Corneal complications of cataract extraction and intraocular lens implantation

Abstract

Corneal complications after cataract surgery and intraocular lens implantation have decreased in the recent past because of advances in surgical techniques; however this new technology has also led to various new complications. The most common complications include mechanical or toxic injury to the endothelium, stripped Descemet's membrane, epithelial toxicity and disruption, infections, sterile corneal ulceration and stromal melt, vitreous touch with damage to the endothelium, and epithelial ingrowth. Careful attention to detail during cataract extraction and in the postoperative period can prevent most serious corneal complications. Patients with compromised endothelial cell counts before surgery are best managed with the surgical technique involving the least intraoperative trauma, minimizing endothelial cell loss. If vitreous loss occurs, careful removal of the vitreous from the anterior chamber can prevent continued endothelial cell loss. If a clinically significant Descemet's membrane detachment occurs, this should be repaired at the time of cataract surgery. Patients with keratoconjunctivitis sicca require extra lubrication to prevent epithelial toxicity at the time of surgery and also postoperatively. Patients with rheumatoid arthritis and other collagen vascular diseases should be monitored carefully in the early postoperative period to prevent or detect early immunologic stromal ulceration. These patients may benefit from systemic steroids during the early postoperative period. Overall, the rate of corneal complications with modern cataract extraction and lens implantation is low, and the operation is remarkably successful.