Cataract surgery advances bring new complications

As new techniques in cataract surgery present so, too, do new complications and challenges in the management of such cases,said Gregg Kokame, MD, MMM, medical director of The Retina Center at Pali Momi, and clinical professor, Division ofOphthalmology, University of Hawaii School of Medicine, Honolulu.

Clear corneal incisions, for example, carry with them the risk of leakage and hypotony, according to Dr. Kokame. It'simportant to stitch the wound if another procedure to the eye is going to be necessary.

Another example is capsular tension rings. While these can help the surgeon by stabilizing the capsule during lensimplantation, IOLs still can dislocate in the bag. Dislocation of the tension rings themselves is another possibility.Removal of capsular tension rings, if necessary, requires a fairly challenging bimanual technique because the rings are sobroad in diameter, Dr. Kokame said.

When it comes to dislocated IOLs, there are several management alternatives: reposition the IOL, exchange it, or remove it ifthere's a poor prognosis or other pathology.

"Exchanging the lens is a more straightforward procedure than repositioning it. The exchange rate is growing, especially withthe increasing number of foldable optics that are available," Dr. Kokame said. "Exchanging offers a quicker operative timethan repositioning. However, it does require that you open up a large limbal incision, which increases the risk ofastigmatism."