DEPARTMENT OF INPATIENT
POST OPERATIVE COMPLICATION
ARAVIND EYE CARE SYSTEM
Aravind Eye Hospital
& Postgraduate Institute of Ophthalmology
AIM
The MLOP shall identify the early post
operative complications in the ward and shall
help in the effective management of the same.
Objectives
The MLOP shall
• Develop wide range of basic knowledge of
immediate post surgical complications
•
In early identification of post operative
complications
•
Helping doctors in prompt remedial measures
•
In explaining and reassuring patients in a
proper way about their complications.
Theory
The ocular post surgical complications can broadly
be divided into
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Anterior segment complications
Posterior segment complications
Early post operative complications
Late post operative complications
Early Post - Operative Anterior
segment complications
• Lid
- Oedema; ptosis
• Conjunctiva - Chemosis, Subconjunctival
haemorrhage
• Cornea
- Oedema, Striate Keratopathy,
Epi. defect
• Ant. Chamber - Shallow, Cortex, Hyphaema,
Hypopyon
Cont…
•
Iris
- Iritis, Iris prolapse
•
Pupil
- Fibrin Membrane ,
Pupilary capture
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Lens
- Decentred IOL,
Haptic in AC,
Panophthalmitis
Late post-operative Ant. segment
complications
• Bullous Keratopathy
• Vitreous touch syndrome
• Vitreous wick syndrome
• Secondary Glaucoma
- Angle closure
Severe iritis, Pupillary block,
Irisbombe, Peripheral anterior
synechiae
Cont…
 Open Angle
Cortex
Cells
Blood
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Suture infiltration
Iris Prolapse
Uveitis
Late post – op endophthalmitis
POSTERIOR SEGMENT COMPLICATIONS
• Cystoid macular edema (CME)
• Pseudophakic R.D
• PCO ( Posterior capsule opacifications)
• Dislocated IOL/ Decentered IOL
• Vitreous Haemorrhage
• Endophthalmitis
Lid edema
Swelling of the Lid
Causes :
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Injury with instruments
Inflammation ( Iritis)
Allergy to medications
Treatment :
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Anti - Inflammatory drugs
Steroids
Anti histamines in case of allergy
Chemosis
Congestion and collection of fluid
Causes :
 Allergy
 Subconjunctival Injections
 Iritis
 Endophthalmitis
Treatment :
 Observation
 Anti Inflammatory drug
Subconjunctival Haemorrhage
 Collection of blood beneath the conjunctiva
Causes :
 Injury
 Retrobulbar Haemorrhage
 Hypertension
 Bleeding disorders
Treatment :
 Observation
 Absorbs spontaneously – 2 -3 wks
Corneal Oedema
Corneal Oedema
 Increase in corneal thickness epithelial edema
 Causes:
 Increased IOP – 40 mmHg and more
 Iritis
 Descemets membrane stripping
 Endothelial damage
Treatment:
 Timolol eyedrops
 Tab. Diamox
 Oral glycerol
 Injection Mannitol 20%
 Hypertonic Saline drops
Striate Keratitis
Causes :
 Severe endothelium damage
 Tight suture
Treatment :
 Steroid eye drops
 Timolol eye drops
 Cycloplegic eye drops
Descemets Membrane Stripping
 The stroma and thus allowing easy
separation from stroma
Causes:
 Entry in to the globe
 Faulty instrumentation
 Fluid is injected between the descemet’s
membrane and stroma
 If small
 If larger
– Air Bubble left in
anterior chamber
– Needs surgical repair
Epithelial defect
Epithelial defect
 Rupture of epithelium
Predisposing Factors :
 Injury (Instrument, Pad / Cotton )
 During anaesthesia eye is open
Treatment :
 Only antibiotic ointment
pad / bandage.
A.C Shallow
Shallow Anterior Chamber
Causes :
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Wound leak
Pupilary block
Choroidal detachment
Malignant glaucoma
Wound leak :
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Size of the section is larger than the normal
Loose suture wound gape
Trauma
Inadequate and improper suturing of the wound
Treatment :
 Pressure pad / bandage / mydriatic
 If AC does not form within 24 – 48 hrs
 Needs AC reforming / resuturing
Pupilary Block
Causes :
 AC IOL without PI
 Severe Iritis – 360 deg PS
 Vitreous touching the PUPIL
 IOL capture
Treatment :
 Inj. mannitol 20%
 Tab. diamox
 1st Laser PI.
 If not possible Needs surgical PI.
Fibrin Membrane
Appear as a dense fibrin net in pupillary area
Causes:
 Prolonged Irrigation with balance – salt solution
 Unsterile IOL
Treatment:
 Antibiotic drops hourly
 Steriods drops hourly
 Cycloplegic drops TDS
 If needed oral steriods to be given (1mg /1kg)
Cortex
Residual cortex
Predisposing Conditions :
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Small pupil
Pseudo exfoliation
Diabetic mellitus
Positive pressure during surgery
PC rent
Treatment :
 Small piece of loose cortex will get absorbed – steroids
E/D
 Large clumps of cortex not getting absorbed – needs AC
wash.
Treatment :
• Bed rest, bandage both eyes.
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Steroid eye drops.
Cycloplegic eye drops.
Timolol eye drops.
Tab. Diamox.
Tab. Vit C.
Observation for 2 days. If not responding
needs AC wash.
Hypopyon
Predisposing conditions :
• Complicated cat
• Phacolytic / Phacomorphic glaucoma
• Infection.
Treatment :
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Antibiotic
Steroids
Cycloplegic.
SYMPTOMS
Pain , Redness , Defective vision.
• Lid edema , conjunctival chemosis
• Corneal edema, corneal Infiltration
• AC cells, Hypopyon
• Infiltrate in suture / section
• Wound gape or weak wound.
TREATMENT:
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No steroids
Topical antibiotics
AC tap. Vit-tap
Intravitreal antibiotics
IRITIS
• Inflammation of the iris.
• Flare and cells
• Fibrin membrane.
• Treatment :
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Antibiotic drops hourly
Steroids drops hourly
Cycloplegic drops TDS
If needed oral steroids to be given (1mg/1kg)
Iris Prolapse
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IRIS PROLAPSE
Causes :
Loose suture
Wound gape
Injury
Positive pressure.
Treatment :
Hourly antibiotic drops
Iris prolapse excision and resuturing
< 24 hrs – Reposition
> 24 hrs – Excision.
• HAPTIC IN AC :
• One Haptic in AC
• Treatment :
• IOL reposition ( or ) Redialing
ENDOPHALMITIS
(Dreadful complication, follows infection )
Sources:
 Contamination in O.T
(Staffs & Instruments)
 Patients Lids and conjunctival
poor hygiene.
TREATMENT:
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No steroids
Topical antibiotics
AC tap. Vit - tap
Intravitreal antibiotics
Anti inflammatory drug
RISK FACTOR :
 Poor hygiene
 Immune suppressed patient
 Debilatet patient - (diabetic, cancer &
weak )
 Suture abscess or suture removal
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ORGANISMS :
Bacteria
Staphylococcus
Staphylococcus
Streptococcus
Pseudomonas
Fungal
Aspergillus
Candida
Fusarium