Cataracts represent the most common condition of preventable blindness worldwide. Cataract surgery is also one of the most commonly performed and successful surgeries in the world. While the results are generally very satisfying, a few patients may complain of worsening of vision after cataract surgery.
Swelling
Swelling is perhaps the most common finding in patients with decreased vision post-operatively. The swelling can occur at the level of the cornea or the retina. Patients may also be predisposed to having more postoperative swelling as a result of conditions like Fuch's endothelial dystrophy or diabetic retinopathy. Corneal swelling will usually subside quickly. Swelling of the retina may require multiple treatments (lasers and injections).
Inflammation
Many patients are prone to excessive inflammation after cataract surgery because of pre-existing medical conditions. Complicated cataract surgeries are more likely to have an increase in post-operative inflammation. Prolonged inflammation can lead to swelling of the cornea/retina and intraocular scarring.
Cloudy Vision
Occasionally, a patient complains that her vision was great right after surgery, but that it has steadily decreased over many months. In essence, she reports a film over her vision. An exam may reveal a slight haziness to the posterior capsule of the lens' bag, referrred to as a secondary cataract or posterior capsule opacification. Its incidence has dropped dramatically with improved cataract removal techniques and better lens implant material. It is treated two to three months after the surgery with a laser, generally in the doctor's office.
Intraoperative Problems
Prior to surgery, your physician will discuss the risks, benefits, and alternatives to proceeding with cataract surgery. Complications can range from small incision leaks to more severe findings such as hemorrhage (within, around and behind the eye), capsular rupture, lens dislocation and retinal detachment. The implant lens that is positioned in your eye, calculated to a predetermined prescription, may occasionally not be the correct calculation or it may be positioned badly.
Infection
A big concern with any change in vision after cataract surgery is endophthalmitis, a severe infection in the eye. Symptoms include pain, light sensitivity, floaters, redness and significantly decreased vision. It may occur acutely after surgery (with one week) or as a chronic condition (after four weeks). This is an emergency and requires immediate evaluation and treatment. Your ophthalmologist will provide you with the medications via drops or injections. If vision loss is severe, immediate surgery may be necessary.
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