ARAVIND EYE CARE SYSTEMAravind Eye Hospital

& Postgraduate Institute of Ophthalmology

ARAVIND EYE CARE SYSTEMAravind Eye Hospital

& Postgraduate Institute of Ophthalmology

DEPARTMENT OF INPATIENTDEPARTMENT OF INPATIENT

POST OPERATIVE COMPLICATIONPOST OPERATIVE COMPLICATION

The MLOP shall identify the early post The MLOP shall identify the early post

operative complications in the ward and shall operative complications in the ward and shall

help in the effective management of the same. help in the effective management of the same.

AIMAIM

The MLOP shall The MLOP shall • Develop wide range of basic knowledge of Develop wide range of basic knowledge of

immediate post surgical complicationsimmediate post surgical complications

• In early identification of post operative In early identification of post operative complications complications

• Helping doctors in prompt remedial measures Helping doctors in prompt remedial measures

• In explaining and reassuring patients in a In explaining and reassuring patients in a proper way about their complications. proper way about their complications.

Objectives Objectives

TheoryTheoryThe ocular post surgical complications can broadly The ocular post surgical complications can broadly

be divided into be divided into

• Anterior segment complications Anterior segment complications

• Posterior segment complications Posterior segment complications

• Early post operative complicationsEarly post operative complications

• Late post operative complicationsLate post operative complications

• Lid Lid - Oedema; ptosis - Oedema; ptosis

• ConjunctivaConjunctiva - Chemosis, Subconjunctival - Chemosis, Subconjunctival

haemorrhage haemorrhage

• CorneaCornea - Oedema, Striate Keratopathy, - Oedema, Striate Keratopathy,

Epi. defectEpi. defect

• Ant. Chamber - Shallow, Cortex, Hyphaema, Ant. Chamber - Shallow, Cortex, Hyphaema, Hypopyon Hypopyon

Cont…Cont…

Early Post - Operative Anterior Early Post - Operative Anterior segment complicationssegment complications

• IrisIris - Iritis, Iris prolapse - Iritis, Iris prolapse

• PupilPupil - Fibrin Membrane , - Fibrin Membrane , Pupilary capture Pupilary capture

• LensLens - Decentred IOL, - Decentred IOL, Haptic in AC, Haptic in AC,

PanophthalmitisPanophthalmitis

• Bullous KeratopathyBullous Keratopathy

• Vitreous touch syndromeVitreous touch syndrome

• Vitreous wick syndromeVitreous wick syndrome

• Secondary GlaucomaSecondary Glaucoma

- - Angle closureAngle closure

Severe iritis, Pupillary block, Severe iritis, Pupillary block, Irisbombe, Peripheral anterior Irisbombe, Peripheral anterior synechiaesynechiae

Cont…Cont…

Late post-operative Ant. segment Late post-operative Ant. segment complicationscomplications

Open AngleOpen Angle

CortexCortex

CellsCells

BloodBlood

• Suture infiltrationSuture infiltration

• Iris ProlapseIris Prolapse

• Uveitis Uveitis

• Late post – op endophthalmitisLate post – op endophthalmitis

• Cystoid macular edema (CME) Cystoid macular edema (CME)

• Pseudophakic R.DPseudophakic R.D

• PCO ( Posterior capsule opacifications) PCO ( Posterior capsule opacifications)

• Dislocated IOL/ Decentered IOLDislocated IOL/ Decentered IOL

• Vitreous HaemorrhageVitreous Haemorrhage

• EndophthalmitisEndophthalmitis

POSTERIOR SEGMENT COMPLICATIONSPOSTERIOR SEGMENT COMPLICATIONS

Lid edemaLid edema

Swelling of the LidSwelling of the Lid CausesCauses :: Injury with instrumentsInjury with instruments Inflammation ( Iritis)Inflammation ( Iritis) Allergy to medicationsAllergy to medications

Treatment :Treatment : Anti - Inflammatory drugsAnti - Inflammatory drugs SteroidsSteroids Anti histamines in case of allergyAnti histamines in case of allergy

ChemosisChemosisCongestion and collection of fluidCongestion and collection of fluid Causes Causes :: Allergy Allergy Subconjunctival InjectionsSubconjunctival Injections IritisIritis EndophthalmitisEndophthalmitisTreatment :Treatment : ObservationObservation Anti Inflammatory drugAnti Inflammatory drug

