In the name of Holy Allah, The Most Beneficent, The Most Merciful.

i
Early post operative complications of cataract surgery in patients presented
in Ophthalmology Out-Patient Depatrment Holy Family Hospital
Rawalpindi.

A report submitted in partial fulfillment of the requirement for the degree of B.Sc. (Hons.)
Optometry & Orthoptics.

By

NAYAB FATIMA

Reg. No: 2014-RMC-0375-UHS

Supervisor

Professor Dr. Ali Raza

M.B.B.S, M.C.P.S (Ophth.), F.C.P.S (Ophth.)

Head of Ophthalmology Department

i
i
 Declaration

I hereby declare that all the data during this study was collected by me and the data collection
was used only for academic purpose.

NAYAB FATIMA

i
i
 CERTIFICATE OF APPROVAL

It is certified that the research proposal of, NAYAB FATIMA Roll no: 15023 has been
approved on the study topic of Early post operative complications of cataract surgery in patients
for the partial fulfillment of the degree requirement of B.Sc(Hons.) Optometry & Orthoptics
from Rawalpindi Medical College & Allied hospitals Rawalpindi.

Dated:_____________ _____________________
Signature of supervisor
Dr. Ali Raza
M.B.B.S, F.C.P.S, M.C.P.S (Ophth)

i
v
 Acknowledgements

Firstly, I would like to thanks Allah Almighty for giving me courage to complete this research
project. I would like to thank my parents and collegues for their constant encouragement and
kind support without which this project would not be possible.

Secondly, I would like to express my profound gratitude and deep regards to my course
supervisor Dr. Ali Raza , course coordinator Dr. Rasheed Sheikh, my research/ biostatics
professor Dr. Rizwana, professor Muhammad Ibraheem and Ms. Maryam Riaz for their
exemplary guidance, monitoring and constant encouragement throughout the research project
and Dr. Arshad Malik who responded every time with the best attitude.

I would also like to express my gratitude to the principle, and to class teachers of, Rawalpindi
Medical College for their cordial support, valuable information and guidance, which helped me
in completing this task through various stages.

I am also obliged to the participants of my research for their cooperation during the period of
my research.

NAYAB FATIMA

v
 ABSTRACT

Background
Cataract is a lack of transparency of lens in the eyes that leads to reduced vision. Cataract is

defined as a lens opaqueness that causes visual impairment. This is usually seen in elderly people.

There are no known protective agents that can delay the onset or progression of cataracts. This

disease can not be cured with laser or medicine, and in the past it led to blindness .Cataract surgery

is the most common surgical procedure performed in developed countries and the amount of

surgery has increased significantly over the past decade. Various aspects of the surgical procedure

including the size of the surgical incision and the intraocular lens have changed markedly and

improve the safety and quality of the outcome Symptoms can often be due to age, but eye

surgery can occur for vibration, radiation exposure, birth or other problems. Risk factors are

diabetes, tobacco smoke, sunlight and long-standing. An airborne backpack can be placed in a

lens for protein or yellow-brown lenses to reduce light transmission to the eye. After an optical

test, an extra capsular extraction (ECCE) can be used more widely, by inserting a large lens , but

it may cause more complication as compared to Phacoemulsification (PHACO). Small scale or

small incision surgery is performed

Aim

To find the early post operative complications in cataract surgery in patients presented in
ophthalmology out- patient department at holy family hospital Rawalpindi

Methods

50 patients of different ages undergone cataract surgery (Phaco-emulsification and ECCE) of eye
in Out Patient Department of Holy family hospital Rawalpindi during 1st October to 30th December

v
i
were included in my study. Patients were exposed to various diagnostic procedures to confirm the
diseases caused by cataract surgery.

After detailed ocular examination, the complications of cataract surgery were noted along with
the causes of inaccuracies and postoperative visual status. And patients were referred for further
treatment.

Results :

Results are drawn on basis of selected variables i.e. gender, type of cataract surgery, various
diagnostic procedure, presence of any complication.A sample population of about 50 patients as
studied in hospital based studies. Among 50 patients 18 (36%) were females and 32 (64%) were
males .Majority of the patients have keratitis .Out of 50 patients,25 patients suffering from it.The
complication due to which patient is suffering least is Retinal Detachment. The diagnosis can be
made with slit lamp only but it is important for the detailed diagnosis that patient should be exposed
to the full diagnostic criteria.

Conclusion :

The study indicated towards the point that Post Operative Complications is an important problem
in population. males are effected more than females and immediate medical treatment is cheapest
and easiest solution for preventing complete visual loss. This study showed that if we do not treat
post operative complications in time.it may result in a vision threatening disease

v
i
 TABLE OF CONTENTS

Serial Page
No. Title No.

1 Abstract vii
2 Tables x
3 Figures xi
4 Abbreviations xii
5 Anatomy of Eye 1
6 Introduction 6
7 Literature review 22
8 Rationale of study 24
9 Aim & objective of the study 24
10 Material & Methodology 25
11 Statistical analysis 27
12 Results 28
13 Discussion 34
14 Conclusion 35
15 Limitations 35
16 Recommendations 35
17 References 36
18 Performa 38

Tables

v
i
Table Page
No. Table No.

1 Mean age & Standard deviation 28

2 Gender wise distribution 29

3 Age Frequency distribution 30

4 Distribution according to surgery typr 31

5 Distribution according to V.A 32

6 Complications 33

Serial Page
No
No
Figures
1 Anatomy of Eye ball 3

2 Human visual system 4

3 Physiology of eye 5

4 Nuclear cataract 8

5 Cortical cataract 10

6 Posterior subcapsular cataract 11

7 Technique of phacoemulsification 13

8 Technique of ECCE 14

9 Gender wise distribution 29

10 Age wise distribution 30

i
x
11 Frequency Type of surgery 31

12 Pre & Post operative 32

13 Frequency of complications 33

Abbreviations

1. V.A Visual acuity

2. IOL Intraocular lens

3. RE Right Eye

4. LE Left Eye

5. Nd:YAG Neodymium-yttrium-aluminium-garnet

6. ECCE Extracapsular cataract extraction

7. ICCE Intracapsular cataract extraction

8. Pre-op Pre-Operative

9. Post-op Post-operative

10. ICCE Intra capsular cataract extraction

x
CHAPTER 1

ANATOMY OF EYE

The human eyeball consists of three basic layers as follows:

 Outer layer: This includes the cornea and sclera.

 Middle layer: It has the responsibility of maintaining blood supply because the eyes also hold
the pupils and iris
 Inner layer or retina: Light-sensitive tissue layer that lines the inner surface of the eye.

In addition, for the three layers mentioned above, three fluid chambers are also present. These
include the following:

 Anterior chamber: It is between the iris and the cornea.

