Management
Table 5. High-Risk Characteristics for Intraoperative and
Postoperative Complications
High-Risk
Characteristic Special Considerations
Anterior megalopia • Zonular laxity
• Pigment dispersion (associated with elevated IOP)
• Retinal detachment
Contour abnormalities • Keratoconus
• Pseudoexfoliation
• Short eye (i.e., hyperopia)
Corneal opacification • Reduced visibility
• Worsening of corneal clarity
Deeply set eye, narrow
lid fissure, or prominent
brow
• Reduced visibility
• Poor access to the limbus
• Pooling of irrigation fluid
• Wound deformation and leakage
Dense brunescent
nuclear cataract
• Concomitant zonular laxity and intraoperative miosis
• Little cortex to protect the capsule during
phacoemulsification
• Increased phacoemulsification time with increased risk of
postoperative corneal edema
• Greater risk of thermal and mechanical injury to the cornea
and iris with phacoemulsification
• Increased risk of posterior capsule rupture and zonular
dehiscence
High hyperopia (with
short axial length)
• Shallow anterior chamber with increased risk of
endothelial trauma
• Increased risk of iris trauma and prolapse
• Difficulty calculating lens implant power
• Intraoperative suprachoroidal effusion (particularly in
nanophthalmic eyes)
High myopia • Anterior chamber depth fluctuation due to reverse
pupillary block
• Difficulty calculating lens implant power, especially with
posterior staphyloma
• Decreased ocular rigidity, difficulty sealing the wound
• Increased risk of retinal detachment
12
High-Risk Characteristics
