What Are the Risks of Cataract Surgery in Singapore?

Cataract surgery is one of the most common and successful surgical procedures worldwide, including in Singapore. It involves removing the cloudy lens of the eye and replacing it with an artificial one. Although it is generally safe, like any surgery, cataract surgery carries some risks. Understanding the risks of cataract Singapore can help patients make informed decisions and know what to expect.

Understanding Cataract Surgery

1. Pre-surgery Preparation

• Comprehensive Eye Examination: Before surgery, a thorough eye exam is conducted to assess the health of the eye and determine the extent of the cataract.
• Discussion of Medical History and Medications: The surgeon reviews the patient’s medical history and current medications to identify any potential complications or necessary adjustments.

2. Surgical Procedure

• Use of Local Anesthesia: To numb the eye and prevent pain during surgery.
• Small Incision in the Eye: A tiny cut is made to access the cloudy lens.
• Removal of the Cloudy Lens: The cataract-affected lens is removed, often using ultrasound waves.
• Insertion of an Artificial Intraocular Lens (IOL): A clear artificial lens is implanted to restore vision.

3. Post-surgery Care

• Follow-up Visits: Regular check-ups to monitor healing and address any issues.
• Use of Prescribed Eye Drops: Medications to prevent infection and reduce inflammation.
• Avoiding Strenuous Activities: To prevent pressure on the eye and ensure proper healing.

Common Risks of Cataract Surgery

1. Infection (Endophthalmitis)

• Description: Endophthalmitis is a severe infection that occurs inside the eye, usually resulting from bacteria or fungi that enter the eye during or after surgery. This condition can cause significant damage to the eye’s internal structures if not promptly treated.
• Symptoms: Patients may experience intense eye pain, redness, swelling, decreased vision, and sensitivity to light. These symptoms typically arise within a few days after surgery.
• Prevention: To prevent infection, surgeons employ sterile techniques during the procedure, including the use of sterilised instruments and wearing sterile gloves and masks. Postoperatively, patients are prescribed antibiotic eye drops to further minimise the risk of infection.

2. Inflammation

• Description: Postoperative inflammation is common and involves swelling and redness of the eye tissues. It is the body’s natural response to surgery.
• Symptoms: Symptoms include discomfort, eye redness, swelling, and blurred vision. These symptoms can interfere with the healing process if not managed properly.
• Treatment: Anti-inflammatory eye drops or oral medications are typically prescribed to reduce inflammation. In some cases, more potent steroid medications may be necessary to control severe inflammation.

3. Increased Intraocular Pressure (IOP)

• Description: Elevated intraocular pressure can occur after cataract surgery, potentially leading to glaucoma if not managed. High IOP can damage the optic nerve and result in vision loss.
• Symptoms: Symptoms of increased IOP include eye pain, headache, blurred vision, and nausea. Some patients may not experience any symptoms, making regular check-ups crucial.
• Management: Treatment involves medications such as eye drops or oral drugs that help lower eye pressure. Regular monitoring by an eye doctor is essential to ensure that the pressure remains within a safe range.

4. Posterior Capsule Opacification (PCO)

• Description: PCO, sometimes referred to as a “secondary cataract,” occurs when the back of the lens capsule, which holds the artificial lens in place, becomes cloudy. This can happen months or even years after the initial surgery.
• Symptoms: Patients may notice a gradual return of blurred vision, glare, and difficulty seeing clearly, similar to the symptoms experienced with the original cataract.
• Treatment: YAG laser capsulotomy is a quick, painless outpatient procedure used to treat PCO. The laser creates a small opening in the cloudy capsule, restoring clear vision almost immediately.

5. Retinal Detachment

• Description: Retinal detachment is a serious condition where the retina, the light-sensitive tissue at the back of the eye, peels away from its underlying layer of support tissue. If not promptly treated, it can lead to permanent vision loss.
• Symptoms: Warning signs include sudden flashes of light, an increase in floaters (small spots or threads in the field of vision), and a shadow or curtain effect over part of the visual field.
• Treatment: Retinal detachment requires urgent surgical intervention to reattach the retina. Procedures may include pneumatic retinopexy, scleral buckling, or vitrectomy, depending on the severity and location of the detachment.

6. Dropped Nucleus or Lens Fragments

• Description: During cataract surgery, pieces of the cataract or lens fragments may fall into the back of the eye. This can happen if the lens is not fully removed or if it disintegrates during extraction.
• Symptoms: Patients may experience blurred vision, discomfort, and potentially inflammation if the fragments cause irritation.
• Treatment: Additional surgery, often a vitrectomy, is required to remove these fragments. The procedure involves using specialised instruments to safely extract the lens pieces from the eye, ensuring proper healing and restoration of vision.

Less Common Risks

1. Corneal Edema

• Description: Swelling of the cornea, the clear front surface of the eye.
• Symptoms: Blurred vision and eye discomfort.
• Treatment: Eye drops to reduce swelling or, in severe cases, additional surgery.

2. Dislocation of the Intraocular Lens (IOL)

• Description: The artificial lens moves out of its intended position.
• Symptoms: Blurred or double vision.
• Treatment: Surgery to reposition the lens correctly.

3. Cystoid Macular Edema (CME)

• Description: Swelling in the central part of the retina, called the macula.
• Symptoms: Blurred or distorted central vision.
• Treatment: Anti-inflammatory medications or injections to reduce swelling.

Rare but Serious Risks

1. Loss of Vision

• Description: Complete blindness in the operated eye, a very rare outcome.
• Causes: Severe infection, retinal detachment, or bleeding.
• Prevention: Prompt treatment of complications and regular follow-ups to catch issues early.

2. Haemorrhage

• Description: Bleeding inside the eye, which can occur due to surgical trauma or pre-existing conditions.
• Symptoms: Sudden vision loss and eye pain.
• Treatment: Immediate medical attention and possibly surgery to address the bleeding.

3. Anaesthesia Complications

• Description: Adverse reactions to local anaesthesia used during the procedure.
• Symptoms: Allergic reactions or breathing difficulties.
• Management: Thorough pre-surgery screening to ensure safe anaesthesia use.

Preventive Measures

Patients and surgeons can take several steps to minimise the risks of Singapore cataract surgery:

• Choose an Experienced Surgeon: Ensure your surgeon has extensive experience and a good track record.
• Follow Pre-surgery Instructions: Proper preparation, such as stopping certain medications, can reduce the risk of complications.
• Post-surgery Care: Adhere to all post-operative instructions, including using prescribed eye drops and avoiding strenuous activities.
• Report Any Issues Immediately: Early detection of problems can prevent severe complications.

Conclusion

While cataract Singapore surgery is generally safe and effective, understanding the potential risks is crucial for informed decision-making. By following preventive measures and choosing an experienced surgeon, patients can significantly reduce the likelihood of complications and enjoy the benefits of improved vision. If you have any concerns, discuss them with the best eye care professional – Dr Natasha Lim, Phone: +65 6570 2220 to ensure the best possible outcome.