 Posterior chamber: Located between the iris and lens.
 Vitreous chamber: This is between the retina and the lens. Eyes see all kinds of things -
big or small, close or far away, smooth or textured, color and dimensions. The eye has many
parts that all function differently so they can see properly

Eyelids

Eyelids are outermost parts of eye’s anatomy and their basic role is in preservation as well as
protection of eyes from external factors..

Cornea

The cornea is a transparent structure, present in front of the colored part of the eye. The cornea
helps the eye focus as light makes its way through.

Iris

The iris is the colored part of the eye. The iris has muscles attached to it that change its shape.

Pupil
The pupil is the black circle which is an opening in the in the center of iris, and it lets light
enter the eye and changes shape according to the light.

1
Lens
A transparent and elastic structure situated behind your pupil[3]. It is enclosed in a thin
transparent capsule and helps to refract incoming light and focus it onto the retina.with the age
lens loose its transparency A cataract is when the lens becomes cloudy, and a cataract operation
involves the replacement of the cloudy lens with an artificial plastic

vitreous
A clean, gel-like substance that fills the center of the eye.

Retina
A photosensitive layer that is present inside of the eye. Photosensitive cells are known as rods
and cones. The human eye contains about 125 million rods that are needed to see in dim light.
Cones, however, work best in bright light. There are 6 to 7 million cones in the face and are
essential for sharp, sharp images and distinctive colors.

macula
Yellow spot on the retina on the back of the eye, which surrounds the fovea.

fovea
It forms a small indentation in the middle of the macula and is the area with the largest cone cell
concentration

Optic Disc
The optic nerve is visible (when the eye is examined) on the retina. The optical disc identifies the
onset of the optic nerve

Optic nerve
Optics are never substantially involved in transmitting information and images to the brain[4]. It
extends from the posterior of the eyeball and through the optical foramen where it is connected to
the brain. Optics never have the task of transmitting signals for vision to the brain and therefore
play an important role in visual perception and integration

2
 Fig. 1: Anatomy of Eyeball

Physiology o f vision

Main Procedures which are involved are being mentioned below

• Light beam’s incidence
• Transduction
• Visual sensation’s transmission
• Visual perception

3
 Fig. 2: Human Visual System

Human Visual System

Human visual system Light waves emanating from an object gain access to the eye through the
cornea. After this light moves through the pupil.[5] The size of the pupil is changed in response to
the fluctuations, which are represented by the intensity of the light. When bright light enters the
eye, the pupil becomes narrowed by the papillary light response. When the light becomes weak, the
pupils dilate as a reaction.

Cornea slightly breaks the incident light rays and after this crystalline lens the light that enters from
the pupil converges. It is the point where the formed image is both reversed and reversed. Light
continues his journey through vitreous humor to concentrate on the light-sensitive retina.

Macula is the smaller central part of the retina, which has the potential to offer the best vision
compared to other retinal parts. With a normal eye, light passes through the transparent lens to the
retina. Once it reaches the retina, the light changes into nerve signals that are sent to the brain.

In retinal layers, light pulses change to electrical signal, and these are transmitted via the optical
nerve along the visual path towards the occipital cortex, which is present at the posterior part of
the brain. Here at the visual cortex, the interpretation of electrical signals is performed and a
visual image is perceived by the brain. Visual perception is the ability to interpret information and
surroundings from visible light reaching the eye. The resulting view is also known as vision,
vision or vision.

4
.

Fig.3: Physiology of Eye

INTRODUCTION
LENS

The lens is a transparent biconvex structure of crystalline appearance. The crystalline lens
grows with continuous growth of body during lifetime. The structure is transparent, biconvex,
and avascular, and situated in the anterior part of the eye, behind the iris.

5
Adult lens diameter is 9-10 mm equatorially and 4.5 to 5 mm anteroposteriorly.It is
composed of 66% water and 34% protein.In a non accommodative state, Refrective power
of lens is 15 to 20 diopters.The Accomodative power of lens varies with age.

At birth, 14-16 diopters.

At 25 years of age, 7-8 diopters.

At 50 years of age, 1-2 diopters

Development

Lens develops from the surface ectoderm,during third week of gestation and continuous to grow
throughout life.

Location

Lens is placed between the iris and vitreous,in a saucer shaped depression called patellar fossa.

Transparency

Lens transmits 80% of the electromagnetic radiation between 400 nm to 1400 nm.

Structure:

It consist of

1. Capsule
2. Epithelium
3. Fibres
4. Zonules

Function
The main function of the lens is Refrection.So that light rays can concentrate on the retina. Lens
contributes approximately 15 diopters to the total (59 diopters) refractive power of an eye. The
second main function is Accomodation.it is the mechanism by which the eye changes focus, from
distance to near-images. up to 2.5 mm; a depth of less than 2.5 mm may pose a risk for glaucoma
with closed angles

6
Cataract
Cataract is the opacification of crystalline lens of an eye. . cataract can occur in either one or
both eyes. It cannot spread from one eye to the other. Cataracts are the cause of half of
blindness and 33% of visual.impairment worldwide. Cataract is not always due to ageing.

Fig. 4: Nuclear Cataract Causes of Cataract

Cataracts are most commonly due to aging, but may also occur due to trauma, radiation
exposure, be present from birth, or occur following eye surgery for other problems. Risk
factors include diabetes, smoking tobacco, prolonged exposure to sunlight, and alcohol.
Either clumps of protein or yellow-brown pigment may be deposited in the lens reducing the
transmission of light to the retina at the back of the eye.Other causes include congenital
disorders, metabolic conditions, and various forms of trauma, e.g. direct penetration and
contusion.
Furthermore, cataract such as smoking development is enhanced by environmental factors
and ultraviolet radiation. Systemic and inhaled corticosteroids and longer duration increase
the risk for cataract have been associated with posterior subcapsular cataract, and higher
doses. In several epidemiological studies, diabetes has also been considered a risk factor for
cataract

7
Symptoms
May include
• faded colors
• blurry vision
• halos around light
• trouble with bright lights
• and trouble seeing at night
• in trouble driving, reading, or recognizing faces
• Poor vision may also result in an increased risk of falling and depression

Main Types
There are three main types of age-related cataracts: nuclear, cortical and posterior
subcapsular
: nuclear, cortical, and posterior subcapsular-nuclear cataracts Slow progress and
usually bilateral.
Nuclear cataracts
This kind of cataract occurs in the nucleus in the middle of the lens. They typically cause greater
long-term vision damage as the increased density of the lens core causes a "myopic shift", which
also allows the presbyopic individuals to read without glasses .

Cortical Cataract The lens may have opacification, where the main symptoms may be
reflections and monocular diplopia. Opacities are located in the cortical layer and initially form on
the lower part of the lenses. In the early stages of the cortical corpus, water drops and vacuoles are
visible. In more advanced stages, wedge-shaped opacities are circled.

