Complex cataract surgery is adapted to coexisting eye changes and additional surgical risks. Comprehensive assessment guides IOL selection, the extent of surgery and follow-up planning.
Cataract is accompanied by zonular weakness, zonular defect, phacodonesis or lens subluxation. The cataract is dense, white, intumescent, mature or hypermature, or its anatomy increases the complexity of standard phacoemulsification. Cataract coexists with glaucoma and separate or combined glaucoma surgery is being considered.
Uveitis or previous intraocular inflammation requires disease control and a modified perioperative plan.
Cataract coexists with diabetic retinopathy, macular disease, haemophthalmos, epiretinal membrane, retinal detachment or another vitreoretinal condition.
There are consequences of eye trauma, previous intraocular surgery or unusual anatomy affecting the zonular ligaments, pupil, cornea or IOL fixation.
Complex cataract carries greater surgical and postoperative uncertainty than a routine case. Visual outcome depends not only on successful cataract removal but also on glaucoma, macular disease, diabetic retinopathy, uveitis, corneal scarring and other comorbidity.
Potential complications include capsular tear, zonular loss, vitreous prolapse, the need to change IOL fixation, inflammation, elevated intraocular pressure, corneal or macular oedema, infection, IOL displacement and retinal detachment.
Pseudoexfoliation, a small pupil or a high risk of inadequate intraoperative dilation is present.
Bring previous medical summaries and surgical results, details of eye trauma, laser procedures, glaucoma, uveitis, diabetes and retinal disease, and a list of all regular medicines. Report poor pupil dilation in the past, episodes of eye inflammation, alpha-1 blockers, anticoagulants and antiplatelets. Do not stop systemic medicines yourself.
The scope of diagnostics is often broader for complex cataract and is determined by the surgeon after examination.
Severe pain, sudden visual loss, marked redness, a curtain-like shadow, flashes, a rapid increase in floaters or purulent discharge require urgent assessment.
Complex cataract carries greater surgical and postoperative uncertainty than a routine case.
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Cataract, cornea, anterior chamber, pupil, IOP, zonules, retina and optic nerve are assessed; OCT, ultrasound, gonioscopy or other tests are added when needed.
Biometry and keratometry are performed, astigmatism is assessed and expected vision is discussed in the context of comorbidity.
The surgeon anticipates whether capsular support, pupil expansion, alternative IOL fixation, vitreoretinal or glaucoma surgery may be required.
Active inflammation, uncontrolled glaucoma, diabetic disease and relevant systemic or ocular conditions are stabilised when possible; laboratory tests and medication instructions are individualised.
Phacoemulsification with cataract removal and IOL implantation remains the core technique, with additional steps only when indicated.
Visit frequency and medication depend on surgical complexity and comorbidity; complex cases may need closer follow-up.
Surgery is adapted to cataract density, pupil size and the condition of the lens-supporting structures.
When needed, the surgeon uses additional techniques to support the capsule and stabilise the lens during surgery.
Corneal, retinal and optic nerve health are considered when choosing treatment and discussing the expected outcome.
The IOL model and fixation method are selected according to eye anatomy and the condition of the lens capsule.
Table prices are per eye. The applicable tariff depends on the operation and relevant conditions.
In complex cataract, the consultation aims to identify risk factors in advance, assess visual potential, select the lens-removal technique and the type and fixation of the IOL, and determine whether a combined operation is needed.
A team of experienced doctors across specialties.
Candidate of Medical Sciences, Associate Professor; Highest-category ophthalmologist
Candidate of Medical Sciences; Highest-category ophthalmologist
Candidate of Medical Sciences; Highest-category ophthalmologist
Candidate of Medical Sciences; Highest-category ophthalmologist
Candidate of Medical Sciences; Highest-category ophthalmologist
Highest-category ophthalmologist
Highest-category ophthalmologist
First-category ophthalmologist
First-category ophthalmologist
First-category ophthalmologist
On this page, “complex cataract” is a patient-friendly term for a cataract whose surgery requires more extensive planning or additional surgical techniques. KazRIED’s official price list uses the term “complicated cataract” for the main tariff item.
These factors affect the lens removal technique, visual prognosis, intraocular lens (IOL) selection, the need for additional devices, and the frequency of postoperative monitoring.
The basic approach remains removal of the clouded lens with IOL implantation. If the capsular bag is stable, the surgeon may perform phacoemulsification with lens implantation.
With zonular weakness, a capsular tension ring or another capsular support system may be needed. In some cases, an alternative method of IOL fixation is used.
If glaucoma or posterior segment surgery is also required, a combined operation may be planned. KazRIED publishes separate tariffs for these procedures.
The goal is to remove the cataract and safely restore the eye’s optical system to the extent permitted by the condition of the retina, optic nerve, cornea, and other structures.
Possible pathways after diagnostics include standard or complicated phacoemulsification; phaco with a capsular tension ring for zonular weakness; an alternative IOL-fixation plan when capsular support is inadequate; combined glaucoma surgery; combined vitrectomy for vitreoretinal disease; or treatment of active inflammation or retinal disease before cataract surgery when this is safer. The surgeon determines the sequence.
Phaco + IOL + capsular tension ring: For zonular pathology when indicated
Phaco + IOL + trabeculectomy: Combined cataract-glaucoma pathway
Phaco + IOL + vitrectomy: Combined vitreoretinal surgery
Phaco + IOL + closed 25G vitrectomy + membrane peeling: For an indicated macular/vitreoretinal condition
Phacoemulsification without IOL: Separate route when primary IOL is not feasible/appropriate
Tunnel extracapsular cataract extraction with IOL: Alternative in selected surgical situations
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
Kazakhstan’s first specialized ophthalmology institute, operating since 1933.
Modern diagnostics and surgery using world-class equipment.
Leading ophthalmologists in Kazakhstan, scientists and experienced surgeons.
More than 30,000 operations and around 270,000 consultations annually.
