Reducing Cataract Complications: a Review

In this series of articles we are reviewing an article by Aaronson et al [2020] where over 14,500 cataract surgeries are taken into consideration and learnings on complications are discussed. They conclude that technological advancement has made cataract surgeries faster and safer. Regardless the general decline observed in rates of adverse events, they conclude several patient and ophthalmic characteristics have been associated with increased risk of perioperative complications. We will discuss them (and their solutions) below:

1. Significant Risk Factors Identified: Pseudoexfoliation syndrome (PXF) and small pupil size were significantly associated with increased risk of capsular bag-related complications in cataract surgery. These factors were particularly over-represented in the complication cases, highlighting the need for careful preoperative assessment and planning.
2. Impact of Surgical Experience: A marked decrease in complication rates was observed with increasing surgical experience. At the beginning of the study, residents had a higher complication rate (7.03%) compared to senior surgeons (0.36%). By the end of the study, these rates had decreased to 1.32% for residents and 0.32% for senior surgeons, illustrating the steep learning curve and the effectiveness of experience in improving surgical outcomes.
3. Improvements Over Time: Despite the constant rate of complications among senior surgeons, there was an overall decline in complication rates over the study period, reflecting advancements in surgical techniques, training, and possibly patient selection strategies. Additionally, best-corrected visual acuity improved from the beginning to the end of the study, indicating enhanced patient outcomes over time.
4. Intraocular Lenses (IOLs): The introduction of premium IOLs, including multifocal, toric, and extended depth of focus lenses, provides options for correcting vision at multiple distances and reducing dependency on glasses post-surgery.
5. Femtosecond Laser-Assisted Cataract Surgery (FLACS): This technology offers precision in creating incisions, anterior capsulotomy, and lens fragmentation, potentially reducing risks associated with manual procedures.

These technologies, alongside improvements in surgical techniques and preoperative planning, contribute to enhanced patient outcomes and satisfaction. All of the above factors underscore the importance of experience, the identification of high-risk patients, and the continuous evolution of surgical education, equipment and techniques in optimizing cataract surgery outcomes.