Management of dislocated intraocular implants

Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches

Anterior capsular contraction syndrome (ACCS) is a challenging complication that can occur following phacoemulsification cataract surgery. Characterized by capsular bag wrinkling, intraocular lens (IOL) decentration and tilt, ACCS can have negative effects on visual outcomes and patient satisfaction. This review aims to investigate the pathogenesis, clinical course, influencing factors, and intervention approaches for ACCS after cataract surgery. By understanding the underlying mechanisms and identifying factors that contribute to ACCS, surgeons can enhance their ability to predict and manage this complication. Various intervention strategies are discussed, highlighting their importance in reducing complications and improving surgical outcomes. However, further research is needed to determine optimal prevention and management strategies through long-term follow-up and comparative analyses. Advancements in this field will ultimately lead to improved visual outcomes and optimized cataract surgery for patients.

Knot-free suture scleral fixation of dislocated intraocular lenses: clinical results of a novel surgical technique

PURPOSE

To describe and report surgical outcomes of a novel, knot-free technique to manage dislocated intraocular lenses (IOLs).

SETTING

Beyoglu Eye Education and Research Hospital, Istanbul, Turkey.

DESIGN

Retrospective observational clinical study.

METHODS

The files of 47 patients were retrospectively reviewed, and the patients who had a follow-up time of 6 months or more were included in this study. The surgery of every case was watched for the surgical complications and calculation of the surgical time. The postoperative complications and success rate were specifically tabulated.

RESULTS

Thirty-five eyes of 35 patients were included in this study (23 men, 12 women; mean age 63.1 ± 19.2 years). The mean follow-up time was 22.5 ± 9.9 months. The mean surgical time was 28.2 ± 6.8 minutes. Corrected distance visual acuity improved significantly after surgery (P = .001). Anatomic success rate was 97.1% after a single surgery. Most common complications included transient intraocular pressure (IOP) elevation (n = 2), persistent IOP elevation (n = 1), mild IOL tilt (n = 1), mild IOL decentration (n = 1), secondary IOL dislocation requiring intervention (n = 1), transient corneal edema (n = 1), and bullous keratopathy (n = 1).

DISCUSSION

Knot-free suture scleral fixation of dislocated IOLs was a minimally invasive approach for the management of dislocated IOLs and required only two 20-gauge corneal incisions without the need for scleral flaps or incisions. This technique had a low complication rate and delivered successful results in most cases.

Scleral fixation of Carlevale intraocular lens: A new tool in correcting aphakia with no capsular support

PURPOSE

To report the clinical outcomes of the use of a novel specially designed scleral fixated intraocular lens, the Carlevale intraocular lens (carlevale IOL, Soleko, Italy) for the correction of aphakia in the absence of capsular support of variable etiology.

METHODS

This retrospective, non-comparative study included 169 eyes of 169 consecutive patients who underwent 3-port pars plana vitrectomy and scleral fixation on Carlevale IOL. Inclusion criteria were at least 6 months' follow-up period, patients > 18 years old who underwent vitrectomy and Carlevale IOL placement for aphakia and inadequate capsular support.

RESULTS

The median follow up period of 9 months (range 6-18 months). Mean post-operative BCVA at the last follow-up visit was 20/25 (0.09 ± 0.1 LogMAR), improving from a mean baseline BCVA of 20/80 (0.58 ± 0.49 LogMAR), a statistically significant change (p = 0.0001). Regarding the post-operative complications, a transient rise in the IOP was observed in 28 patients (16.5%) and mild vitreous hemorrhage was observed in the immediate post-operative period in eight eyes (4.7%) and it spontaneously resolved within 3 weeks. All patients demonstrated good IOL position at the end of the follow-up without IOL capture. None of the patients required re-operation.

CONLCUSION

The present study represents the largest to date in evaluating the use of carlevale IOL in patients with aphakia and inadequate capsular support. The technique is safe and provides excellent post-operative IOL fixation without IOL capture in any of the patients studied.

Modified Cow-Hitch Suture for Repositioning of Subluxated Scleral-Fixated Rigid Intraocular Lens

BACKGROUND AND OBJECTIVE

To describe a new technique for repositioning a subluxated scleral-fixated rigid intraocular lens (IOL).

