Cataract Surgery (Advanced)
This patient was referred to me after a complication with cataract surgery, where the cataract fell deep inside the eye. Here, I am removing the white piece of cataract. The retina and its blood vessels are visible as I am operating a few millimetres above them.
What are complex cataracts?
Complex cataracts have a higher risk of complications during the surgery. The main complication that most surgeons are concerned about is known as a posterior capsular rupture or tear.
The capsule is a thin structure that forms a bag that holds and supports the natural lens and later, the cataract. This bag can tear during surgery.
If this happens, the cataract surgery can be completed safely. However, the torn bag may not be able to support the new lens implant or may allow pieces of cataract to fall deeper into the eye. At this point, a vitreoretinal surgeon such as myself is usually asked to complete the surgery.
During the pre-operative assessment for cataract surgery, ophthalmologists look for features that suggest a higher risk of a posterior capsular tear that include smaller pupils, being on certain prostate medications and previous trauma to the eye. If these are found, a vitreoretinal surgeon is often asked to perform the cataract surgery.
A vitreoretinal surgeon is able to insert lens implants in cases where a cataract surgeon has been unable to do so. This may require special lens implants or techniques that secure the implant to the wall of the eye. This is also the case when a lens implant inserted previously becomes dislocated.