Posterior subcapsular cataract

The rear convex-shaped Cataract is located in the back cortical layer of the lenses. Occasionally,
there are also granular lights in the rear pole for the slit lamp test. This type of cataract is
particularly associated with the use of steroids, myopia and diabetes. Patients with posterior sub-
capsular cataracts often complain of brilliance and poor vision under bright light conditions. The
near visual acuity is generally less than the long-range visual acuity. All three types of cataracts
result in blurred vision in the near and near vicinity, reduced contrast accuracy and color
perception.

• Ultraviolet radiation from sunlight and other sources

8
 • Diabetes

• Hypertension

• Obesity

• Smoking
• Prolonged use of corticosteroid medications

• Statin medicines used to reduce cholesterol

• Previous eye injury or inflammation

• Previous eye surgery

• Hormone replacement therapy

• Significant alcohol consumption

• High myopia

• Family history

Cataracts may be partial or complete, stationary or progressive, or hard or soft. The main types
of age-related cataracts are nuclear sclerosis, cortical, and posterior sub capsular.

9
 Fig. 5: Cortical Cataract

Fig. 6: Posterior sub capsular Cataract

Epidemiology
The main types of age-related cataracts are nuclear sclerosis, cortical, and posterior sub capsular.
Aging cataracts cause 51% of the world's blindness, about 20 million people. Roughly cataract
causes moderate or severe injury in 53.8 million (2004), of which 52.2 million are in low and
middle income countries.

In many countries, surgical services are inadequate and cataract is still the leading cause of
blindness. Cataracts cause half of blindness and 33% of visual impairment worldwide. Although
surgical services are available, cataract surgery-related low vision may still be common due to
long waiting times and surgical obstacles such as cost, lack of information, and transport
problems.

In the United States, age-related lens changes have been reported in 42% of 52-64-year-olds, 60%
of 65-74-year-olds and 91% of those aged 75-85 years. Cataract affects nearly 22 million
Americans over 40 years old. At the age of 80, over half of all Americans have cataracts. The
direct medical costs of cataract treatment are estimated at $ 6.8 billion a year. In the eastern
Mediterranean, cataracts cause more than 51 programmed for surgery are tested with the help of

1
0
Snellen's remote viewing chart and then manual refraction to determine the best possible
correction.

Treatment of cataract

We can reduce the possibility of developing cataracts by wearing anti-UV sunglasses. Cataracts
can be diagnosed through a standard exam. For mild cataracts, a change in the prescription can
provide improved vision. When the vision becomes so blurred as to make daily activities such as
reading and driving difficult, it is necessary to consider cataract surgery. In cataract surgery, the
consultant surgeon makes an incision in the eye and removes the cloudy lens, leaving behind the
lens capsule. The lens is replaced with a clear artificial lens and can also correct the eye for
myopia or hypermetropia (although glasses or contacts may still be needed). Surgery is performed
under topical or local anesthesia and takes only 15-30 minutes.

phacoemulsification

it is the most used cataract surgery. This procedure uses ultrasonic energy to emulsify the cataract
lens :Phacoemulsification typically includes six phases:

Anesthetic: The eye is anesthetized with an injection of undertones around the eye or with
simple eye drops.

Corneal incision Two cuts are made through the transparent cornea to allow the insertion of
instruments into the eye.

Capsulorrehxis: A needle or small forceps is used to create a circular hole in the capsule where
the lenses are supported.

Phacoemulsification :A manual probe is used to emulsify the lens in liquid using ultrasonic
wave energy. The resulting "emulsion" is sucked away.

Irrigation and aspiration: the bark is aspirated or aspirated. The removed fluid is continuously
replaced with a saline solution to prevent collapse of the anterior chamber structure.

Inserting the lens: a plastic folding lens that previously contained the natural lens is inserted
into the capsule bag. The antibiotic and salt water are injected into the corneal wounds to make
the area swell and seal the incision.% of blindness. Patients with cataracts, the main cause of
vision loss .

1
1
Extra capsular cataract extraction (ECCE):

(ECCE) consists of the manual removal of the lens, but leaves most of the capsule intact. The lens
is expressed by an incision of 10 to 12 mm, which is closed with stitches at the end of the
operation. ECCE is performed less frequently than phacoemulsification, but can be useful for very
hard cataracts or other situations where emulsification is problematic. Manual small incision
cataract surgery (MSICS) has evolved from ECCE. At MSICS the lens is removed by a self-
sealing scleral tunnel that is wrapped in the sclera and that is ideally waterproof and does not need
to be attached. Although "small", the incision is still considerably larger than the portal in
phacoemulsification. This operation is becoming increasingly popular in developing countries,
where access to phaco-emulsification is still limited.

During standard ECCE:

An incision of 8 mm to 10 mm is made in the eye where the clear front of the eye (cornea)
meets the white of the eye (sclera). A small incision is made in the front part of the lens
capsule. The lens is removed along with the remaining lens material. IOL then can be placed
inside the lens capsule. And the incision is closed. When implantation of IOL is not possible due
to other eyes, contact lenses and, in some cases, glasses can correct the vision. Insular lenses enter
into three basic forms: freeware, astigma (torch) and multifocal lenses. Monophonic lenses are
the most commonly used lenses. They have the same power in all places of the lens. They can
have a fixed focus or allow changes in focus.

Fixed Focus Monofone IOLs can provide a superb vision. However, since these lenses have a
fixed focus for a distant vision, you may need to use smart glasses for a good near vision.
Accomodation of Monofocal-IOLs is a relatively new option that can be used for patients who
wish to be very good and near vision without the use of glasses or contact lenses. These lenses
also have a single focus power. However, they can move from focusing on distant objects to focus
close to physically moving in the eyes in response to the focusing actions of the muscle eyes.
Astigmatic (toric) IOLs have a correction of astigmatism in them. These can be used for patients
who have a lot of astigmatism and who want to reduce it.

Multifocal lenses are like bifocal glasses. Several lens areas have different powers, allowing
individuals to see clearly at distant, intermediate and close distances. However, these multifocal
lenses are not suitable for everyone. For some individuals, they can cause more problems with
brighter vision and vision than monofocal IOL goals. The type of intraocular lens implant that

1
2
will work best for you will depend on your current state of vision and your vision and lifestyle.
Your optometrist and cataract surgeon can advise on the most appropriate lens implant

Recovery

Patients are normally sent home after a few hours of recovery in the clinic or in the hospital, and
when sedation has been wiped out. An eye pad is usually positioned over the eye for the first
night to protect the eye. Patients after surgery are tested using Snellen's remote visual dia- gnosis
and then manual refraction to determine any inaccuracies in the IOL's strength

1
3
Complications
Less than 10 out of 100 people have cataract surgery complications that could threaten their
vision or require additional surgery. The rate of complications increases in people who have other
eye diseases in addition to cataracts.