PATIENTS AND METHODS

The authors present a modified intraocular threading technique to tie a cow-hitch knot around the eyelet on the dislocated haptic of a scleral-fixated rigid IOL. This technique uses three small corneal incisions to eliminate the need for IOL externalization and minimized the size and number of wounds.

RESULTS

Three consecutive cases of subluxated haptics in two patients underwent this procedure. Postoperative IOL centration and alignment were satisfactory without tilt. No surgical-related complication was observed 1 year after surgery.

CONCLUSION

A rigid IOL could be repositioned to a desired axis and centration via this modified cow-hitch technique, with better IOL support as compared with a single tie. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:179-182.].

Long-term Outcome of Pars Plana Vitrectomy and Sutured Scleral-Fixated Posterior Chamber Intraocular Lens Implantation or Repositioning

PURPOSE

To assess the long-term stability of sutured scleral-fixated posterior chamber intraocular lenses (PCIOLs) performed in combination with pars plana vitrectomy.

DESIGN

Retrospective, consecutive, interventional case series.

METHODS

Retrospective single-surgeon study of 118 eyes of 111 patients seen at Retina Consultants of Hawaii, who underwent sutured scleral fixation of at least 1 haptic of a posterior chamber intraocular lens with 10-0 polypropylene combined with a pars plana vitrectomy. The fixation knot-tying technique required 2 separate 10-0 polypropylene sutures tied into 1 combined knot-1 suture closed the fixation sclerotomy and created the scleral fixation, and 1 suture looped together around the haptic of the PCIOL, securing the haptic to the scleral fixation site. The primary outcomes were position of the PCIOL at last follow-up, dislocation of either 1 or both haptics of the PCIOL, and breakage of the 10-0 polypropylene fixation suture.

RESULTS

PCIOLs remained well stabilized and positioned at last follow-up in 116 of 118 eyes (98.3%), with a mean follow-up of 6.0 years. The maximum stable follow-up with 2 intact fixation sutures was 24.75 years. There were 4 cases of redislocation (3.4%), but 2 cases were owing to unstable residual capsular support. There was 1 case of suture breakage in 214 fixation sutures (0.47%) and 1 case of haptic breakage.

CONCLUSIONS

Scleral fixation sutures with 10-0 polypropylene provide excellent long-term fixation of PCIOLs, with a less than 0.5% incidence of suture breakage and documented suture stability for up to 24+ years.

Visual outcome and complications of various techniques of secondary intraocular lens

BACKGROUND/AIMS:

The purpose of this study was to compare and evaluate the visual outcome and complications of various techniques of secondary intraocular lens (IOL) (i.e., anterior chamber IOL [ACIOL], suture-fixated posterior chamber IOL [PCIOL], and glue-fixated PCIOL).

STUDY DESIGN AND SETTING:

This was a randomized, prospective, interventional, comparative, clinical trial study.

SUBJECTS AND METHODS:

Patients of either sex having aphakia and lacking posterior capsular support were included in the study, and patients having corneal or scleral pathology, optic atrophy, uncontrolled glaucoma, retinal detachment, and other retinal pathology were excluded from the study. The patients were divided into three groups after comprehensive ophthalmological examination – Group A (secondary ACIOL) included 44 patients, Group B (secondary scleral-fixated sutured PCIOL) included 32 patients, and Group C (fibrin glue-fixated sutured PCIOL) included 34 patients.

RESULTS:

A total of 110 patients were included in this study, of which 59 (53.63%) were males and 51 (46.37%) were females. The best-corrected visual acuity (VA) after 6 weeks was in the range of 20/60–20/40 in 36.4% of Group A and 40.6% of Group B patients. In Group C, 52.9% of patients had best-corrected VA in the range of 20/30–20/20. The overall complications were less in glued PCIOL group.

CONCLUSION:

It can be concluded that fibrin glue-assisted PCIOL implantation provides better visual outcome with minimal complications in eyes with deficient capsular support.

