What happens if there are complications during my cataract surgery?

A lot of our patients are nervous about having cataract surgery. It’s not uncommon for them to put it off for as long as possible, even if cataracts are affecting their ability to do the things they love, because they’re worried about what’s involved, or what happens if something goes wrong. We understand why having cataract surgery can be daunting – patients who are already suffering with poor vision because of cataracts don’t want to do anything that might jeopardise their eyesight even more – but that means they often miss out on the many benefits of cataract surgery.  

You’ve probably already been told by your optician or GP that there’s nothing to worry about when it comes to having cataract surgery – it’s a routine procedure and hundreds of thousands of successful surgeries are carried out every year – but we also know that putting your fears aside can be easier said than done. With this in mind, we’re going to share some statistics to help put your mind at rest and explain what happens on the rare occasions that complications do arise during surgery, and what we do to avoid – and address – them. We hope, once you’ve finished reading this article, you’ll be able to see that the benefits of surgery far outweigh the risks. 

How often do complications occur during cataract surgery?

Statistics show that complications during cataract surgery are incredibly rare. Based on the latest data audit published by the Royal College of Ophthalmologists, which looked at the outcomes of 172,320 cataract surgeries performed from 1 April 2020 to 31 March 2021, just 0.91% of patients experienced the most common complication of cataract surgery (something known as Posterior Capsule Rupture, or PCR for short). This means that, in 99% of the operations performed by hospitals that participated in the national data audit, cataract surgery was a resounding success and patients saw a noticeable improvement in their vision. Out of the 0.91% of patients who did experience PCR, just 0.42% went on to experience deterioration in their vision as a result (something known as visual acuity loss). So, it’s safe to say the odds are very much in your favour! 

This is even more true at SpaMedica, because we have some of the lowest complication rates in the country, despite being the largest NHS cataract surgery provider in the UK. In 2021, across all of our hospitals, only 0.47% of our patients experienced PCR (almost half the national average) and, in some of our hospitals, the figure was as low as 0.13%. So, rest assured, you’re in safe hands! 

After surgery, our patients often tell us they don’t know what they were worried about in the first place because the operation itself is quick (less than ten minutes), painless (thanks to the anaesthetic eyedrops we use – there are no needles or injections involved) and the results are life-changing. But don’t just take our word for it – you can read some of the 7200 five-star reviews left by our patients on NHS Choices:  

You can see the reviews for your nearest SpaMedica hospital and read more about our patients’ experiences here. 

What is Posterior Capsule Rupture? 

Posterior Capsule Rupture (PCR) is a break/tear in the posterior lens capsule (shown in the diagram below). 

We usually place your replacement lens on top of the posterior capsule during surgery. However, sometimes removing the cataract can cause the capsule to break/tear. This can cause several complications: 

  • The vitreous humor (the gel in the back of your eye) can start leaking through the hole in the posterior capsule 
  • This can increase the risk of retinal detachment – this occurs when a thin layer of tissue (the retina) at the back of the eye pulls away from its normal position  
  • Part, or all, of the cataract might drop into the back of your eye 
  • Bleeding can occur within the eye and, in extreme cases, this can lead to loss of sight 

If PCR occurs, you will need to have corrective surgery carried out by a specialist surgeon – known as a vitreo-retinal surgeon – as soon as possible. Depending on the experience and qualifications of the surgeon carrying out your operation on the day, the PCR may be fixed then and there, or you may have to return within a few days for further surgery. It may also be necessary to delay the replacement of your lens until the problem has resolved. 

While PCR may sound serious, in most cases, patients make a full recovery and there is no long-term impact on their vision – as we mentioned above, just 0.42% of the patients included in the national data audit experienced vision loss as a result of cataract surgery. That means, out of the 172,320 surgeries that were included the Royal College of Ophthalmologists’ data audit, just 724 patients experienced some loss of vision. 

What causes PCR?

PCR can be caused by a variety of factors, but it is more common in patients who have had retinal surgery or experienced retinal disease in the past. The risk of PCR is also higher if patients have:  

  • Diabetes (particularly if their diabetes has caused issues with their eyes in the past) 
  • Dense (thick) cataracts, including black or white cataracts  
  • Small pupils 
  • A high degree of short-sightedness 
It’s important to note that, even if you have one or more of these risk factors, PCR is still incredibly rare – remember, just 0.47% of SpaMedica’s patients experience this complication. 

What steps do we take to avoid PCR during surgery? 

During your pre-operative assessment (your first appointment with us), we perform some eye tests and ask you questions about your medical history that help us to determine whether you are at higher risk of PCR. If you are, it’s likely that you’ll be added to a special waiting list (you may hear this referred to as the “complex” waiting list), where your operation will be carried out by one of our most experienced, highly qualified surgeons. This means that, in the unlikely event that you do experience a PCR during your operation, the surgeon will be able to fix the rupture and deal with any associated complications then and there. In most cases, you will make a full recovery, and experience the same improvements to your vision as our other patients.

Vitreo-retinal surgeons are at the top of their field and have more experience dealing with complications due to the nature of the operations they perform, which means they are harder to come by and more in demand. As a result of this, you may find you have to wait longer for your surgery than patients who don’t have any risk factors, but we will keep you updated throughout the process. 

If you are put on our “complex” waiting list, don’t worry – this is only a precautionary measure and in 99% of cases, your surgery will go exactly as planned without any complications or the need for additional intervention by your surgeon. 

PCR can occasionally occur in patients with no risk factors during routine cataract surgery. In this scenario, it’s unlikely that your surgeon will be able to treat the complications on the same day and we’ll ask you to return within a few days for follow-up treatment. This short wait has no bearing on the eventual outcome of your surgery. 

Conclusion 

At SpaMedica, complications during cataract surgery occur in less than 0.5% of our patients, and in the unlikely event that something does go wrong during your surgery, we have contingencies in place to ensure that any complications are dealt with efficiently and effectively. The overwhelming majority of our patients are thrilled with the results of their surgery and feel like they’re seeing the world from a fresh perspective, and it’s full of vibrant colours again. If you’re finding it difficult to do the things you love because of cataracts – whether it’s reading, watching television, doing a crossword, sewing, or just being able to see the leaves on the trees – please don’t hesitate to book an appointment with your optician and ask them to refer you to your provider of choice for surgery. 

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