This month's cover focus is dedicated to the management of difficult cataract and refractive cases. We invited surgeons from around the world to share their expertise with us. They have all contributed with (1) a case report of an extremely challenging or interesting situation, (2) viable options for surgical intervention, (3) a description of their chosen solution, (4) follow-up, and (5) a brief synopsis of what was learned from the case.
Often, I am hesitant to operate on a very difficult eye—such as the two cases described in this issue by Aliza Jap, FRCS, FRCOphth, and Soon-Phaik Chee, MMed(Ophth), FRCS, FRCOphth, FCRS(Ed), both of Singapore; and Ehud I. Assia, MD, of Israel—but I always enjoy reading how other surgeons have dealt with these problems. Over the years, I have picked up many tips and tricks from reading these articles.
Achieving a successful outcome after a complicated case is rewarding for both patient and surgeon. In my own practice, the satisfaction I get from managing difficult cases keeps me motivated to deal with the routine workload of everyday practice; however, I acknowledge that not everyone enjoys the stress that is associated with challenging situations. Nonetheless, it is interesting to read what experts can do in seemingly hopeless situations. It would also be interesting to read what has gone wrong in the management of complicated cases—although it is probably not as easy to recruit authors for such a topic.
In her article, Lisa Brothers Arbisser, MD, of Salt Lake City, Utah, recommends performing a fire drill for emergency situations such as a broken posterior capsule. I could not agree more with that! For those surgeons who do not have a fully trained and experienced staff (I think that includes the vast majority of us who work in public hospitals), I suggest not only organizing training sessions for exceptional situations but also developing protocols and preparing special kits for use in those situations.
It is, of course, desirable that you first collect the necessary skills and experience yourself. Each year, major conventions hold numerous instructional courses and wet labs, which are useful to update your skill set and learn new tricks and tips. During my activities as a phaco course instructor, I noticed that many colleagues still have a gap in their skill set when it comes to phaco machine settings and special techniques for complicated situations.
Complicated cases in laser and/or lens-based refractive surgery must be even worse for the surgeon to manage because the patient did not suffer from any disease initially. As a pure cataract and glaucoma surgeon, I have no experience with refractive surgical complications, and I do not envy my refractive colleagues at all.
The key questions for this month's issue are: (1) how do you manage a difficult case, and (2) what can you learn from your peers? The answer to both questions is simple: We constantly learn from the pearls and pitfalls of fellow surgeons.
Cataract & Refractive Surgery Today Europe contributes to our constant educational process in an easy and enjoyable way. We hope that you appreciate our efforts, and we always invite you to give us feedback and suggestions. We certainly welcome your comments in the form of e-mail or letters to the editor.
