss after he makes the first manual slice of the capsulorhexis — if a femtosecond laser is making the cut, you're not getting the same feel and feedback, says Dr. Melendez.

When the bag feels loose, he makes the incision slightly larger — approximately 6.25 mm instead of his standard 5.75 mm — to relieve stress on the zonules. He considers the larger capsulorhexis a safety measure that lets him prolapse the lens into the anterior chamber if necessary.

Is a small pupil more dangerous than a small capsulorhexis? "Experienced surgeons can operate successfully through a small pupil," says Dr. Melendez. "But it's extraordinarily difficult to perform surgery through a smaller capsulorhexis, especially when dealing with a really dense cataract."

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