Management Of Incomplete Cataract Surgery Due To Development Of A ‘Hard’ Eye

Development of a hard eye during cataract surgery which does not allow the entry of instruments can be an intimidating complication that means surgery cannot continue. It is important to understand options for further management if faced with this situation to allow optimal outcomes for patients.

All patients were admitted for day case elective cataract surgeries under topical anaesthesia.

5 cases of cataract surgery were identified which developed a hard eye due to elevated intraocular pressure at different stages meaning the procedure had to be abandoned – 3 during hydrodissection and 2 during lens insertion. In the cases complicated during hydrodissection, patients were monitored with B-scan, revealing an intact capsule and no posterior pole pathology. Surgery was delayed from 2 days to 2 weeks due to raised intraocular pressure (IOP), corneal oedema and anaesthetic requirements.

In the cases complicated during lens insertion, monitoring was less intensive as important structures such as the capsule were visible. Surgery was delayed by 1 week and 6 weeks, due to raised IOP and for posterior choroidal engorgement to settle.

All cases were completed successfully. Each case will be presented for its unique learning points, alongside videos of some of the procedures. From the hydrodissection cases, learning points included managing refractory high intraocular pressure with mannitol pre-operatively, a cloudy cornea which took several days to recover and permit surgery, and pseudocorneal oedema which was actually due to lens material adhering to the cornea. For the other 2 cases, delay in secondary intraocular lens implantation should be minimised in order to avoid fibrotic adhesion of the capsule.

This case series demonstrates completion of abandoned cataract surgery is possible in such difficult cases. Careful management, particularly of intraocular pressure and corneal oedema, should allow surgery to be completed sooner.