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Cataract surgery has evolved dramatically over the last two decades, largely as a result of technological advances. As a result, visual outcomes and patient convalescence have improved significantly. A second consequence of increased instrumentation and technology, however, is increased complexity of cataract surgery and the advent of complications unique to these advances. Cataract surgeons must be aware and capable of managing the many possible adverse events that can occur during cataract surgery. This review identifies many of the common complications of cataract surgery, describes methods to avoid these complications and discusses techniques to address complications that do occur. It is the ability to avoid, quickly identify, and properly manage complications that defines the accomplished cataract surgeon.

We report 3 cases of significant late intraocular lens/capsular bag subluxation after uneventful capsulorhexis, endolenticular phacoemulsification, and capsular bag implantation in patients with pseudoexfoliation syndrome.

Early iris prostheses were made of black irradiated poly(methyl methacrylate) (PMMA) or another acrylic (Perspex) in light blue, brown, or green. While functional results were excellent, cosmesis was lacking. Two currently available iris prostheses are the (1) CustomFlex (HumanOptics AG), which is made of silicone and customized to match a photograph of the residual, fellow, or desired iris, and the (2) IrisMatch (Morcher GmbH), a clear PMMA implant with an annular opaque film applied to a 9.0 mm diaphragm and optic. It is available in 45 colors, achieved by pixilated specks of black and primary colors. With iris prosthesis implantation, we recommend vital staining of the capsule. Visualization of the capsulorhexis margin becomes difficult during insertion

Purpose: To determine the efficacy and safety of surgical implantation of prosthetic iris devices in patients with anatomic or functional iris deficiencies. Setting: Cincinnati Eye Institute, Cincinnati, Ohio, USA. Methods: Twenty-five patients were enrolled in an interventional prospective noncomparative case series. Twenty-eight eyes had prosthetic iris diaphragm implantation for traumatic iris defects, congenital aniridia or iris coloboma, herpetic iris atrophy, surgical iris loss, or ocular albinism. Prosthetic iris implantation was performed with phacoemulsification and intraocular lens (IOL) implantation in 20 eyes, secondary IOL implantation in 6 eyes, and IOL exchange in 1 eye. A single pseudophakic eye with disabling glare secondary to traumatic aniridia had secondary prosthetic iris implantation alone. The surgical ease of insertion, intraoperative and postoperative complications, postoperative anatomic results, visual acuity, and subjective glare reduction were evaluated. Results: Patients were followed postoperatively for a mean of 10.2 months (range 1.4 to 25.7 months). All eyes achieved the desired anatomic result. Visual acuity was improved in 22 of 28 eyes (79%), unchanged in 5 eyes, and worsened by a single line in 1 eye. Patients were surveyed postoperatively to determine the change in glare disability. The severity of glare disability was subjectively improved in 23 of 24 patients (96%) who responded to the survey. Intraoperative complications included 3 fractured implants as well as an incomplete or torn capsulorhexis in 3 eyes. Postoperative complications included transient hypotony in 2 eyes, mild persistent inflammation in 1 eye, and macular edema followed by a retinal detachment in 1 eye with recent severe trauma. Conclusions: Implantation of prosthetic iris devices improved postoperative outcomes by reducing glare disability and, in selected cases, by correcting aphakia. Although operating on traumatized, congenitally aniridic, or uveitic eyes presents special challenges, implantation of prosthetic iris devices appears to be a safe and effective method for reducing the ubiquitous glare in patients with iris deficiency.

We describe a 62-year-old man with a deep brain stimulator who had cataract surgery performed by phacoemulsification. Representatives of Medtronic and Alcon Laboratories would not sanction our proceeding with cataract surgery because of the possible interaction between the ultrasound and the device. Simulated cataract surgery 1 week before the scheduled operation failed to produce any consequences. One week later, the patient had uneventful cataract surgery. Although a single case does not guarantee the lack of interference between the ultrasound used in phacoemulsification and the deep brain stimulator, our safe outcome may warrant a place in the ophthalmic literature.

Three patients who developed anterior chamber fibrinous exudates after cataract surgery were treated with tissue plasminogen activator injected into the anterior chamber. There was prompt dissolution of the fibrinous exudates and no observed complications. When fibrinous exudates occur in high-risk patients after cataract surgery, tissue plasminogen activator provides an excellent means of clearing the fibrin.

We believe that Burchfield et al 1 and Rosenberg and Siegfried 2 made an important contribution with their case reports of endophthalmitis associated with releasable sutures. In their case report, Burchfield et al 1 describe that "the free corneal ends were buried" in the cornea, yet their accompanying figure seems to show a loose end of suture on the corneal surface. Rosenberg and Siegfried 2 mention that "the ends of the releasable suture on the cornea were cut to approximately 2 mm of exposed length." Both groups of authors discuss the benefit of burying the suture end within the cornea, as has been described by Kolker et al, 3 to avoid the "windshield-wiper effect." We have found that placing the 2 partial-depth corneal suture segments close to each other, with minimal exposed suture between them, almost always results in epithelialization over the short segment of exposed suture. As a result

We compared the incidence of various complications in consecutive series of cases in which 76 eyes received STAAR silicone intraocular implants and 76 eyes received small incision IOLAB G708G polymethylmethacrylate (PMMA) intraocular implants. All surgeries were performed by the same surgeon employing the same phacoemulsification technique. A higher incidence of lens subluxation, lens repositioning, corneal edema, and elevated intraocular pressure was observed in the eyes receiving STAAR silicone implants than in the eyes receiving IOLAB PMMA implants, In addition, a YAG laser posterior capsulotomy could not be performed through several STAAR silicone RMX 1 model implants. An invasive pars plana posterior capsulotomy was necessary in these eyes. We also found that the STAAR silicone RMX 3 model implants were often pitted by the YAG laser during successful posterior capsulotomies. Despite these problems, the STAAR silicone intraocular lens group achieved corrected vision similar to the PMMA lens group.

Forty patients with melanocytoma of the optic disc were evaluated to determine their clinical variations and behavior. Follow-up examination of 1 to 19 years was obtained in 27 patients. Of the 27 lesions, four (15%) showed a slight increase in size, and one tumor (4%) decreased in size. The remaining 22 tumors (81%) have not yet demonstrated ophthalmoscopic changes. In spite of occasional growth, the melanocytoma is a benign tumor that requires no treatment.

With the increased popularity of extracapsular cataract surgery, the need for a peripheral iridectomy has been questioned. Some surgeons feel that the risks involved in performing the iridectomy are greater than when leaving the iris untouched. The indications and risks of iridectomy with cataract surgery are discussed. Four case reports are presented. In three cases, iridectomy was not performed with cataract surgery, and a pupillary block developed. In one of these three, a congenital cataract, secondary angle closure, developed requiring filtering surgery. In the fourth case, an iridectomy prevented serious complications from an unusual degree of postoperative inflammation with complete posterior synechia following uneventful cataract surgery.

In five patients, extreme gaze resulted in the appearance and expansion of a lesion located at the site of a venous vortex ampulla. The dimensions and color of the lesion varied depending upon the direction and duration of gaze. The lesion expanded when the head was positioned below the level of the heart and when a Valsalva maneuver was performed, even when the primary position of gaze was maintained. The lesion rapidly detumesced and disappeared when the head was elevated, digital pressure was exerted on the globe, or gaze was directed elsewhere. Fluorescein angiography confirmed that this tumefaction originated from the venous vortex ampulla. These dynamic features observed ophthalmoscopically and demonstrated by ultrasonography are characteristic of the vortex ampulla varix; the lesion should not be confused with a malignancy.