BOOK REVIEW

“Never underestimate a ‘simple’ cataract operation,” a senior cataract surgeon and corneal transplant specialist told me during my cataract surgery rotation. “It can go wrong very quickly if you’re not careful.” This was quite a revelation, coming from someone who was well experienced in dealing with penetrating keratoplasty, DSAEK, and all the other complicated ocular surface procedures. Once I started operating myself, I came to realise how many different types of complications could occur. From the initial corneal incisions to the final hydration of the wounds, essentially everything can go wrong. It is these problems that are addressed in a new book from Slack Incorporated, Cataract Surgery Complications.

“All surgeons have complications… we hope you only have a few… and that this book will help to resolve them very well,” the authors write. Within 150 pages, Lucio Buratto, Stephen F Brint, and Mario R Romano have produced a concise manual with well-illustrated text for the beginning and intermediate-level cataract surgeon. Indeed, despite our specialty’s total familiarity with cataract surgery, the concept of inserting a highly energetic tool and many sharp instruments into one of the body’s most delicate organs remains vaguely disconcerting. So, we should be highly prepared, both for the operation itself and the potential pitfalls during and after surgery.

Chapter 1, “Anesthesia by Injection,” covers a topic frequently skipped in cataract surgery texts. In fact, it is frequently overlooked in residency training, due to the widespread adoption of topical anaesthesia and the presence of anaesthesiologists who administer the occasional retrobulbar injection. Chapter 2 covers the corneal incision, concentrating on the optimal techniques to ensure watertight closure and thus minimise endophthalmitis risk.

Chapters 3 and 14 discuss the capsulorrhexis and the seemingly endless ways that this step can ruin an entire procedure. “Since the anterior capsule cannot be mended once a complication has occurred, management must be prompt and principles of prevention are paramount.” The rhexis can be too big, too small, decentred and irregularly shaped. This book provides advice on how to cope with these and other problems.

The text is not limited to cataract surgery, per se. In case of posterior capsular rupture, posterior segment manoeuvres must be undertaken. “The surgeon’s primary concern with capsular rupture is to prevent nuclear dislocation into the vitreous.” Chapters 9 and 10 cover anterior and posterior vitrectomy, respectively. A posterior vitrectomy is beyond the reach of most cataract surgeons, but it’s nonetheless good to know how to prepare an eye for transfer to the vitreoretinal specialist and to read, in simple terms, what happens once the patient’s care has been assumed by the posterior segment surgeon. The same applies for endophthalmitis, which is covered in Chapter 11. CME, or Ivine Gass syndrome, the treatment of which is usually the responsibility of the cataract surgeon, is the topic of Chapter 12.

Besides the classic complications, more modern concerns are also discussed, such as those associated with the femtosecond laser, and the avoidance of posterior capsular opacification with the endocapsular ring. Further, advanced complication management techniques, like using the intraocular lens as a scaffold to prevent dropped nuclei after posterior capsule rupture, are introduced to the reader. “Cataract Surgery Complications” is intended for the beginning and intermediate-level cataract surgeon, which includes ophthalmology residents during their surgical rotations and ophthalmologists who are considering or completing a cataract surgery fellowship.