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    Premium cataract surgery: Correcting complications and side effects

    Keys to unfolding the specific surgical plan of action

    Take-home message: Arun C. Gulani, MD, continues the cataract surgery series addressing methods to correct complications and side effects of premium cataract surgery, including patient dissatisfaction postoperatively.

    This designing cataract surgery series addresses methods to correct complications and side effects of premium cataract surgery, including patient dissatisfaction postoperatively.

    Sponsored: 5 reasons toric IOLs manage astigmatism most effectively

    For simplification, I have devised a classification system based on more than two decades of correcting complications associated with cataract surgery in patients from around the globe and categorized the system for simplicity in understanding the core issue—patient perception of the problem—and thereby unfolding the specific plan of action.

    (All images courtesy of Arun Gulani, MD.)

    I.               Surgery-Related Complications

    Complications associated with cataract surgery can be linked to the surgery itself in that the surgery can have resulted in anatomic damage in the corneal, iris, or vitreoretinal tissue. There may also be combinations of these directly or indirectly.

    Additionally, surgery can cause inflammation that can decrease the visual outcomes, i.e., cystoid macular edema, and even involve adjacent anatomy-related optical pathway like decentration of the lens implant relative to pupil centration and thus the resultant visual symptoms. When the vision is impacted negatively, this in turn affects patient satisfaction.

    Anatomic damage can be corrected in the appropriate sequence, as I described in previous columns, keeping in mind the least-interventional Corneoplastique techniques for restoring the anatomy in planning for the optimal optical outcome.

    Inflammation can be appropriately and aggressively treated to resolution while optical pathway incoherence can be addressed in pupil-IOL relations with many approaches, the most minimal of which could be the Donnenfeld Argon Iris Laser (at the site of the decentered pupillary edge) technique.

    II. IOL-based complications

    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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