Subconjunctival HaemorrhageSubconjunctival Haemorrhage Collection of blood beneath the conjunctivaCollection of blood beneath the conjunctiva

Causes :Causes : InjuryInjury Retrobulbar Haemorrhage Retrobulbar Haemorrhage HypertensionHypertension Bleeding disordersBleeding disorders

Treatment :Treatment : ObservationObservation

Absorbs spontaneously – 2 -3Absorbs spontaneously – 2 -3 wkswks

Corneal OedemaCorneal OedemaCorneal OedemaCorneal Oedema Increase in corneal thickness epithelial edemaIncrease in corneal thickness epithelial edema Causes:Causes: Increased IOP – 40 mmHg and moreIncreased IOP – 40 mmHg and more IritisIritis Descemets membrane stripping Descemets membrane stripping Endothelial damageEndothelial damage

Treatment:Treatment: Timolol eyedropsTimolol eyedrops Tab. DiamoxTab. Diamox Oral glycerolOral glycerol Injection Mannitol 20%Injection Mannitol 20% Hypertonic Saline dropsHypertonic Saline drops

Striate KeratitisStriate Keratitis

Causes :Causes : Severe endothelium damageSevere endothelium damage Tight sutureTight suture

Treatment :Treatment : Steroid eye dropsSteroid eye drops Timolol eye drops Timolol eye drops Cycloplegic eye dropsCycloplegic eye drops

Descemets Membrane Stripping Descemets Membrane Stripping The stroma and thus allowing easy The stroma and thus allowing easy

separation from stromaseparation from stromaCauses:Causes: Entry in to the globeEntry in to the globe Faulty instrumentationFaulty instrumentation Fluid is injected between the descemet’s Fluid is injected between the descemet’s

membrane and stromamembrane and stroma

If small If small – Air Bubble left in – Air Bubble left in anterior chamber anterior chamber

If larger If larger – Needs surgical repair – Needs surgical repair

Epithelial defectEpithelial defectEpithelial defectEpithelial defect Rupture of epitheliumRupture of epithelium

Predisposing FactorsPredisposing Factors : : Injury (Instrument, Pad / Cotton )Injury (Instrument, Pad / Cotton ) During anaesthesia eye is openDuring anaesthesia eye is open

Treatment :Treatment : Only antibiotic ointmentOnly antibiotic ointment

pad / bandagepad / bandage..

A.C ShallowA.C Shallow

Shallow Anterior Chamber Shallow Anterior Chamber

Causes :Causes :

Wound leakWound leak Pupilary blockPupilary block Choroidal detachmentChoroidal detachment Malignant glaucomaMalignant glaucoma

Wound leakWound leak : : Size of the section is larger than the normal Size of the section is larger than the normal Loose suture wound gapeLoose suture wound gape TraumaTrauma Inadequate and improper suturing of the woundInadequate and improper suturing of the wound

Treatment :Treatment : Pressure pad / bandage / mydriatic Pressure pad / bandage / mydriatic If AC does not form within 24 – 48 hrsIf AC does not form within 24 – 48 hrs Needs AC reforming / resuturingNeeds AC reforming / resuturing

Pupilary BlockPupilary Block

Causes :Causes : AC IOL without PIAC IOL without PI Severe Iritis – 360 deg PS Severe Iritis – 360 deg PS Vitreous touching the PUPILVitreous touching the PUPIL IOL captureIOL capture

Treatment :Treatment : Inj. mannitol 20%Inj. mannitol 20% Tab. diamoxTab. diamox 1st Laser PI.1st Laser PI. If not possible Needs surgical PI.If not possible Needs surgical PI.

Fibrin MembraneFibrin MembraneAppear as a dense fibrin net in pupillary areaAppear as a dense fibrin net in pupillary area

CausesCauses:: Prolonged Irrigation with balance – salt solutionProlonged Irrigation with balance – salt solution Unsterile IOLUnsterile IOL

Treatment:Treatment: Antibiotic drops hourlyAntibiotic drops hourly Steriods drops hourlySteriods drops hourly Cycloplegic drops TDSCycloplegic drops TDS If needed oral steriods to be given (1mg /1kg)If needed oral steriods to be given (1mg /1kg)

CortexCortexResidual cortexResidual cortex

Predisposing ConditionsPredisposing Conditions : : Small pupilSmall pupil Pseudo exfoliationPseudo exfoliation Diabetic mellitusDiabetic mellitus Positive pressure during surgeryPositive pressure during surgery PC rentPC rent

Treatment :Treatment : Small piece of loose cortex will get absorbed – steroids Small piece of loose cortex will get absorbed – steroids

E/DE/D Large clumps of cortex not getting absorbed – needs AC Large clumps of cortex not getting absorbed – needs AC

washwash. .

