There are risks to eye surgery, especially intraocular operations such as cataract removal or vitrectomy. Cataracts are the most common eye surgery and vitrectomy eye surgery is usually performed by a retina specialist for various problems of the retina and vitreous. Infection, inside the eye, called endophthalmitis, is uncommon, yet can blind.
There are all sorts of “eye” surgery. There is cosmetic “eye” surgery to lift the eyelids, there is “eye” muscle surgery to correct strabismus (crooked eyes), laser “eye” surgery to get rid of glasses, etc. These are all procedures that do not invade the eyeball, and thus, are “extraocular” operations; surgeries that stay outside of the eye.
“Intraocular surgery” is surgery that cuts into the eye. Cataract surgery, certain glaucoma operations and retina surgery are all invasive and, thus, introduce certain risks not found in other types of “eye” surgery.
Infection is the biggest risk of any intraocular procedure. As with any surgical procedure, there is a risk of infection. Intraoculuar infection; however, can be devastating to the vision as it can cause blindness. Most cases of “endophthalmitis” occur shortly, within days, after intraocular surgery. The cause is usually due to aggressive bacteria that attack the inside of the eye leading to damage of the retina.
The damaged retina, even after the infection is controlled, does not see.
Endophthalmitis following cataract surgery is estimated to be less than 1/2000. Endophthalmitis from vitrectomy retina surgery is even less common. I usually give the estimate of about 1/10,000 or lower. Certain types of glaucoma surgery carry a life long chance of developing an infection.
Symptoms of endophthalmitis are pain and decreased vision, although with advances in technology, these symptoms are sometimes less apparent. In general, if there are concerns about pain or decreased vision following eye surgery, make sure your doctor is aware. The results can be devastating.
Early identification of possible infections is really, really key. Treatment can range from antibiotic injections, intravenous antibiotics and vitrectomy surgery.
Retinal detachment is the second biggest risk of intraocular surgery. By operating inside the eye, an inadvertent retinal tear can be made in the retina leading to a retinal detachment. Retinal detachments usually do not lead to blindness, but they can. Additional retinal surgery could be necessary to repair the retinal detachment, but some visual loss is possible. The chance of developing a retinal detachment following intraocular surgery is somewhere from 1-3%. Again, with advances in technology, I believe this rate has decreased over the past decade.
Other risks of intraocular procedures are relatively minor, but can include bleeding, but most bleeding into the eye is usually self-limited, sounds horrible, but usually does no permanent damage. Cataract formation can be caused or enhanced by retina or glaucoma surgery. This is not a true risk, per se, but hastened cataract formation following intraocular surgery is common. Sometimes the intraocular pressure can be too high or low following surgery. There are many reasons why either can occur.
What Does This Mean? These are the most common, and feared, complications of intraocular eye surgery. This is not a complete listing, but certainly items that should be considered when contemplating surgery.
Your eye surgeon should be able to comfortably discuss, with you and your family, the risks and benefits of any surgery offered to you. If not, move on.
Eye surgery, especially in America, is extremely safe. Don’t get me wrong, cataract surgery enjoys about a 99% technical success rate, that is, over 99% of the time the cataract is removed and replaced with an implant…as planned! Retina and glaucoma surgery, too, are both very successful and usually performed with a high rate of technical success. Technical success is defined as the ability to perform the actual surgical task.
Complications are the risks undertaken with surgery despite technical success, and no surgery, however, is without risk.
Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
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