There are some pretty amazing things about cataract surgery. The surgery and the recovery are pretty quick. The procedure also is very safe with a low risk of complications. However, despite all that, there can be some complications long after everything has healed up.
Long after cataract surgery, there are 3 main complications related to the surgery that you need to worry about.
- An after-cataract is the most common but can be easily treated with a laser within the office.
- Having a retinal detachment is the most serious, but knowing the signs of it can ensure prompt treatment.
- Finally, it's possible that the supports for the new artificial lens can weaken and the lens dislocate inside the eye.
So let’s go over what happens with each issue.
After-Cataract
A cataract is a clouding of the natural lens inside the eye. During cataract surgery, this lens is removed. This lens doesn’t regrow; because of this, cataracts can ONLY occur once in your lifetime. It is impossible to get cataracts after cataract surgery.
But colloquially there is something called an after-cataract…
When the cataract is removed, a capsule surrounding the cataract is left behind. This capsule is supported and suspended within the eye and becomes a great position for the new artificial lens to sit.
Capsule within eye; image by File:Three Internal chambers of the Eye.png: Artwork by Holly Fischer derivative work: Pixelsquid, CC BY 3.0, via Wikimedia Commons / modified from original
When the cataract is dissolved during cataract surgery, microscopic particles of cataract can remain behind. These cataract cells can attach to the back of the capsule and start growing. This causes the capsule to become cloudy.
What does this cause?
- Vision becoming more blurry
- An increase in starbursts and glare
Instead of looking through a clear capsule and clear lens, you are now looking through a hazy capsule (but the artificial lens is still clear).
While this is commonly called an After-Cataract, it is more accurately called: Posterior Capsular Opacification.
Also check out Do Cataracts Grow Back After Cataract Surgery?
Cloudy capsules can happen anytime within the first few years after cataract surgery. And it is the most common complication of cataract surgery. Within the first 5 years after cataract surgery, close to 25% of all cataract patients will develop a cloudy capsule!
Fortunately, while technically a complication of cataract surgery, it does have a very easy fix. And so, it isn’t something to really worry about.
In the office, your surgeon or other ophthalmologist can use a laser to create a small opening through this capsule clearing the cloudiness from your vision. This procedure is called a YAG laser capsulotomy or sometimes just simply YAG surgery.
This procedure is easy to go through, painless, and doesn’t have very much recovery afterwards. It’s a very straightforward treatment to the common complication of “after-cataracts".
Also check out Exactly What To Expect With The Recovery After YAG Surgery
Retinal Detachments
If after-cataracts are more of a nuisance with an easy fix, retinal detachments are the complete opposite.
Untreated, retinal detachments can lead to permanent loss of vision after cataract surgery.
This is the most serious late complication of cataract surgery. So it is very important to be aware of it.
How does it occur?
In the back of our eye is a thin layer of cells that detect light and transmit that information to the brain. This layer is the retina.
The retina; Image by BruceBlaus. When using this image in external sources it can be cited as:Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0, via Wikimedia Commons / cropped from original
In front of the retina is another structure called the vitreous. This transparent jelly-like structure initially supports the eye as it develops. But gradually over time, this structure breaks down and eventually pulls away from the retina. This event is called a posterior vitreous detachment and is a key reason people develop floaters in their vision.
But sometimes, this vitreous is very firmly attached to certain spots on the retina. As it pulls away from the retina, tugging from the vitreous can tear the retina in these spots. Fluid can then get through these tears and underneath the retina, causing the retina to detach from the back of the eye.
Meanwhile, the retina gets most of its nutrients from a layer in the back of the eye called the choroid. If the retina detaches from the choroid and can’t get enough nutrients, it will die. This causes permanent vision loss.
Risk after cataract surgery
The vitreous is at a greater risk of detaching from the back of the eye after cataract surgery. Because of this, the risk of having a retinal detachment goes up after cataract surgery.
Fortunately, this complication is much less common than cloudy capsules. Less than 1% of all cataract patients can experience a retinal detachment. But similar to the development of a cloudy capsule, retinal detachments can occur years out after cataract surgery. About half occur by 3 years out and the risk gradually decreases the further out you get from surgery.
So what do you notice?
- Flashing lights followed by the development of new floaters within the eye - this can indicate that a tear has developed in the retina. A tear is a precursor to a retinal detachment. If you notice symptoms of a tear, you need to get a dilated eye exam ASAP. Retinal tears can be sealed with a laser procedure to prevent the development of retinal detachments.
- A shade or curtain of vision loss. The part of the eye that the retina has detached from is missing vision.
Retinal detachments are emergencies and warrant a trip to the emergency room for prompt treatment. If the retina remains detached for too long, permanent vision loss occurs.
Dislocation of the artificial lens
There is one final late complication of cataract surgery. But fortunately again this complication is also uncommon.
As mentioned above when talking about after-cataracts, the new artificial lens is placed within the capsule that the cataract used to sit in. This capsule is suspended within the eye by special suspensory ligaments called zonules. This keeps the lens perfectly centered inside the eye.
But these zonules can be weak or become weak over time. This is especially true with certain conditions including trauma, previous retinal surgery or inflammation inside the eye, diabetes and with a condition called pseudoexfoliation syndrome.
If these support structures become weak over time, the lens can shift out of position. And unlike the risk of the other two complications, the risk of this can gradually increase over time (because the suspensory ligaments can become weaker). Still however, this occurs in less than 1% of individuals up to 20 years out from cataract surgery.
If this does occur, the main things that can be noticed
- Sudden blurry or decrease in vision
- Seeing the edge of the lens
- Possible increase in glare or development of double vision
A dislocation of the artificial lens out of position must be repaired surgically. For this, it is important to visit your eye doctor for further evaluation.
Check out Key Symptoms Of Dislocated Lens After Cataract Surgery to learn more
Unrelated Eye Problems
Above, are all issues directly related to the cataract surgery. But it is worth noting that cataract surgery doesn’t prevent you from having other unrelated health issues with the eyes. After cataract surgery, it is still possible to develop conditions such as macular degeneration, glaucoma, retinal blood vessel issues or other conditions. These can all cause your vision to become blurry or deteriorate over time. Thus, even after the cataracts are removed, it is still important to have regular follow-up with your eye doctor in order to make sure that your eyes stay healthy.
Summary
Cataract surgery is a very safe procedure and works great to get rid of cataracts and improve vision. But long after cataract surgery, you can still develop certain issues and complications. While fortunately the most common complication of a cloudy capsule has a very easy fix, it is also important to know about other more serious complications such as retinal detachments and dislocation of the artificial lens after cataract surgery.
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