A Comparison of Clinical Outcomes of Dislocated Intraocular Lens Fixation between In Situ Refixation and Conventional Exchange Technique Combined with Vitrectomy

Purpose. To evaluate surgical efficacy of in situ refixation technique for dislocated posterior chamber intraocular lens (PCIOL). Methods. This was a single-center retrospective case series. 34 patients (34 eyes) who underwent sclera fixation for dislocated IOLs combined with vitrectomy were studied. Of 34 eyes, 17 eyes underwent IOL exchange and the other 17 eyes underwent in situ refixation. Results. Mean follow-up period was 6 months. Mean logMAR best corrected visual acuity (BCVA) was not significantly different between the groups 6 months after surgery (0.10 ± 0.03 in the IOL exchange group and 0.10 ± 0.05 in the refixation group; p = 0.065). Surgically induced astigmatism (SIA) was significantly lower in the refixation group (0.79 ± 0.41) than in the IOL exchange group (1.29 ± 0.46) (p = 0.004) at 3 months, which persisted to 6 months (1.13 ± 0.18 in the IOL exchange group and 0.74 ± 0.11 in the refixation group; p = 0.006). Postoperative complications occurred in 3 eyes in the IOL exchange group (17.6%) and 2 eyes in the refixation group (11.8%). However, all of the patients were well managed without additional surgery. Conclusion. The in situ refixation technique should be preferentially considered if surgery is indicated since it seemed to produce a sustained less SIA compared to IOL exchange.

Single-suture scleral fixation of subluxated foldable intraocular lenses

PURPOSE

To evaluate the results of single-suture scleral fixation of subluxated foldable intraocular lenses (IOL) in eyes with sufficient residual capsular support.

METHODS

The results of IOL repositioning by single-suture scleral fixation in 6 eyes of 6 patients with IOL subluxation were included. All subluxated IOLs were single-piece hydrophilic acrylic. Subluxation resulted from posterior capsule tears in 3 eyes, zonular dialyses in 2 eyes, and zonular dialysis with a capsulorhexis tear in 1 eye. A similar technique was used in all eyes in which one haptic was externalized through a superior clear corneal incision and tied with a Pair-PAK 10-0 polypropylene suture, and was finally retracted and fixated behind the iris close to the ciliary sulcus at the 12:00 meridian. All patients were followed up for at least 6 months.

RESULTS

Best-corrected visual acuities ranged between finger counting and 20/70 (mean logMAR 1.02±0.64) preoperatively, and between 20/100 and 20/20 (mean logMAR 0.22±0.26) at the final postoperative visit. All IOLs remained centered and no significant postoperative complications were encountered except for an IOL tilt which resulted in a considerable oblique astigmatism in one eye.

CONCLUSIONS

Subluxated foldable IOLs may safely be repositioned and secured with a single scleral fixation suture in selected cases with adequate amount of capsular remnants.

Repositioning a dislocated intraocular lens in the ciliary sulcus using 23-gauge sutureless pars plana vitrectomy

Intraocular lens (IOL) dislocation is a common complication of phacoemulsification. We describe a technique for retrieving a dislocated IOL using 23-gauge transconjunctival sutureless pars plana vitrectomy and repositioning the IOL in the ciliary sulcus in cases with adequate capsule support. This technique provides the benefits of sutureless surgery despite the complication of a dislocated IOL.

[Vitreoretinal surgery in Oman]

PURPOSE

Vitreoretinal diseases in Middle Eastern countries currently rank in importance behind cataract, trachoma and glaucoma. This study reports on the most frequent causes of vitreoretinal diseases and the results of vitreoretinal surgery in Oman in order to gain insights into requirements in training and equipment.

METHODS

Demographic data and biomicroscopic examinations were performed over a 5-year period. Pars plana vitrectomies were carried out with the Accurus 800CS (Alcon) and EyeLite® 532 nm Laser (Alcon), endotamponade with silicone oil 5600 cs (adatomed) or C₃F₈ Ispan (Alcon), oval silicone sponge scleral buckles 5.5 x 7.5 mm type 507 (Geuder®) in adults and oval silicone sponge scleral buckles 3.0 × 5.0 mm type 506 (Geuder®) in children (up to 12 years) were sutured with Mersilene parallel to the limbus. Patients were followed after 4 weeks and 1 year. Evaluation of data was done by descriptive statistics (Fisher exact and χ²-tests).

