CATARACT 20 EWAP JUNE 2023 Even with a successful cataract surgery, there are a variety of issues that can pop up postoperatively that can be problematic for patients, warranting further follow-up from the physician. Kevin M. Miller, MD, and Richard Tipperman, MD, discussed some of the most common issues that they see following cataract surgery and how to address them. “While we may consider them minor nuisances, the patient’s perception is ‘What went wrong with my surgery?’” Dr. Tipperman said. “Surgeons should realize that the first thing they need to do is reassure and explain to the patient what’s going on and what we’ll do or not do about it.” On a busy day, when you’re seeing a lot of patients and one of them tells you that their eye feels scratchy or they’re only 20/25 instead of 20/20, surgeons might discount everything as fine, while from the patient’s perspective, something went wrong with the surgery. Of the issues that can come up postop, Dr. Tipperman said one of the most common he sees is corneal neuralgia and general complaints that “the eye doesn’t feel normal.” That could mean it feels big, small, uncomfortable, etc. After cataract surgery, the eye is irritated, and patients worry that there’s something wrong, even though for other surgeries, it’s normal to have swelling and postop effects. Dr. Tipperman said that cataract surgeons recognize dry eye and the difference it can make. “I think 100% of patients get surface irritation that’s related to the betadine prep on the eye before surgery,” he said. “I tell them that this helps reduce risk of infection, but it also irritates goblet cells and the surface of the eye.” This short discussion helps calm the patient’s worries, he said. Dr. Miller said another common source of dissatisfaction is small refractive errors. It’s not possible for surgeons to guarantee 20/20, but it’s important to tell patients you’ll do everything in your power to get the best result. “We can’t control where a lens will sit inside the eye; we Subtle, prolonged corneal edema after cataract surgery can be a source of patient dissatisfaction. Source: Kevin M. Miller, MD Contact information DhaliwMiller: kmiller@ucla.edu Tipperman: rtipperman@oppdoctors.com Potential issues after cataract surgery by Ellen Stodola EyeWorld (US) Editorial Co-Director This article originally appeared in the April 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. can’t determine exactly how incisions will heal. But patients will wonder what went ‘wrong’ if their vision doesn’t turn out perfectly,” he said. If there’s a small refractive error, the options for fixing it include glasses, contact lenses, and additional surgery. The additional surgery in Dr. Miller’s practice, in the cataract age range, is usually PRK, although sometimes he performs LASIK. “Less commonly, but for larger refractive errors, one might consider a lens exchange or a piggyback lens,” he said. When addressing small refractive errors, timing is also a big factor. For example, he said that you don’t want to do PRK too soon because you want there to be refractive stability. He suggested waiting 3–6 months after surgery. But by that time, another problem is often kicking in, which is that the capsule starts wrinkling.
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