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When you see a complication ...
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You're seeing a new patient consultation who previously had cataract surgery of the first eye a few months ago across town. The patient had cystoid macular edema of the first eye but eventually recovered 20/25 vision in the eye. He now wants surgery of the other eye with you.
 A tongue of vitreous coming through an area of zonular loss. |
At the slit lamp, you note a clear cornea, a quiet anterior segment and a well-positioned posterior chamber IOL. There is a tongue of vitreous coming around the temporal edge of the IOL, and it appears that there is some zonular loss in that area. You examine the other eye, and it looks relatively routine: 3+ nuclear cataract (20/60 best corrected vision) and a normal posterior segment.
The big red flag is the complication in the first eye — this tells me that there is likely some issue with the patient's anatomy or protoplasm. I always assume that the previous surgeon did an excellent job and that it was more the patient's difficult ocular conditions that led to the complications. This was certainly the case in this patient. A more careful examination of the anterior segment of the unoperated eye revealed pseudoexfoliation with a shallow anterior chamber (2 mm) in the presence of a normal axial length (24 mm).
So the next time you see a surgical complication of the first eye, be extra cautious and vigilant with the surgery of the second eye because you may have anatomic deficiencies to overcome.