Although the risk is low, cataract surgery involves the risk of partial loss until total vision loss if
surgery is unsuccessful or if complications occur. Some complications can be treated and reversed
sight loss, but others can not. Complications that may occur in cataract surgery include:

In high income countries, the incidence of capsular rupture and vitreographic loss seems to
decrease and is now in the region of 1-2%. This improvement may be related to the use of
facoemulsification and previous intervention, which means that the vast majority of cataractes are
now removed before being mature. In low and middle income countries, however, the incidence
of capsular rupture and vitreographic loss appears to be higher. This is probably due to the
complexity of more cataract operations in developing countries, and not to specific deficiencies in
the training, expertise or equipment used.

The loss of vitreous also increases the risk of endophthalmitis, the most feared complication of
intraocular surgery. The incidence of endophthalmitis may vary. Studies from Europe give

estimated incidence as 0.14%. At Aravind Eye, India, this incidence is about 0.05%.

Causes of endophthalmitis may vary according to geography. In most European studies,

Staphylococcus epidermidis is the most common infective micro-organism. This bacterium is
located in the normal skin of the eye and conjunctiva and penetrates the eye during surgery.

1
4
However, in South India, Nocardia species were the most common cause of infection. When
endophthalmitis occurs, the prognosis is gloomy. In the UK, one third of patients who suffered
from this complication had a visual acuity (VA) of less than 6/60, and 13% lost all light
perceptions. At Aravind Eye Hospital in India, 65% of the eyes were VA <6/60. However, these
data also indicate that prognosis after endophthalmitis is by no means hopeless. The success rate
of cataract surgery is high, with more than 90% of cases achieving a good result. However
complications can occur.There is a small risk of infection but this is rare and can usually be easily
treated signs of complications following cataract surgery, such as:

Decreasing vision.

Increasing pain.

Increasing redness.

Swelling around the eye.

Discharge from the eye. New floaters, flashes of light, or changes in your field of vision

Complications of cataract Surgery

Complications that may occur with cataract surgery include:

 Infection in the eye (endophthalmitis)

 Swelling and fluid in the center of the nerve layer (cystoid macularedema)
 High Astigmatism.
 Swelling of the clear covering of the eye (corneal edema).
 Bleeding in the front of the eye (hyphema).
 Detachment of the nerve layer at the back of the eye (retinal detachment).

Complications that may occur some times after surgery include:

Problems with glare

Dislocated intraocular lens.

Clouding of the portion of the lens covering (capsule) that remains after surgery, often
called aftercataract (posterior capsular opacification). This is usually not a big problem and
can be treated with laser surgery, if needed. The type of IOL may affect how likely it is to
have clouding after surgery.

1
5
 Retinal detachment.

Glaucoma.

Astigmatism or strabismus.

Sagging of the upper eyelid (ptosis).

Macular edema

Toxic anterior segment syndrome.

Posterior capsular tear

KERATITIS
Persistent edema of the cornea after cataract surgery. All cataract surgeries (even "perfect"
surgeries) do some damage to the corneal endothelial cells needed to keep the cornea clean.
Most corneas have many "extra" endothelial cells, so a little loss of endothelial cells from
cataract surgery usually does not cause problems. However, sometimes, after cataract
surgery, endothelial cell cells do not function well to keep the cornea clean, causing poor
vision and often discomfort. Cells can recover during the first few months after surgery
Poor vision after cataract surgery, often worse in the morning, improves throughout the day
the damage to endothelial cells during cataract surgery.slit lamp checks are very important.
Cornea thickness testing (pachymeters). Imaging of selled cornea endothelium with a
specular microscope can help.

Treatment options include 5% saline drops and / or ointment to reduce swelling. Blowing cold
or warm air (not heat) from the blow dryer when you wake up can often improve vision early
in the day. Then, transplanted cornea, transplantation of endothelial with a partial thickness
(eg endothelial keratoplast stripping [DSEK] Descemet or endothelial membrane keratoplast
[DMEK] Hemorrhoid or full thickness corneal transplant

Medical treatment can prevent or delay the appearance or corneal fog. Endothelial
keratoplasts are more successful in eyes with minimal or no corneal fog. In corneal scarring,
full corneal thickness may be needed to achieve good vision.

1
6
ENDOPTHALMITIS
Ophthalmic surgeons usually make great efforts at the time of surgery to reduce the
possibility of an intraculosal infection called endophthalmitis. Patients usually receive
Topical antibiotic eye drops on the day of the operation. The ocular surface and the skin
around the eye are disinfected with antiseptic compounds, and the patient's face is excluded,
the eye is covered with sterile drapes. Sterile techniques are used for all instruments, similar
to all modern operations.

After completing surgery, surgeons prescribe topical antibiotic eye drops. Despite these
precautions, in about one in 3,000 cases, an intraocular infection called endophthalmitis
occurs. Symptoms and signs of endophthalmitis include excessive redness, pain,
photosensitivity and deterioration of vision.

In some cases, patients may feel quite comfortable on the first day after the operation, but a
few days later may be worse in terms of pain, vision and photosensitivity. Patients undergoing
cataract surgery should be instructed to call their ophthalmologist immediately if they worsen.
When a patient develops endophthalmitis, intraocular antibiotics are often injected into the
eye to minimize the spread of the infection. Sometimes an additional operation (vitrectomy)
is performed to remove the jelly-like substance of the eye. This can help to control the
infection.

Posterior Vitreous Detachment

Cataract surgery is the most common type of eye surgery. In the vast majority of cases, about
95% of the time, the operation is uncomplicated. Cataract surgery usually leads to improved
vision and a satisfied patient. However, cataract surgery should never be trivialized. In a small
percentage of patients, events occur that can lead to less than ideal results. Most of these
events are well-known risks of the operation itself and can occur even if the operation is well
performed by an experienced surgeon. The occurrence of these events is often unpredictable.
Patients should be aware of such possibilities when deciding to continue surgery. Some of the
most common risks are reviewed in this article. Posterior capsule / posterior hierarchical facial
opacification accounts for 38% of the eyes with a postoperative best corrected sharpness of
<6/12. About 40% of ECCE + IOL eyes had posterior capsule opacification, while 5% of
ICCE eyes had posterior hierarchical level opacification. PCO is by far the most common
complication after cataract surgery,

1
7
 and is considered a normal wound healing process. The contribution of posterior capsule
opacification seems very high, but it does not differ from the Rajasthan study (40
pseudophakic eyes) where 5 out of 13 (38.4%) pseudophakic eyes with an appearance of
<6/18 posterior capsule did not have the opera. The Sivanganga study (pseudophakic eyes)
reported that 23% of ECCE + IOL eyes with <6/18 appearance had posterior capsule
opacification. The high incidence of posterior capsule opacification is worrying as there are
very few Nd: YAG laser facilities outside tertiary-level (urban) centers in Pakistan, and an
increasing proportion of ECCE + IOL operations are now being conducted. . This is reflected
in the finding that only 3% of ECCE + IOLs that recorded posterior capsule pickup as the
main cause of a presentation vision of <6/12, already had Nd: YAG laser treatment. Possible
solutions to this increasing problem could be the provision of low-cost IOLs of a form and
material that reduces the risk of posterior capsule updating and / or the provision of more laser
facilities at district level.

