Postoperative Care & Treatment After Small Incision Cataract Surgery (SICS)

Proper postoperative care is crucial for preventing complications, ensuring healing, and achieving optimal visual outcomes after SICS. Below is a structured guide:

1. Immediate Postoperative Care (First 24 Hours)


A. Eye Protection

  • Eye Shield: Apply a rigid shield (preferably metal) to prevent accidental rubbing/trauma.

  • Avoid Pressure: No straining, heavy lifting, or bending.


B. Medications (Starting Immediately After Surgery)

i) Topical Antibiotics (Prevent Infection)

  • Moxifloxacin 0.5% or Gatifloxacin 0.3% – 4 times/day for 1-2 weeks.

ii) Topical Steroids (Reduce Inflammation)

  • Prednisolone acetate 1% or Dexamethasone 0.1% – 6 times/day (taper over 4-6 weeks).

iii) NSAID Eye Drops (Prevent CME & Pain)

  • Nepafenac 0.1% or Bromfenac 0.09% – 3 times/day for 4-6 weeks.

iv) Cycloplegic (If Significant Inflammation)

  • Homatropine 2% or Cyclopentolate 1% – 2-3 times/day (short-term, if needed).


2. Follow-Up Schedule


  • Day 1: First postoperative check (VA, IOP, wound integrity, anterior chamber reaction).

  • Week 1: Assess corneal edema, inflammation, and early complications.

  • Week 4-6: Refraction and glasses prescription (if needed).


3. Patient Instructions


A. Do’s

✔ Use medications as prescribed (strict adherence).
✔ Wear sunglasses outdoors (protect from UV/glare).
✔ Maintain hygiene (wash hands before touching eyes).


B. Don’ts

❌ Avoid rubbing/pressing the eye.
❌ No swimming or dusty environments for 2-4 weeks.
❌ Avoid heavy exercise for 2 weeks.


4. Managing Common Postoperative Symptoms

SymptomPossible CauseAction
Mild discomfortNormal healingAnalgesics (Paracetamol)
RednessMild inflammationContinue steroids
Blurred visionCorneal edema, residual refractive errorMonitor, check IOP
Pain + vision lossEmergency (endophthalmitis, acute glaucoma)Immediate referral



5. Recognizing & Managing Complications


A. Infectious Endophthalmitis (Medical Emergency!)

  • Signs: Severe pain, vision loss, hypopyon (pus in anterior chamber).


  • Action:

    • Immediate vitreous tap + intravitreal antibiotics (Vancomycin + Ceftazidime).

    • Systemic antibiotics (IV/oral).


B. Corneal Edema

  • Cause: Surgical trauma, pre-existing Fuchs’ dystrophy.


  • Treatment:

    • Hypertonic saline (5% NaCl drops).

    • May resolve in days-weeks; severe cases may need DSAEK.


C. Cystoid Macular Edema (CME)

  • Signs: Blurred vision (4-12 weeks post-op).

  • Treatment:

    • Topical NSAIDs + Steroids.

    • Oral Acetazolamide (if resistant).


D. Posterior Capsule Opacification (PCO)

  • Signs: Gradual vision blurring (months/years later).

  • Treatment: YAG laser capsulotomy.


6. Long-Term Care

  • Refraction Check: At 4-6 weeks for glasses.

  • Dry Eye Management: Artificial tears if needed.

  • Annual Eye Exams: Monitor for late complications (retinal detachment, glaucoma).

Key Takeaways

✅ Strict adherence to eye drops prevents infection & inflammation.
✅ First 24 hours are critical—shield the eye, avoid pressure.
✅ Watch for red flags (pain + vision loss → endophthalmitis).
✅ Most patients recover well with proper follow-up.

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