A “complicated cataract” is one arising secondary to another eye or systemic disease rather than simply ageing. These eyes need more individualised pre-operative planning, because the underlying condition affects both the surgical approach and the final visual outcome. Suraj Eye Institute routinely manages the full range of complicated cataract cases.

Common Causes

Uveitic cataract

Chronic inflammation inside the eye — iridocyclitis, intermediate uveitis, posterior uveitis — leads to PSC changes, posterior synechiae (iris sticking to the lens), and capsular changes. Successful surgery requires a quiet eye and peri-operative inflammatory control.

Diabetic cataract

Cataract develops earlier and progresses faster in diabetics. Dedicated perioperative planning is important — see our cataract in diabetics page.

Steroid-induced cataract

Long-term oral, inhaled or even topical steroid use causes classic posterior subcapsular changes. We screen patients on chronic steroids — including those under rheumatology, respiratory medicine and dermatology — to catch this early.

Post-vitrectomy cataract

Nuclear sclerosis accelerates after pars plana vitrectomy, especially with silicone oil tamponade. Anterior chamber dynamics are altered in vitrectomised eyes, requiring adjusted surgical technique.

Cataract in retinitis pigmentosa and other retinal dystrophies

PSC commonly develops in RP. Surgery can meaningfully improve the small residual visual field.

Radiation-induced cataract

After therapeutic radiation to the head or eye region. PSC is typical, developing months to years after exposure.

Special Pre-operative Considerations

• Control of systemic and ocular inflammation — often requires 3 months of quiet eye before elective surgery
• Pupil mobilisation — synechiolysis, iris hooks, Malyugin ring for poorly dilating pupils
• Peri-operative steroids and NSAIDs — pre-op loading and extended post-op course
• Detailed retinal assessment — macular OCT, fluorescein angiography where needed
• IOL selection — hydrophobic acrylic single-piece monofocal IOL preferred in uveitic eyes; multifocal IOLs generally avoided
• Careful biometry — previous vitrectomy, silicone oil or retinal dystrophy affects axial length and keratometry accuracy

Surgical Approach

For most complicated cataracts, phacoemulsification remains the procedure of choice. Specific adjustments include:

• Small incision with stable anterior chamber
• Pupil expansion devices when needed
• Capsule staining with trypan blue when visibility is poor
• Careful synechiolysis to free the iris from the lens
• Gentle hydrodissection — more cautious in uveitic or post-vitrectomy eyes
• Lower phaco energy and flow settings in vitrectomised eyes
• Capsular tension rings where zonular weakness is suspected
• Careful IOL choice based on ocular status