Managing intraoperative complications in cataract surgery.

PURPOSE OF REVIEW: This article surveys the literature from 2002 and 2003 and addresses a variety of complications that may arise during cataract surgery. Modern surgical techniques and technology contribute to the decreased incidence of complications. Surgeon experience, early recognition of potential complications, and optimal handling of events lead to better outcomes.

RECENT FINDINGS: Recognizing eyes preoperatively that are particularly at risk for having dysgenesis of the capsular bag, cortical-capsular adhesions, low endothelial cell reserve, dropped nucleus, and bag-lens dislocation will allow for contingency planning and appropriate tailoring of techniques. Capsular tension rings are indispensable for achieving in-the-bag implantation in the presence of weak zonules and zonulolysis. Viscolevitation to rescue sinking implants, avoidance of foldable lens complications, and proper lens placement with an open capsule are discussed. High-frequency ultrasound biomicroscopy is a useful diagnostic tool. Noninjection sub-Tenon anesthesia is not benign. Complications have been documented that include traumatic optic neuropathy. Immediate diagnosis and a trial of corticosteroids could be vision saving. Mastering topical anesthesia is a worthy goal. In some cases, faulty instruments result in complications. Routine inspection of reusable instruments, or the use of disposable instruments is warranted. Though there is no FDA-recognized use, at the time of this writing, for trypan blue dye, it has become the world standard for intraocular staining because of its safety and efficacy. Clear corneal self-sealing incisions are increasingly mainstream and, when properly constructed, are extremely secure. The most significant trend for successful management of intraoperative complications this year is the increasing use of pars plana anterior vitrectomy. The ability to identify prolapsed vitreous by intracameral Kenalog staining is an invaluable tool. Surgeons depend on a team of nurses and technicians for optimal outcomes.

SUMMARY: With new technology and techniques highlighted by capsular tension rings, Kenalog vitreous identification, and fourth-generation fluoroquinolones, even complicated cataract surgery can result in optimal outcomes.