Treatment Treatment ::• Bed rest, bandage both eyes.Bed rest, bandage both eyes.• Steroid eye drops. Steroid eye drops. • Cycloplegic eye drops.Cycloplegic eye drops.• Timolol eye drops.Timolol eye drops.• Tab. Diamox.Tab. Diamox.• Tab. Vit C.Tab. Vit C.• Observation for 2 days. If not responding Observation for 2 days. If not responding

needs AC washneeds AC wash..

HypopyonHypopyon Predisposing conditionsPredisposing conditions : :

• Complicated catComplicated cat• Phacolytic / Phacomorphic glaucomaPhacolytic / Phacomorphic glaucoma• Infection.Infection.

Treatment :Treatment :

• AntibioticAntibiotic• SteroidsSteroids• Cycloplegic.Cycloplegic.

SYMPTOMSSYMPTOMS

Pain , Redness , Defective visionPain , Redness , Defective vision..• Lid edema , conjunctival chemosisLid edema , conjunctival chemosis

• Corneal edema, corneal InfiltrationCorneal edema, corneal Infiltration

• AC cells, HypopyonAC cells, Hypopyon

• Infiltrate in suture / sectionInfiltrate in suture / section

• Wound gape or weak wound.Wound gape or weak wound.

TREATMENT:TREATMENT:

No steroidsNo steroids Topical antibioticsTopical antibiotics AC tap. Vit-tapAC tap. Vit-tap Intravitreal antibioticsIntravitreal antibiotics

IRITISIRITIS• Inflammation of the iris.Inflammation of the iris.

• Flare and cellsFlare and cells• Fibrin membrane.Fibrin membrane.

• Treatment :Treatment :

• Antibiotic drops hourlyAntibiotic drops hourly• Steroids drops hourlySteroids drops hourly• Cycloplegic drops TDSCycloplegic drops TDS• If needed oral steroids to be given (1mg/1kg)If needed oral steroids to be given (1mg/1kg)

Iris ProlapseIris Prolapse• IRIS PROLAPSE IRIS PROLAPSE

• Causes Causes ::

• Loose sutureLoose suture

• Wound gapeWound gape

• InjuryInjury

• Positive pressure.Positive pressure.

• Treatment Treatment ::

• Hourly antibiotic dropsHourly antibiotic drops

• Iris prolapse excision and resuturingIris prolapse excision and resuturing

• < 24 hrs – Reposition< 24 hrs – Reposition

• > 24 hrs – Excision. > 24 hrs – Excision.

• HAPTIC IN AC :HAPTIC IN AC :

• One Haptic in ACOne Haptic in AC

• Treatment :Treatment :

• IOL reposition ( or ) RedialingIOL reposition ( or ) Redialing

ENDOPHALMITISENDOPHALMITIS

(Dreadful complication, follows infection )(Dreadful complication, follows infection )

Sources:Sources: Contamination in O.T Contamination in O.T

(Staffs & Instruments)(Staffs & Instruments) Patients Lids and conjunctival Patients Lids and conjunctival

poor hygiene. poor hygiene.

TREATMENT:TREATMENT:

No steroidsNo steroids Topical antibioticsTopical antibiotics AC tap. Vit - tapAC tap. Vit - tap Intravitreal antibioticsIntravitreal antibiotics Anti inflammatory drugAnti inflammatory drug

RISK FACTOR :RISK FACTOR :

Poor hygienePoor hygiene Immune suppressed patientImmune suppressed patient Debilatet patient - (diabetic, cancer & Debilatet patient - (diabetic, cancer &

weak )weak ) Suture abscess or suture removalSuture abscess or suture removal

• ORGANISMS :ORGANISMS :

• BacteriaBacteria FungalFungal

• Staphylococcus AspergillusStaphylococcus Aspergillus

• Staphylococcus CandidaStaphylococcus Candida

• StreptococcusStreptococcus Fusarium Fusarium

• PseudomonasPseudomonas