Cystoid Macular edema

The retina is the neural tissue that protrudes the entire inside of the back. The center of the
retina is called the macula, which is responsible for central vision. After cataract surgery,
inflammation can sometimes cause retinal blood vessels to leak fluid that accumulates in the
macula, resulting in reduced central vision. This swelling is referred to as "cystoid macular
edema". When vision is affected by macular edema, the ophthalmologist may recommend a
specialized test, a fluorescein angiogram, in ORDER to determine the extent of swelling.
Ophthalmologists often treat macular edema with topical steroidal eye drops or non-steroidal
anti-inflammatory eye drops that alleviate inflammation, often improving in weeks or months.
Sometimes, injections of steroids behind the eye, or even intraocular vitrectomy surgery, are
useful for improving cystoid macular edema

Retinal detachment

A retinal detachment occurs when liquid vitreous humor enters the retina through a fine crack, as a
result of which it can abnormally separate from the back wall of the eye. A retinal detachment can
cause a curtain over part or all of the vision of the eye. Retinal detachment can occur in patients
who have not undergone previous eye surgery, especially in patients who are very nearsighted.
However, cataract operations increase the risk of retinal detachment after cataract surgery, releasing
of the retina occurs in about 1.5% of patients. The symptoms are curtain blocking of the sight,

1
8
flashes of light such as lightning or new floating spots in sight. These symptoms can sometimes
announce retinal detachment

Posteriorly dislocated lens material

In some cases, lens material may fall into the back cavity (vitreous cavity) of the eye. Often small
pieces of the rear dislocated lens material are well tolerated by the eye without problems. When
larger parts have been avoided, the ophthalmologist can recommend a second operation, called a
vitrectomy, to remove the lens material. This removal prevents excessive ignition from developing.

Choroidal Hemorrhage

Not often and unpredictably during cataract surgery, acute bleeding can occur in the choroid, the
delicate pattern of blood vessels that underlies and nourishes the retina. Although this complication,
called "choroidal haemorrhage," is more common in elderly patients, it is unpredictable. In some
cases of choroidal haemorrhage, bleeding is localized and patients are doing well. In more serious
cases of choroidal haemorrhage, visual loss can be significantg the vision.

HIGH ASTIGMATISM DUE TO TIGHT SUTURES

Surgeons are sometimes confronted with a situation where a corneal wound needs to be fastened
with sutures until complete healing occurs. Common situations include an enlarged phaco incision,
PKP, corneal surgery in children, wound burn and corneal extension. It is often difficult to
adequately position the wound edges without causing undue compression of the corneal tissue.

Wound incineration and wound dehiscence lead to local flattening, while tight adhesion leads to
local compression and steeper cornea.1 The tight suture can cause severe irregular astigmatism and
reduced visual acuity. The attached cornea heals within 6 weeks or longer, and if stromal healing
has occurred, the adhesion is removed. An intrastromal mattress attachment technique that is
astigmatically neutral is described.2 However, most surgeons use radial sutures.Suture cutback is a
simple technique that can reduce corneal compression and irregular astigmatism and maintain the
wound position, allowing safe healing and earlier visual recovery. The procedure can be performed
at any time after the first postoperative week

POST CAPSULAR OPACITY

Although some people call PCO a "secondary cataract", it really is not a cataract. Once a cataract
has been removed, it does not return.During a cataract operation, your surgeon will remove the
cloudy natural lens of your eye (cataract) and replace it with an intraocular lens (IOL). A large

1
9
portion of the thin lens surrounding the natural lens (called the lens capsule) remains intact during
surgery and the IOL is usually implanted therein.

When the cataract is removed, any attempt is made to maintain the integrity of the lens capsule
and normally your vision after cataract surgery should be very clear.However, about 20 percent of
patients, the posterior part of the capsule sometimes becomes hazy during recovery from cataract
surgery or even months later, causing PCO. The opacification of the posterior capsule occurs
because lens epithelial cells remain after cataract surgery.In some cases, if the condition
progresses significantly, your vision may be worse than before cataract surgery.

Avoid complications

Some eyes are more likely to suffer from complications than others. It is therefore very important
to find these conditions before surgery. For example, eyes with dystrophy (such as duchrophole and
corneal dystrophy), pseudoexfoliation, adult cataracts, or high ametrophy (> 6 in myopia or
hypermetropia) are much more risky than eyes that do not have parts. Simple marking systems are
designed to treat patients with low, medium, and high risk.

It is important to collect data to identify patients at risk and to monitor their management before
and after surgery. Regardless of the causes of complications, routine data collection helps identify
the patients who are in danger and confirm that they are properly administered. Monitoring the
results of cataract surgery is associated with reduced incidence of surgical complications.

Some risk factors are intrinsic to the patient and, without the ability to avoid surgery, can be very
small to eliminate it. However, during surgery, high-risk cases should be operated in an appropriate
condition, a surgeon with the right level of experience. It shows that surgery performed by eye
camps, or inexperienced trainees, is more likely to result in complications than surgery performed
by an experienced surgeon. Therefore, if patients with eyes have a risk of recognition, they should
be operated by a fully trained surgeon, preferably at a hospital base.

While things that are not avoided are inadmissible, other things that increase the risk of
complications in surgery are related to giving birth. These later risks can, and need, be changed.
Many can do before and after surgery to reduce the number of complications.

The sterilization of all surgical instruments and fluids, and aseptic surgery is essential. Recently, a
large randomized clinical trial demonstrates a significant reduction in the risk of endophthalmitis if
1 mg of cefuroxime is injected into the anterior chamber after the operation .This method should
be absorbed in all, because it has the potential to save thousands of people every year
2
0
Complications management

With all complications, including capsular rupture and glassy loss, and even endophthalmitis, the
prognosis is better if the complication is effectively controlled. Not all patients suffering from
capsular rupture and glassy loss experience a poor result. If the complication is well controlled, it
is possible for the patient to maintain excellent vision. But we often do not accept glassy losses as
we should. In the case of endophthalmitis, early recognition and rapid treatment with intravitreal
vancomycin and either ceftazidime or amikacin appear to give the best hope for visual recovery.
With the immediate use of intravitreal antibiotics, some eyes will regain useful vision.

Because complications can and will occur, the eye care team must be able to handle them
effectively, even at best. If phacoemulsification is used, a protocol is needed to treat appropriately
with fallen nuclei. When this complication is controlled by rapid vitrectomy and fragmentation of
the nucleus, the results are usually good. However, if the nuclear material is not removed, the eye
is blocked by a combination of severe inflammation and glaucoma. As phacoemulsification
becomes more common in low and middle income countries, the number of fallen grains will also
increase. Dislocation of fragments of the lens core into the glass body occurs for approx. 0.3%
phacoemulsification operations.

