Intraoperative and Postoperative Complications

Abstract

Cataract surgery in children is more difficult and the rate of complications is higher when compared to adult surgery. The rate of intraoperative and postoperative complications is inversely proportional to the age at surgery. In addition to age, surgical technique can influence the rate of complications (e.g., primary intraocular lens implantation vs. aphakia). Higher intraoperative complications in children may be attributed to the common occurrence of an immature iris that results in poor pupil dilation. In addition, the eyes of young children are small and soft. Even small and well-constructed surgical wounds leak when not sutured securely. The anterior capsule in children is highly elastic and difficult to predictably tear into a circular and centered capsulorhexis. Scleral collapse and a formed, non-liquified, vitreous body create the upthrust commonly referred to as posterior vitreous pressure. Postoperative complications are also higher due to an intense inflammatory response and poor compliance to postoperative topical anti-inflammatory drops. The detection of postoperative complications can be challenging because of the difficulties encountered in performing detailed postoperative examinations in children, who may be uncooperative.

Postprocedural Complications Hospitalization Pattern Among Paediatric Patients at National Health Service Trusts: An Ecological Study in England and Wales

“…Age at surgery has an inverse relationship with intraoperative and postoperative problems. 12 Age and surgical method can both affect the frequency of problems. A strong inflammatory response and poor compliance also increase the risk of postoperative complications.…”

“…Due to the challenges in doing thorough postoperative tests on children, who may be recalcitrant, postoperative problems might be difficult to detect. 12 Shock due to a severe drop in blood pressure, hemorrhage, wound infection, deep vein thrombosis, reaction to anesthesia, pulmonary embolism, and lung difficulties due to a lack of deep breathing and coughing exercises within 48 hours of surgery are also common postoperative consequences. Inhaling food, water, or blood into the airways can also cause these symptoms.…”