RESULTS

From 2002 to 2006, 2,910 vitreoretinal surgeries were performed on 784 adult and 101 pediatric eyes. Main indications were proliferative diabetic vitreoretinopathy (PDVR) (229/784 eyes=29%), followed by trauma (166/784=21%), and PVR retinal detachment (112/784=14.3%) in adults and in children the main indication was trauma (73/101 eyes=73%). The postoperative vision in adults with trauma, PVR retinal detachment, epiretinal gliosis and IOL extraction was significantly different and better (p=0.003, p=0.044, p=0.029, p=0.001, respectively) and the postoperative vision in PDVR with uncontrolled diabetes mellitus II significantly different and worse (p=0.001). Of the eyes with PDVR in uncontrolled diabetes mellitus 165 out of 229 (72%) lost distance vision (p=0.00014). All patients with serious macular edema and an HbA(1c) of ≥9.5% lost 5 m distance in vision. The mean HbA(1c) in all patients who experienced postoperative blindness was 13.5%. Postoperative vision was significantly better in children operated for trauma complications (p=0.046) whereby patients with contusion of the globe had a significantly better final result (p=0.0302) than patients with penetrating injuries. Revision surgery was indicated most frequently after surgery for proliferative vitreoretinopathy due to prior retinal detachment surgery.

CONCLUSIONS

The most frequent causes of preventable retinal blindness in Oman are pediatric trauma and advanced diabetic vitreoretinopathy. Eyes operated for trauma had a better outcome than PDVR in patients with uncontrolled diabetes mellitus. The large number of eyes with PDVR in the final stages and sequelae of trauma legitimates preventive medical measures and an expansion of vitreoretinal services with supportive external training of specialists and allied health professions.

Management of dislocated intraocular lenses

PURPOSE

The purpose of this study was to characterize the contemporary clinical presentation and treatment results of patients with dislocated intraocular lenses (IOLs).

DESIGN

Retrospective, noncomparative, single-surgeon interventional case series.

PARTICIPANTS

Two hundred eighty-four eyes of 277 patients operated for dislocated IOLs; 184 eyes with >3 months follow-up information were analyzed for visual outcomes.

METHODS

Review of preoperative, intraoperative, and postoperative clinical features from patient charts.

MAIN OUTCOME MEASURES

Best-corrected visual acuity, reoperations, and complications such as retinal detachment and postoperative refraction.

RESULTS

The study included eyes with polymethyl methacrylate IOLs (n = 113), silicone plate IOLs (n = 51), 3-piece silicone IOLs (n = 38), acrylic IOLs (n = 60), and others (n = 12). There were 51 (18%) with "in-the-bag" IOL dislocations; their proportion increased during the study period and were associated with pseudoexfoliation (P = 0.01), ocular trauma (P = 0.013), and time after implantation of IOL (P = 0.006). Recurrent dislocation (17 eyes; 6%) and decentration (11 eyes; 4%) of IOLs occurred, and resulted in further surgery in 18 (6%) eyes, but were not related to the types of IOL or surgical technique. The most common complication was cystoid macular edema (29 eyes; 10%); retinal detachment occurred after management of dislocated IOL in 11 (4%) eyes. Visual results and median postoperative refractive changes for the 184 eyes with follow-up >3 months were similar regardless of surgical techniques.

CONCLUSIONS

Currently, IOL dislocation more commonly involves foldable IOLs and in-the-bag dislocation. Existing techniques of IOL repositioning with or without scleral suture fixation or IOL exchange are effective for contemporary dislocated IOLs. Preexisting conditions and postoperative complications may limit the visual outcomes.

‘Mini-Gauge’ Pars Plana Vitrectomy: ‘Inside-Out View’ with the GRIN Solid Rod Endoscope

PURPOSE

To stimulate the discussion about 'mini-gauge' pars plana vitrectomy.

METHODS

Gradient index high-resolution endoscopy to analyze the 23- or 25-gauge access into the vitreous cavity. A total number of 66 pars plana interventions (almost 200 cannulas) were performed and recorded with the gradient index solid rod endoscope as well as through the microscope.

RESULTS

Five main 'inside-out' observations were made through the endoscope. Some very slight rotating movement of the trocar was required to achieve a safe cannula implantation. Rotating the cannula too much could result in some unwanted side effects. The major amount of vitreous incarceration occurs during the implantation of cannulas. Incarcerated vitreous causes significant anterior-posterior vitreous traction. Intraocular cleaning of the port with the suction cutter releases the anterior-posterior traction without increasing the postoperative rate and degree of hypotony. Side effects like bleeding of the wound are likely to occur due to any sort of manipulation to the outside of the sclerotomy (i.e. cotton tips) other than the essential replacement of the conjunctiva.

