Understand the risks of cataract surgery
We at Bettersight take an unequivocal position – that our patients should have a clear understanding of the risks involved in any surgical or medical intervention. Perhaps its best to first put the issue of risk itself under the spotlight.
Risk is essentially the chance or more accurately the probability (possibility) of an adverse event occurring within a surgical setting. Risk itself however is something that surrounds all of us all of the time. Essentially everything that we do in our lives is associated with some level of risk. As an example taking a drive to work or even going for a gentle stroll have a very small level of risk of serious mishap occurring. Clearly these activities have only a very small level of risk – but risk is present nevertheless. Other activities such as skydiving or other extreme sports are associated with much higher levels of risk.
The next important issue about surgical risk is that with careful assessment and expert evaluation there are numerous ways in which we can control, contain and therefore minimise risk . It is however important to acknowledge from both the patient and the surgeons perspective that even with the highest level of care possible we cannot eliminate risk entirely.
Understanding risk in this way is essential for patients before outlining the specific risks of cataract surgery. At Bettersight we have an outstanding safety record with all surgery including cataract surgery. When discussing risk its important to point out that at Bettersight we expect that over 99.5% of our patients undergoing cataract surgery will have a routine and uneventful procedure. The specific risks of cataract surgery are outlined below.
- Risks During Surgical Treatment
This refers to complications that can arise during cataract surgery itself. The specific issues that can arise range in severity from very mild and therefore inconsequential to the more severe and therefore more consequential problems.
Mild complications are for example a small scratch or abrasion on the eye that will heal within a few hours and will have no lasting impact on the eye or the eyesight.
Moderate complications include complications involving the capsule or the supporting ligaments of the cataract. A particular example of such complications termed posterior capsular rupture (PCR) is reported to occur in around 2% of surgeries, though expert surgeons will typically report PCR rates of around 1%. At Bettersight we can report that PCR rates with our cataract / lens replacement surgeries is consistently under 0.5% (less than one case per 200 surgeries). This rate is generally regarded to be about “as good as it gets”.
Posterior capsular rupture is often of little consequence to the eventual outcome of the operation with the vast majority of these eyes still achieving excellent eyesight. It is however a complication that increases the risk of subsequent problems such as infection and retinal detachment . In patients who were scheduled for custom lens implants such as multifocal, bifocal or toric implants the occurrence of PCR in cataract surgery may lead the surgeon to use a more standard mono-focal lens implant instead as these implants will tend to work better in such an eventuality.
Severe Complications - are genuinely very unlikely. The major such complication is intra-ocular haemorrhage. This is rare and affects fewer than 0.05% of surgeries. It can have a severe impact on the eye and on the eyesight if it occurs – but thankfully in healthy eyes and healthy individuals it is very rare.
- Early Postoperative Complications
Post operative complications occurring within the first month after cataract surgery are uncommon. Issues such as more severe than expected inflammation are managed with additional eyedrops or other medication. A condition called cystoid macular oedema can affect around 0.5% surgeries and very often responds extremely well to specific eyedrop treatment and therefore does not usually have any lasting significance.
More serious but thankfully very rare is the tiny risk of infection – also called endophthalmitis.
Symptoms to ReportThe following symptoms should prompt an urgent call to your surgeon/hospital
Increasing eye pain after the first day or two post op
Reducing eyesight after the first day or two
Increasing redness of the eye
Infection is unlikely, but please report such issues especially if you are within the first two weeks of your recovery.
This complication has gradually declined in recent years partly due to smaller incisions, more precise surgery but perhaps most importantly because we now routinely administer antibiotic fluid inside the eye at the end of cataract surgery. This has had a major impact on lessening the risk of infection which at present stands at around the 0.05% level or less. At Bettersight we also help educate our patients to play their role in reducing this risk.
- Late Postoperative Complications
The commonest issue that can arise months and indeed years after cataract surgery is a benign condition called posterior capsular opacification (PCO). This can affect around 10% of eyes within the first five years after surgery. It is caused by gradual opacification of the capsule that holds the lens implant in place. It can cause a gradual decline in eyesight and when identified can be easily treated with a 10 minute outpatient, painless laser procedure called YAG laser capsulotomy.
A much rarer post operative development after cataract surgery is retinal detachment. Expert opinion is divided on the subject of how much additional risk is created with routine cataract surgery.Warning signs of Retinal DetachmentPlease report the following symptoms to your specialist;
Flashing lights that weren’t present before
New floaters- especially if numerous and not present before surgery
Dark shadow coming over part of the vision- often dark grey.
Such symptoms may not represent a retinal detachment but should be reported to your specialist.
Most experts feel that a doubling or more of the natural baseline lifetime risk of developing retinal detachment is to be expected after cataract surgery – this risk may be further amplified in people who have short sighted eyes and may remain about the same as natural baseline risk for people with long-sighted eyes.
Its also important to bear in mind that spontaneous retinal detachment (without previous eye surgery) is still far and away the most common type of detachment that eye specialists encounter. Furthermore if caught in a timely manner repair of retinal detachment carries a very high success rate.