Risks and complications of cataract surgery
Every operation carries risks, and you are entitled to know them. Cataract surgery is among the safest surgical procedures there are: over 95% pass without complications. Most problems that can occur are easy to treat. On this page you will find every risk explained honestly, with frequencies and specific treatment options.
The posterior lens capsule clouds over after some time, like a windscreen misting up again. This condition is often called ‘secondary cataract’. Vision deteriorates in a similar way to the original cataract.
YAG laser capsulotomy: a 5-minute outpatient laser procedure, no anaesthetic needed. Vision is clear again straight away. No repeat surgery is required.
Despite precise calculation, the target (for example spectacle-free distance vision) can be missed by a small number of dioptres. The eye is slightly short-sighted or long-sighted.
In most cases a light pair of glasses is enough. Rarely: LASIK correction or an IOL exchange.
The cornea swells slightly and vision stays blurred for a while. This usually settles by itself within a few days.
Eye drops. In rare cases (for example with a previously damaged cornea) it persists; corneal treatment may then be needed.
The eyes often feel dry after surgery. Typical signs are scratching, burning or the feeling of a grain of sand or a foreign body in the eye. The cause: the small incisions and the eye drops containing preservatives temporarily disturb the protective tear film.
Lubricating eye drops (artificial tears), ideally without preservatives. The symptoms usually settle on their own within a few weeks.
Some patients notice light phenomena after surgery. With positive dysphotopsia these are glare, halos or bright arcs of light. With negative dysphotopsia, a crescent-shaped dark shadow appears at the outer edge. Both are caused by the changed refraction of light at the new artificial lens.
In the vast majority of cases the brain adapts within a few weeks to months and the perception disappears. If the phenomena remain permanently disturbing, there are solutions up to and including a lens exchange, but that is rarely necessary.
The gel (viscoelastic) that protects the eye during surgery can briefly raise the pressure inside the eye.
Pressure-lowering eye drops for a few hours to days. Resolves on its own.
Fluid collects in the centre of the retina (the macula) and vision becomes blurred. The risk is higher with diabetes or uveitis.
Anti-inflammatory eye drops (NSAID, cortisone). Full recovery in most cases.
The posterior lens capsule tears. This raises the risk of later complications (retinal detachment, macular oedema).
An experienced surgeon can respond immediately in hospital: the IOL is placed in a different position (the sulcus). Long-term monitoring is important.
An infection inside the eye, the most serious complication of all. Symptoms: sudden severe pain, redness, massive loss of vision.
An emergency. See a doctor immediately. Intravitreal antibiotics (an injection into the eye); in severe cases a surgical rinse of the eye (vitrectomy). Early treatment is decisive.
The retina detaches from the wall of the eye. The risk is higher with severe short-sightedness or if a capsule rupture occurred.
An emergency. See a doctor immediately. Surgical reattachment (vitrectomy or scleral buckle). The chances of success are good with early treatment.
Warning signs: when should you see a doctor immediately?
Mild irritation, watery eyes and some sensitivity to light after the operation are normal. These symptoms are not; if they occur, seek medical help immediately:
Slight pressure is normal; severe pain is not.
Especially if your vision had already improved.
Slight redness is normal; pronounced swelling is not.
Possible signs of retinal detachment.
Can point to raised pressure inside the eye.
A possible sign of infection.
What minimises the risk
Any complication can be treated directly on site: no transfer, no delay. This matters most when problems arise during the operation itself.
With experienced surgeons, the capsule rupture rate is below 0.5%. Surgical volume and specialisation make a measurable difference.
Antibiotic eye drops before and after surgery, disinfection with povidone-iodine and sterile technique lower the infection risk to below 1 in 2,000.
The surgeon must know about alpha-blockers (for example tamsulosin, taken for prostate conditions); they considerably raise the risk of the so-called IFIS syndrome.
Eye drops on schedule, keeping follow-up appointments, knowing the warning signs: this stops small problems from becoming big ones.
Thorough biometry, corneal topography and a check of the retina reveal risk factors before the operation.
Explained step by step, from anaesthesia to wound closure.
Eye-drop schedule, activities and warning signs after surgery.
Answers to the questions patients ask most often.
What the ÖGK (Österreichische Gesundheitskasse, Austria’s largest public health insurer) covers and what you pay yourself.
A personal informed-consent consultation puts many minds at ease. A specialist will explain which risks are actually relevant in your individual case.
Find a specialist near you