DISCUSSION

Surgeons who are considering the conversion to mini-gauge pars plana vitrectomy systems may be aided by endoscopic observations.

Ab externo direct suture technique for dislocated intraocular lens

We describe a scleral fixation technique that uses an ab externo direct suture through the eyelet of a dislocated intraocular lens (IOL). This modified technique may provide an easy and effective way to reposition a dislocated posterior chamber IOL.

Spontaneous, bilateral intraocular lens dislocation in a patient with exfoliation syndrome

BACKGROUND

Exfoliation syndrome (XFS) is a relatively common age-related disorder characterized by the production and progressive accumulation of a fibrillar extracellular material in numerous ocular tissues and throughout the body. XFS is a known identifiable cause of open-angle glaucoma. However, because of its widespread distribution, other structures in the eye are affected. Because of weakening of the zonular apparatus and posterior capsule, and subsequent loss of support for the lens or posterior chamber intraocular lenses (IOLs), its presence must be factored into the pre- and postoperative management of persons undergoing cataract surgery.

CASE REPORT

An 89-year-old white female presented with the sudden onset of decreased vision in her left eye. She had a history of uncomplicated cataract extraction and posterior chamber IOL implantation in each eye about 10 years previously. She was also known to have XFS. Examination found XFS, a dislocated posterior chamber IOL, anterior uveitis, and markedly elevated intraocular pressure. After stabilizing the eye medically, the patient presented 5 months later with the same condition in the right eye. This eye was also stabilized medically. The patient refused further treatment.

CONCLUSIONS

It is imperative that the comanaging optometrist and cataract surgeon be cognizant of the presence of XFS when planning cataract surgery. However, the effects of XFS may not be seen for many years after apparently successful cataract surgery.

Late in-the-bag intraocular lens dislocation: Incidence, prevention, and management

Dislocation of an intraocular lens (IOL) with the capsular bag is a late complication of cataract surgery, reported with increasing frequency in recent years. Pseudoexfoliation, uveitis, myopia, and other diseases associated with progressive zonular weakening and capsular contraction are the predisposing conditions. Capsular tension rings probably help but do not prevent this complication. Management includes IOL exchange, replacement with an anterior or a sutured posterior chamber IOL, or suturing the IOL through the bag to the iris or the sclera.

Long-term safety and efficacy of repositioning dislocated plate haptic intraocular lenses in the ciliary sulcus

PURPOSE

To report safety and efficacy outcomes of repositioning posterior dislocated plate haptic lenses (PHLs) in the ciliary sulcus (CS).

DESIGN

Retrospective interventional case series.

METHODS

Fifteen consecutive eyes with dislocated PHL repositioned in the CS were reviewed retrospectively. Pars plana vitrectomy was required in 12 of 15 cases. The main outcome variables were initial and final best-corrected visual acuity (BCVA) and length of follow-up.

RESULTS

All lenses remained centered for an average of 48.7 months (range 4 to 99 months) of follow-up with no recurrent dislocation, cystoid macular edema, chronic iritis, or iris chaffing. Initial and final BCVA of 20/40 or better was attained in 93.3% (14 of 15) and 66.7% (10 of 15) of eyes, respectively. Decline of final BCVA was attributable to secondary eye diseases and not related to repositioning.

CONCLUSIONS

Our study reports dislocated PHL may be managed safely and effectively by placement in the CS with long-term stability under certain clinical scenarios.

Zonular Dehiscence Two Years After Phakic Refractive Lens (PRL) Implantation

PURPOSE

To report two cases of zonular dehiscence two years after phakic refractive lens (PRL) implantation.

METHODS

In case 1, a 31-year-old myopic patient with refraction of -12.75 diopters (D) in the right eye and -20.50 D in the left eye, a 12-mm white-to-white measurement, and anterior chamber depth (ACD) of 3.7 mm underwent implantation of a -11.0 D and a -15.5 D PRL-101. Two years after surgery, a temporal-superior PRL decentration was observed in the left eye. In case 2, a 48-year-old pseudophakic patient with refraction of +8 -2.5 x 20 degrees underwent implantation of a piggyback PRL-200. Two years after surgery, an inferior PRL decentration was observed.

