Management
8
Corneal Complications
Î Improper instrument entry into the anterior chamber can lead to
Descemet membrane tears or detachment.
Î Prolonged elevated IOP can lead to further endothelial
decompensation and corneal edema. The surgeon should avoid
working close to the cornea and orient the irrigation port away from
the corneal endothelium. (III, G, S)
Prolonged Inflammation
Î Malposition or misplacement of IOLs of specific design may also lead
to persistent intraocular inflammation. The surgeon should ensure
proper orientation of IOLs to prevent corneal complications. (III, G, S)
• Insufficient postoperative anti-inflammatory medication may also be a
contributory cause.
Endophthalmitis
Î If endophthalmitis is suspected, referral to a retina specialist is
appropriate. If a retina specialist is not available within 24 hours,
the anterior or posterior segment should be tapped for evaluation of
possible pathogens, followed by an intravitreal injection of antibiotics.
(I-, G, S)
Posterior Capsular Tear or Zonular Rupture
Î Known risk factors for posterior capsular tears and vitreous loss
include older age, male gender, glaucoma, diabetic retinopathy,
brunescent or white cataract, posterior polar cataract, inability to
visualize the posterior segment preoperatively, pseudoexfoliation
(exfoliation syndrome), small pupils, axial length >26 mm, use of
systemic alpha-1a (systemic tamsulosin) antagonist medication,
previous trauma, inability of the patient to lie flat, and resident-
performed cataract surgery.
Retained Lens Fragments
Î If there is vitreous loss with posteriorly dislocated lens fragments,
the surgeon should perform an anterior vitrectomy and implant an IOL
with an appropriate size and design. (III, G, S)
Î The most appropriate timing of a secondary pars plana vitrectomy is
unclear, but the eye should be carefully monitored for complications,
such as elevated IOP and inflammation. (III, G, S)
