Complications

Question 1

Describe the complication of corneal oedema after cataract surgery:

Answer 1

• surgical disruption to the anterior chamber or endo
• sx: blur/haloes
• signs: reduced corneal transparency/folds in Decemetes membrane

Question 2

What causes reduced corneal transparency?

Answer 2

Light scatter

Question 3

Describe raised iop as a complication after cataract surgery:

Answer 3

• surgical disruption to the anterior chamber
• sudden iop spike due to corticosteroids to reduce post op inflammation from surgery
• slow development

Question 4

Describe anterior uveitis as a complication after cataract surgery:

Answer 4

• some post op inflammation is normal and may be treated with steroids which increase iop
• 5% : severe or prolonged inflammation leading to mechanical damage to the iris leading to iris inflammation

Question 5

Describe adverse drug reactions as a complication after cataract surgery:

Answer 5

• may have an allergic reaction to medications (preservatives), steroids or antibiotics
• onset: days/weeks
• sx: redness, pain, irritation, watery discharge
• signs: pre orbital swelling, chemosis

Question 6

Describe PCO as a complication after cataract surgery:

Answer 6

• can occur 3/12-4 years
• sx: blur/glare
• signs: opaque posterior capsule with iol being clear
• causes: migration/proliferation of remnant lens epithelium which move posterior and lead to opacification

Question 7

Describe endopthalmitis as a complication after cataract surgery:

Answer 7

• sight threatening
• microbial infection of anterior or posterior chambers
• can be bacterial or fungal
• microbes access through incision, instruments or through the surgeon
• if the infection is not controlled this could lead to total loss of vision

Question 8

Describe the endopthalmitis signs in the anterior chamber:

Answer 8

Cells/flare and hypopyon

Question 9

Describe the endopthalmitis signs of the posterior chamber:

Answer 9

Vitreous signs as the same of post uveitis (snowballs banks oedema)

• loss of vitreous transparency
• elevated iop
• corneal oedema

Question 10

Describe the endopthalmitis symptoms;

Answer 10

Pain/ decreased vision

Question 11

Describe cystoid macula oedema in terms of post cataract complications:

Answer 11

• can occur 6 weeks after
• 75% cases resolve spontaneously within 6 months of getting it
• it can be hard to detect therefore if the px presents with reduced vision then refer as if it was macula oedema with or without signs of macula oedema

Question 12

What is the management of any signs of infection/inflammation or symptoms of cataract complications?

Answer 12

You’d refer them same day with a telephone

Question 13

If the px was at risk of PCO what’s the referral?

Answer 13

Because it’s slow progressing you’d refer routine

Question 14

If the px had reduced vision and it wasn’t correction based but they had cataract surgery 6 weeks prior, what would your concern be?

Answer 14

Macular oedema

Question 15

What is the referral for macula oedema post cataract surgery?

Answer 15

Same day telephone especially if the px has reduced vision but no signs so the optom can decide how urgent it is