Cataract complications

Impact We know from numerous population-based surveys that a significant number of cataract operations may have poor outcomes (defined as presenting visual acuity of less than 6/60). Poor outcomes are distressing or disappointing for patients. They reflect badly on the health or surgical facility and on the surgical team. Poor outcomes may also affect the sustainability of services; they discourage other patients from coming for surgery and make patients even more reluctant to contribute towards the cost of cataract operations. In general, poor vision after cataract surgery is caused by: inadequate correction of post-operative refractive error (lack of spectacles); failure to detect pre-existing eye conditions, e.g. macular degeneration or amblyopia (selection); or surgical complications (surgery). The widespread adoption of intraocular lenses is starting to decrease the number of patients left functionally blind after cataract surgery because they are not able to obtain the necessary aphakic correction spectacles. Problems of selection can be addressed by careful pre-operative evaluation, which should reduce the number of poor results due to the presence of other eye diseases. This will help to prevent complications. Surgical complications, which are the main focus of this issue, can to some extent be prevented by good practice and surgical technique. When complications do occur, proper management is crucial to reduce the possibility of a poor outcome for the patient. There are currently no comprehensive figures on the proportion of poor outcomes of cataract surgery in developing countries and on the relative importance of spectacles, selection, and surgery (Table 1, page 2, provides data from Bangladesh,1 Kenya,2 and Pakistan3). At a conservative estimate, at least 25% (or 1.5 million) of the six million cataract operations performed annually in developing countries will have