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Recognizing retinal complications of cataract surgery is first step in management
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WAILEA, Hawaii — Cataract surgeons who learn to recognize signs of vitreous or retinal complications in their patients are “halfway home to solving the dilemma” for themselves, according to Carmen A. Puliafito, MD, MBA.
Dr. Puliafito delivered the keynote lecture, “Management and prevention of cataract surgery complications: A vitreoretinal surgeon’s perspective” here at the Hawaiian Eye 2006 meeting.
“The first thing is to recognize complications. Not all of them are obvious,” Dr. Puliafito said. “If something seems [strange] to you, stop and ask yourself if the globe has been perforated.”
He noted that while complications sometimes have to do with technique, they can occur “even in the best of hands.”
Endophthalmitis, which is thought by some to be on the rise due to the adoption of clear corneal incision techniques, is still relatively rare, Dr. Puliafito said. Other risk factors may be responsible for the increased incidence of this complication following clear corneal cataract surgery, he said, such as compromised immunity, preoperative blepharitis and using lidocaine gel before povidone-iodine application, he said.
Dr. Puliafito advised surgeons that if vitreous tap or vitrectomy is necessary, peribulbar anesthesia should be used. He also said antibiotics for intravitreal injection should be prepared ahead of time and stored in a refrigerator. Furthermore, Dr. Puliafito said surgeons should not assume that using one of the latest-generation fluoroquinolones will prevent infection.
Retained lens fragments can also complicate cataract surgery, he said, although he noted that very small pieces of cortex might be resorbed without the need for intervention. Risk factors for this complication include unrecognized hard nucleus, pseuodoexfoliation, previous vitreous surgery, the surgeon’s learning curve and patient movement.
For removal of a dislocated posterior chamber IOL, Dr. Puliafito said the surgeon should use a limbal or pars plana approach, and refixation of the IOL can be performed if circumstances permit.
One sure warning sign of a vitreoretinal complication is if the patient experiences a rise in IOP, Dr. Puliafito said.
“Once the patient demonstrates an IOP rise, that’s a sign you need to do something, and that the patient needs vitreoretinal intervention,” he said.
Patients also should be referred for vitreous surgery if there is a vitreous detachment or evidence of retinal incarceration.