The management of complications must be incorporated into educational programs. For example,
control of vitreous loss, like all other surgical skills, can only be learned by practicing under the
supervision of a more experienced surgeon.

Literature Review
• In a study performed at Aravind Eye Hospital, one-year rates of serious postoperative
complications were more common with ICCE surgery (14.5%) than with ECCE surgery
(7.7%). In two other studies, endophthalmitis rates also were lower among patients
undergoing ECCE than those having ICCE.
• An analysis of 117,083 cataract surgeries performed in Australia during 1980–2000
demonstrated no significant difference in risk of endophthalmitis between the two types
of cataract surgery as did an analysis of all cases of endophthalmitis following cataract
surgery at a Canadian hospital from 1989 to 1996 by Somani et al. Castells et al. noted
differences in complication rates between ECCE and phacoemulsification, but only for
less serious complications, such as iris trauma, posterior capsule opacification, and
corneal edema.

2
1
• Another study considered rates of severe events (endophthalmitis, retinal detachment
(RD), suprachoroidal hemorrhage) among Medicare enrollees undergoing cataract
surgery in 1994–1995, 1999–2000, and 2005–2006. Stein et al. found that the risk for
complications was 21% higher in the 1994–1995 cohort than in the 2005–2006 cohort,
and 20% higher in the 1999–2000 cohort than in the 2005–2006 cohort. 1. The folders
of 114 eyes of 100 people operated upon at the University of Port Harcourt Teaching
Hospital within the five year period under review were analyzed in this study. Some
had bilateral surgery. The ages ranged from 10 years to 94 years (Mean 61.06 years,
SD ±15.99).There were 45 males and 55 females. Coexisting medical conditions which
could affect the visual outcome of surgery were seen in the following: Twenty three
had hypertension while six of them had diabetes mellitus. Two each had peptic ulcer
disease and arthritis, one had asthma and one patient had coexisting glaucoma. The
preoperative acuity ranged between Counting Fingers (CF) and Light Perception (LP).
Intra capsular cataract extraction (ICCE) was carried out in 29 eyes (25.4%). ICCE and
Anterior Chamber Intra Ocular Lens (ACIOL) was carried out on one eye (0.9%), Extra
Capsular Cataract Extraction (ECCE) only was performed on eight eyes (7.0%), ECCE
and ACIOL was on two eyes (1.8%), ECCE with Posterior Chamber Intra Ocular Lens
(PCIOL) was performed on seventy-two eyes (63.2%). Two eyes had secondary IOL
inserted into the anterior chamber (1.75%). The power of the IOL used was generally
between 17 and 22 D with 21 D used in about 60% of cases. Of those with lenses
inserted, over 90% had them inserted in the posterior chamber. Intraoperative
complications were mainly vitreous loss in seven cases (6.1 %) ruptured posterior
capsule which precluded IOL insertion in two cases (1.75%) retained soft lens matter
in two cases (1.75 %). Zonnular dialyses or hyphema were noticed in one patient each
and positive pressure in one other during surgery. Postoperatively, corneal opacity and
irido dialysis was observed in one patient each. Of the 114 eyes seen, refraction was
not done on 31 eyes (27.2%) due to lack of patient attendance after surgery. Of these,
four of the eyes had no useful retinoscopic reflex and no improvement with lenses
possibly due to the post-operative complications. The objective refraction 12 weeks
postoperatively gave corrected visual acuities ranging between 6/6 and 6/60. Of the 83
eyes refracted, 57 (68.7%) had astigmatism. The astigmatic errors using the spherical
equivalent ranged from −0.5 D to −4.00 D with a mean of 1.85 D. (SD ±1.07). n this
study, about seventy percent (68.7%) of patients within the period under review had
some level of astigmatism demonstrable following cataract surgery. The majority

2
2
 ranged from between −0.50 D and −4 D with an average of 1.85 D using the spherical
equivalent. Corneal astigmatism after cataract surgery is a well-documented finding in
adults 1719. The majority of patients (63.2 %) studied in the period under review had
extra capsular cataract extraction performed.
• A study was performed with all patients with cataract extractions performed at the
Singapore National Eye Center from 1996 to 2001. During the study period, 44 803
cataract operations (25 476 phacoemulsification and 19 327 extracapsular cataract
extractions) were performed. There were 34 cases of acute endophthalmitis (average
annual incidence of 0.076%), 21 of which were culture positive (average annual
incidence of 0.040%). In multivariate analysis, risk of endophthalmitis was associated
with phacoemulsification technique (relative risk [RR], 1.9; 95% confidence interval
[CI], 0.9, 3.9; P = 0.10 for all endophthalmitis cases; RR, 3.1; 95% CI, 1.1, 9.4; P =
0.04 for culture-positive endophthalmitis cases) and the occurrence of intraoperative
posterior capsule rupture (RR, 8.0; 95% CI, 3.1, 20.7; P<0.001 for all endophthalmitis
cases; RR, 11.0; 95% CI, 3.7, 23.9; P<0.001 for culture-positive endophthalmitis cases).
After a median follow-up of 234 days, half of the eyes achieved a final bestcorrected
visual acuity of 20/40. Predictors of this visual acuity included baseline acuity of
counting fingers or better, culture-negative endophthalmitis, or infection caused by
coagulase-negative Staphylococcus.

Rationale of Study
Cataract is the major cause of blindness in the world. Risk factors such as UVB exposure and
smoking can be addressed, but are unlikely to make a large difference to visual function.
Although no means of preventing cataracts has been scientifically proven, wearing ultraviolet-
protecting sunglasses may slow the development. Phacoemulsification is a modified version of
extracapsular cataract extraction (ECCE) and is the most common surgical procedure for
removing cataracts.
The study was designed to find out the visual out comes and complication of cataract surgery.
The data was collected from holy family hospital in a selected period of time.

2
3
Aim
To find out early complications of post operative complications in cataract surgery in patients
presented in Ophthalmology Out-Patient Depatrment Holy Family Hospital Rawalpindi.

Objective
To find out
• Frequency of patients with cataract surgery( both genders).
• Frequency of patients with post operative complications in cataract Surgery.
• Frequency of patients phacoemulsification verses ECCE

CHAPTER 2

MATERIAL & METHODOLOGY

Subject
Patients with cataract undergone cataract surgery (phacoemulsification and ECCE)

Study design
It was a hospital based descriptive study.

Setting
Ophthalmology out-patient department of Holy Family Hospital Rawalpindi.

Duration of study
3 months after the approval of synopsis

Sample size
50 patients were selected depending upon the time available

Sampling technique

Consecutive sampling

Sample Selection

2
4
Inclusion Criteria

Patient suffering from blurred, decreased vision, worsening of vision at night ,lacrimation,
photophobia, rednes, itching etc after cataract surgery irrespective of age or gender.

