Sometimes you will examine a patient who had surgery elsewhere and you can tell that there were challenges and complications. You must avoid thinking that the first surgeon had issues solely because he or she did not have enough surgical skill. This is a critical lesson: Always give the first surgeon the benefit of the doubt — assume that he / she had good skills and judgment but the patient’s tissues were the true challenge.
It is the combination of the patient’s anatomy and tissue limitations, as well as the surgeon’s technique, that determine the outcome of the case.
This patient had a complicated course for her first cataract surgery which was done elsewhere a few years ago. There was a sulcus IOL, surgical corectopia, and a prolonged inflammatory reaction that lasted months. Ultimately, the first eye achieved good vision. When I saw the patient in consultation, I immediately thought that there must be significant tissue limitations and that I would encounter these same challenges and potential risks when doing a future surgery for her other eye.
Upon review of her old records, the first surgeon was, in fact, one of my professors from two decades prior when I was doing my ophthalmology residency. I knew first-hand that he was skilled and possessed excellent judgment. This made me even more focused on the challenges that would await for her other eye cataract surgery with me.
Sure enough, it was a challenge. Extensive cortical opacities made visualization of the capsulorhexis challenging. The capsule felt thin and the zonular attachments somewhat weak. The dilation was less than ideal. The case turned out well but it was stressful because of the tissues but also because of the patient’s expectations and nervousness. The patient has done very well in the post-op period and is very happy.
Always give the first surgeon the benefit of the doubt. Keep this important lesson in mind the next time you see a patient with complications from surgery done by another surgeon.
Click below to watch this challenging cataract case: