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    Premium cataract surgery: Correcting complications and side effects

    Keys to unfolding the specific surgical plan of action


    Case 3

    Case 3 was that of a patient referred to me who had undergone a multifocal lens implant with her surgeon and she was unhappy with her vision. I include this case to demonstrate the psychological impact on patients, because I do not succumb to a knee-jerk reaction to remove an IOL and blame the previous surgeon unless I have run out of my mental thought process of salvaging vision with that IOL before embarking on any surgery.

    After treating her obvious dry eye, I refracted her and determined her astigmatism to be stable, and on simulation she found improvement in her vision with that correction. We then proceeded with laser vision surgery and she was now 20/20 in this eye.

    She noticed improved vision but came back to me with her husband saying she was still angry at her previous surgeon for not explaining haloes and glare that could occur with this lens implant and hence wanted it removed. The interesting factor in this case is she had no such symptoms even on subjective testing and simulations and she herself admitted to not really having the symptoms described in a Google search.

    After an extensive discussion with me and her husband, she understood how much her vision had improved and that she had no such symptoms which she had read online about. She called me twice and we had lengthy conversations and every time she agreed that she was just paranoid it can happen to her and would thank me for her improved vision of 20/20.

    A month later she called again and said she had determined to have this lens implant removed. It was, she described, “agonizing” for her to live with something that could cause symptoms that she read about online and her surgeon should have at least educated her, let alone warned her.

    She travelled back to me and after another detailed consultation (during which she explained her agony) and informed consent (remember she was 20/20 now) I agreed to remove her multifocal lens and maintain her 20/20 vision using a monofocal lens implant. The next day after surgery she was 20/20 and very happy and relieved.

    An example of a case where psychologically a patient can actually feel so traumatized by what she felt was a “time-bomb” in her eye just because of her anger toward her surgeon. A lawsuit was averted and relations corrected.

    Case 4

    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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