Archive June 2017 XVIII, No. 6

Avoid Complications in Cataract Surgery

How to steer clear of common, but preventable, post-operative adverse events.

Samuel Masket

Samuel Masket, MD


disposable instruments BE SAFE Preventive measures such as disposable instruments and antibiotic prophylaxis are the best cure for complications such as endophthalmitis and TASS.

No matter how hard we try to make things perfect, we can't escape the fact that we live in an imperfect world. We see proof of this tenet every day in the world of cataract surgery and intraocular lens implantation. Even if a surgeon performs the procedure with the utmost precision and flawless surgical technique, an adverse event may occur.

Earlier this year, an American Academy of Ophthalmology Task Force, of which I am a member, issued definitions for 11 post-operative adverse events associated with premium intraocular lenses ( intended to reduce spectacle dependence — namely, chronic anterior uveitis; clinically significant cystoid macular edema; corneal edema; endophthalmitis; mechanical pupillary block; increased intraocular pressure; rhegmatogenous retinal detachment; toxic anterior segment syndrome (TASS); and 3 secondary IOL interventions (exchange, removal and repositioning).

Although some of these adverse events may occur in small numbers for reasons that are beyond a surgeon's control, the surgeon plays a key role in managing, if not preventing, many of these complications. For example, consider 2 of the most serious inflammation-related adverse events:

Endophthalmitis. This rare but potentially devastating infectious intraocular inflammation occurs in fewer than 1 in 1,000 cases. Barring a significant manufacturing glitch from a key supplier — as a reminder, rely only on accredited 503B compounders and reputable manufacturers that can provide proof of sterilization — the majority of endophthalmitis cases originate from ocular flora native to the patient's eyelashes and lid margins.

Prevention may be the best cure. Using disposable injectors, cannulas and phaco tips may decrease the infection risk, as should prophylaxis with antibiotics like intracameral moxifloxacin and careful incision management. Also, using a povidone-iodine-based product, both in and around the eye as a method of surgical prep, may be another reliable form of prophylaxis.

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