Exclusion Criteria

No other eye pathology

Method of data collection

Specially designed performa was used for data collection.

Informed consent
Proper informed consent will be taken from patients and in case of children, from their parents
that their ocular examination will not cause any harm to them and there are no ethical issues
regarding it.

Data collection tools and procedure

 Slit lamp ( for examination )
 Visual acuity charts ( Snellen charts & Lea symbols).
 Pinhole
 Autorefractor for objective refraction.
 Retinoscope for objective refraction.
 Trial box and Trial frame for subjective refraction.
 Torch
Data analysis procedures
By using

• Standard deviation, mean, median and mode.

• Microsoft Word.
Study Methodology

The study started on 1st August 2018 and continued till 31 December 2018. All the patients
having complaint of watering, blurring, decreased vision, glare, diplopia, pain and watering
and having history of intact of eye were referred to OPD of eye of holy family hospital,
Rawalpindi were the sampled population of my study. I selected the sample size of 50 patients

2
5
depending upon the time available and evaluated them under the supervision of senior
ophthalmologists. Data of the patients was collected on a Performa. A detailed external ocular
examination was done with the help of a pen torch. A detailed adnexal and anterior segment
examination was done with the slit lamp bio microscopy. The posterior segment was examined
with the direct ophthalmoscope. Fundoscopy was done to check the fundal glow, optic disc
ratio and retinal imag Visual acuity of all the patients was taken by snellen visual acuity chart.
With the help of slit lamp anterior segment was determined. All of the patients who had
undergone cataract surgeries were evaluated. Patients remained on one week post-op follow up
and again checked by slit lamp biomicroscopy. Visual acuity checked by Snellen visual acuity
chart. Pre-op and post-op vision was obtained to compare visual enhancement and frequencies
of complication after phacoemulsification and ECCE.

Data Analysis
All the data was analyzed using Microsoft excel 2010. Categorical data was represented by
frequency, percentage and cross tabulation. Since it was a study based on non-probability
sampling, no further statistical tests could be applied on it.

Ethical Issues

Written permission was taken from Executive Director of Allied Health Sciences, Rawalpindi
Medical College under whom this research was conducted, before examination of each patient
ethnic clearance was obtained from males as well as females. The particulars of every patient
were taken on specially designed Performa.

CHAPTER 3

Results

A total of 3250 patients visited eye OPD HFH in the selected time stamp. Out of those, 340
patients were of Cataract. I collected data of 50 patients of age group 30-90 years depending
upon the time available.The Mean age was 58.06±10.371.

Table 1: Mean Age and Standerd Deviation

Number of Minimum age Maximum age Mean age (years) SD
patients (years) (years)

2
6
 50 40 79 58.06 10.371

Gender Wise Distribution

Frequency of Female patients (64%) with cataract surgery complications was greater then Male
patients (36%).
Table 2: Gender wise distribution of patients
Gender Frequency Percentage
Female 18 36 %

Male 32 64 %

Total 50 100 %

Age wise Distribution

Females Males

Table 3: Age wise Distribution

Age Frequency Percentage

45-55 2 4%
55-65 7 14 %
65-75 28 56 %
75-85 13 26 %
Total 50 100 %

2
7
 30

25

20

15 Series1

10

0
45-55 55-65 65-75 75-85

Fig. 10: Age wise Distribution

Distribution according to surgery type

Frequency of Phacoemulsification (82%) was greater than Extra Capsular Extraction (18%)
Table 4: Distribution According To Surgery Type
Surgery Type Frequency Percentage
Phaco 41 82%
ECCE 9 18%
Total 50 100 %

2
8
 Frequency

45
40
35
30
25
20
15
10
5
0
Phaco ECCE

Fig.11: Frequency of Type of Cataract Surgery.

Distribution according to Visual acuity;

Table 5: Distribution According To Visual Acuity

6/6 6 / 12 6 / 24 6 / 36 6 / 60 3 / 60

V.A 0 0 10 9 14 17
before
surgery

V.A after 4 8 24 7 6 1
surgery

2
9
 Fig 12: Bar chart of pre and post visual acuity

Distribution according to Complications

Results of my studies shows that keratitis is my the most frequent complication with (50%) .
Second major complication is posterior capsular opacity (18%). Retinal Detachment is the
least occurring complication (2%).

Table 6: Complications

Complications Frequency Percentage

Endophthalmitis 5 10 %

Keratitis 25 50%
High Astigmatism 6 12%
Retinal Detachment 1 2%
Lens Dislocation 3 6%

PCO 9 18 %
Uveitis 1 2%

3
0
 Fig 13: Frequency of complications

Discussion

This study was designed to find out the frequency of patients who were exposed to the
complications after cataract surgery.it was a hospital based study. Population based study was
not possible due to limited resources and time duration. Cataract causes rapid visual loss, which
if untreated can lead total visual impairment.
The main aim behind conducting this study was to find out the early complications
complications occurring afater cataract surgery,so that discomfort of patient can be minimized.
Special importance was given to the control of diabetes. Special measures were taken for
prevention of the transmission of any kind of infection. Hands were properly washed before
the start of examination and also after the finishing of examination, In addition to this, different
kinds of refractive error were treated using reflective lenses of appropriate power for restoring
the vision.
Different types of instrument are used for diagnosisof complications, but Slit lamp was the most
used instrument used in diagnosis of 75 % patients .Ophthalmoscope was the least used
instrument used for diagnosing patients. males were more affected by post operative
complications then the females were. Complications are more common on Diabetic patients.
Purpose of our study was to minimize the visual loss by diagnosing the patients for the post
operative cataract surgery complications.so that before the disease develops and progress
patients should be evaluated following full diagnostic criteria.. Patients were given full

3
1
diagnostic protocol and special care was taken while instilling drops in the patient’s eye and
the patients were referred to the ophthalmologist for treatment of retinopathy and advised to
follow the instructions of the doctor and come on follow ups regularly so as to control the
progress of diseas.

Almost 50% of the patients in the study less than 65 at surgery, had received Nd:YAG laser
treatment This is consistent with earlier observations, reporting a higher incidence of PCO in
younger patients.

Conclusion
The rate of complications increases in people who have other eye diseases in addition to the
cataract
The surgeon's first responsibility is to prevent complications. However, despite our best efforts,
they will occur. Our next priority is to ensure that we are prepared to deal with these
complications effectively so that our patients can obtain good vision, regardless of what went
wrong during surgery. If we improve our management of complications, we can be certain that
we will reduce the number of poor visual outcomes and disappointed cataract patients.

In striving to reach the goals of VISION 2020, we must be careful to maintain a culture that
values outcome (the quality of cataract operations) as highly as output (the number of
operations performed.

Limitations

Limitations of this study are due to:

 Small sample size.