RESULTS

The PRL was explanted in both cases. A zonular dehiscence was found--temporal-superior in case 1 and inferior in case 2.

CONCLUSIONS

We have stopped implanting PRLs for the present time as the cause of this complication has yet to be determined.

Scleral fixation of dislocated posterior chamber intraocular lenses: Temporary haptic externalization through a clear corneal incision

PURPOSE

To report the results of managing dislocated posterior chamber intraocular lenses (PC IOLs) by externalizing the haptics through a clear corneal incision.

SETTING

The Retina Center at Pali Momi, Aiea, Hawaii, USA.

METHODS

This retrospective consecutive series comprised cases in which a dislocated PC IOL was managed with pars plana vitrectomy. With this method, the dislocated PC IOL is retrieved and stabilized in the anterior chamber. The haptic is externalized through a clear corneal incision for suture knot placement and then reinserted. A scleral fixation suture is placed 1.25 mm posterior to the limbus under a scleral flap.

RESULTS

The study included 14 eyes of 14 patients with a minimum follow-up of 6 months (median 15.4 months). There were 2 subluxated PC IOLs, 11 posteriorly dislocated PC IOLs, and 1 in-the-bag IOL dislocation. Postoperative vision and/or visual symptoms were stable or improved in 86% of eyes. Two eyes had worse vision caused by conditions not related to surgery including chronic cystoid macular edema from latanoprost use and optic atrophy. All IOLs were well fixated and stable, although 1 eye with asymmetric haptics had a slightly tilted IOL.

CONCLUSIONS

Dislocated PC IOL management by externalizing the haptic through a clear corneal incision stabilized the IOL in the anterior chamber, minimized intraocular operative manipulations, and allowed easier placement of the opposite haptic over residual capsule, if available. Stable fixation was achieved without dislocation or IOL-related complications recurring.

RECURRENT VITREOUS HEMORRHAGE AFTER SUTURED POSTERIOR CHAMBER INTRAOCULAR LENSES

PURPOSE

To describe the clinical course and management of patients with late vitreous hemorrhage after scleral suturing of posterior chamber intraocular lenses (PCIOL).

METHODS

The authors reviewed patient demographics, ocular findings, and clinical course of six patients with late (>3 weeks) vitreous hemorrhage after sclera-sutured PCIOL. Intraoperative endoscopy was performed on two patients to better assess the haptic sulcus interaction.

RESULTS

Patient age ranged from 39 to 84 years (median 77 years). The interval between scleral suturing of the PCIOL and vitreous hemorrhage ranged from 3 weeks to 68 months (median 5 months). The number of hemorrhages ranged from one to four. The hemorrhage cleared spontaneously in three eyes. Three patients underwent surgery after the hemorrhages including sutured PCIOL removal with concurrent placement of an anterior chamber IOL (ACIOL) (two patients) and resuturing of a PCIOL in a different meridian (one patient). Follow-up ranged from 4 to 36 months, median 19.5 months, starting from the time of the initial postsuturing vitreous hemorrhage. Final vision ranged from 20/20 to hand motions, with four eyes having 20/40 or better vision. Endoscopy revealed a haptic embedded into the pars plicata in one eye but no evidence of neovascularization.

CONCLUSION

Recurrent vitreous hemorrhage may occur as a complication of scleral suturing of PCIOL. The etiology of these hemorrhages does not appear to be related to neovascular proliferation at the haptic suture site, but may be secondary to erosion of the haptic into uveal structures. Not all eyes require reoperation after these hemorrhages; however, good visual results may be achieved by replacing the sutured PCIOL with an ACIOL or by suturing the PCIOL in a different meridian.

Techniques for managing common complications of cataract surgery

Cataract surgery has evolved dramatically over the last two decades, largely as a result of technological advances. As a result, visual outcomes and patient convalescence have improved significantly. A second consequence of increased instrumentation and technology, however, is increased complexity of cataract surgery and the advent of complications unique to these advances. Cataract surgeons must be aware and capable of managing the many possible adverse events that can occur during cataract surgery. This review identifies many of the common complications of cataract surgery, describes methods to avoid these complications and discusses techniques to address complications that do occur. It is the ability to avoid, quickly identify, and properly manage complications that defines the accomplished cataract surgeon.