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Cover Focus | April 2021

Introduction: Cataract Surgery Complications

“These are the key principles that I teach my ophthalmology residents: recognize, react, and recover.”

Cataract surgery is one of the most commonly performed surgeries. In the United States alone, about 4 million procedures are performed every year. Worldwide, that number is nearly 28 million.1 By restoring vision, and even treating preexisting refractive errors, cataract surgery produces an amazing improvement in the lives of our patients.

Despite the seemingly constant reduction in the relative value given to cataract surgery by insurance companies, it is not an easy procedure. Cataract surgery requires incredible dexterity, years of practice, and intense concentration. We surgeons are working within the tiny confines of the anterior segment—a space that is 0.5 mL or smaller. Let’s imagine a cupped palm with eight to 10 drops of water placed in it. That pool is the size of the space in which we place our instruments, take out the cataract, and replace it with an IOL. There is little room for error, and ocular tissues can be unforgiving. No matter how many thousands of surgeries we have performed, complications can happen.

There are two types of doctors who never experience surgical complications: those who don’t operate and those who are not truthful. As we gain experience, our complication rates decrease, and we learn how to deal with just about any intraoperative surprise. Every football player will fumble the ball from time to time, but it is the true professionals who know how to recover. Similarly, when a cataract surgery complication occurs, whether due to poor-quality ocular tissue or an iatrogenic cause, we need to recognize the issue, react appropriately, and recover. These are the key principles that I teach my ophthalmology residents: recognize, react, and recover.

This issue of CRST is packed with complications that we cataract surgeons will all encounter. Our expert authors do an exemplary job of sharing their pearls for successfully dealing with these challenges so that good visual outcomes are still achievable. I want to thank each of our authors for contributing to a valuable resource that will deservedly find a permanent home in our libraries. I am sure you will agree.

1. Lindstrom RL. Future of cataract surgery seems promising. Healio. January 26, 2021. Accessed March 16, 2021. https://www.healio.com/news/ophthalmology/20210126/future-of-cataract-surgery-seems-promising

Guest Medical Editor Uday Devgan, MD, FACS
  • Private practice, Devgan Eye Surgery, Los Angeles
  • Partner, Specialty Surgical Center, Beverly Hills, California
  • Clinical Professor of Ophthalmology, Jules Stein Eye
    Institute, UCLA School of Medicine
  • Chief of Ophthalmology, Olive View-UCLA Medical Center, Los Angeles
  • Member, CRST Editorial Advisory Board
  • devgan@gmail.com
  • Financial disclosure: Owner and publisher (CataractCoach.com)

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