 Short duration of study.
 Non co-operative patients for diagnostic procedures
 Noncompliance of the patient

3
2
Recommendations

The study should be conducted in other hospitals & with relatively large sample size & longer
study duration so that the exact prevalence can be estimated.

There should be organization of awareness programs for the community about complications
after cataract surgery, its treatment potential at all health care levels.
REFRENCE:

 Banerjee K. A review and clinical evaluation of per-operative and post-

operative complications in case of manual small incision cataract surgery
and extracapsular cataract extraction with posterior chamber intra-ocular
lens implantation (Doctoral dissertation, RGUHS).
 .Abel SR, Sorensen SJ. Eye disorders.
 .Atkinson MJ, Tally S, Heichel CW, Kozak I, Leich J, Levack A. A
qualitative investigation of visual tasks with which to assess distance-
specific visual function. Quality of Life Research. 2013 Mar 1;22(2):437-
53.
 .Apple DJ, Escobar-Gomez M, Zaugg B, Kleinmann G, Borkenstein AF.
Modern cataract surgery: unfinished business and unanswered questions.
Survey of ophthalmology. 2011 Nov 1;56(6):S3-53.
 Javitt JC, Vitale S, Canner JK, Street DA, Krakauer H, McBean AM,
Sommer A. National outcomes of cataract extraction: endophthalmitis
following inpatient surgery. Archives of ophthalmology. 1991 Aug
1;109(8):1085-9.

 Norregaard JC, Thoning H, Bernth-Petersen P, Andersen TF, Javitt JC,

Anderson GF. Risk of endophthalmitis after cataract extraction: results from
the International Cataract Surgery Outcomes study. British Journal of
Ophthalmology. 1997 Feb 1;81(2):102-6.
 Somani S, Grinbaum A, Slomovic AR. Postoperative endophthalmitis:
incidence, predisposing surgery, clinical course and outcome. Canadian
journal of ophthalmology. Journal canadien d'ophtalmologie. 1997
Aug;32(5):303-10.

3
3
 Freeman EE, Roy-Gagnon MH, Fortin E, Gauthier D, Popescu M, Boisjoly
H. Rate of endophthalmitis after cataract surgery in Quebec, Canada, 1996-
2005. Archives of Ophthalmolog 2010 Feb

 Stein JD, Grossman DS, Mundy KM, Sugar A, Sloan FA. Severe adverse
events after cataract surgery among medicare beneficiaries Ophthalmology
2011 Sep 1;118(9):1716-23.1;128(2):230-4
 Stein JD, Grossman DS, Mundy KM, Sugar A, Sloan FA. Severe adverse
events after cataract
 surgery among medicare beneficiaries. Ophthalmology. 2011 Sep
1;118(9):1716-23.
 Hatch WV, Cernat G, Wong D, Devenyi R, Bell CM. Risk factors for
acute endophthalmitis after cataract surgery: a population-based study.
Ophthalmology. 2009 Mar 1;116(3):425-30.

 Yi DH, Dana MR. Corneal edema after cataract surgery: incidence and
etiology. InSeminars in ophthalmology 2002 Jan 1 (Vol. 17, No. 3-4, pp.
110-114). Taylor & Francis.

 Zamvar U, Dhillon B. Postoperative IOP prophylaxis practice following

uncomplicated cataract surgery: a UK-wide consultant survey. BMC
ophthalmology. 2005 Dec;5(1):24.

 Shah MA, Shah SM, Mehta R, Shah P. Spontaneous dislocation of lens

bag with acrylic lens after uneventful cataract surgery–unusual
complication of cataract surgery. GMS ophthalmology cases. 2015;5.

 Kamalarajah S, Silvestri G, Sharma N, Khan A, Foot B, Ling R, Cran G,

Best R. Surveillance of endophthalmitis following cataract surgery in the
UK. Eye. 2004 Jun;18(6):580

 Borazan M, Karalezli A, Akman A, Akova YA. Effect of antiglaucoma

agents on postoperative intraocular pressure after cataract surgery with
Viscoat. Journal of Cataract & Refractive Surgery. 2007 Nov
1;33(11):1941-5.

 Devgan U. Management of Iris Prolapse During Cataract Surgery:

Equalizing the pressure gradient is the key. Opthalmology Management.
2007 Jan 1;11(1):16-22.

 Prajna NV, Chandrakanth KS, Kim R, Narendran V, Selvakumar S, Rohini

G, Manoharan N, Bangdiwala SI, Ellwein LB, Kupfer C. The Madurai
intraocular lens study II: clinical outcomes. American journal of
ophthalmology. 1998 Jan 1;125(1):14-25.

3
4
 Li J, Morlet N, Ng JQ, Semmens JB, Knuiman MW. Significant
nonsurgical risk factors for endophthalmitis after cataract surgery: EPSWA
fourth report. Investigative ophthalmology & visual science. 2004 May
1;45(5):1321-8

 Castells X, Comas M, Castilla M, Cots F, Alarcón S. Clinical outcomes

and costs of cataract surgery performed by planned ECCE and
phacoemulsification. International ophthalmology. 1998 Nov 1;22(6):363-
7.

 Dabrowska-Kloda K, Kloda T, Boudiaf S, Jakobsson G, Stenevi U.

Incidence and risk factors of late in-the-bag intraocular lens dislocation:
evaluation of 140 eyes between 1992 and 2012. Journal of Cataract &
Refractive Surgery. 2015 Jul 1;41(7):1376-82.

 Sappenfield DL, Driebe Jr WT. Resident extracapsular cataract surgery:

results and a comparison of automated and manual techniques. Ophthalmic
Surgery, Lasers & Imaging Retina. 1989 Sep 1;20(9):619.

3
5
Early post operative complications in cataract surgery in patients presented
in Ophthalmology Out-Patient Depatrment Holy Family Hospital
Rawalpindi.

Proforma

Patient’s Name: ____________

Age/ Gender: ______________

Hosp Reg No: ______________

Date of surgery:____________

Procedure:_______________

CHIEF COMPLAINTS:

_________________________________________________________
_________________________________________________________

HISTORY:
O/H: _____________________________________________________________
F/H: _________________________ M/H: ____________________________

OCULAR EXAMINATION:

• V.A(SC) :

OD _________ OS ________

3
6
 V.A(cc):

OD _________ OS ________

• A.R:

R __________ L______________

SLIT LAMP EXAMINATION:

Lids and lashes: _______________

Cornea: ______________________

Conjunctiva: ___________________

Sclera: _______________________

Pupil: ________________________

Iris: _________________________

A.C:________________________

Lens: ________________________

IOP: ________________________

Fundus: _______________________

COMPLICATIONS:

_________________________________________________________

TREATMENT:_________________________________________________________

CONCLUSION & RESULT:

Sign of Student : _____________

Sign of Supervisor: ____________

3
7