Complications of Cataract Surgery: A Manual Bruce Nobel and Ian Simmons. Boston, MA: Butterworth-Heinemann, 2001; 108 pages. $80.00.
Although the subject Complications of Cataract Surgery is very broad, it was a pleasure to find that the authors were able to encompass all the relevant points in a book of such modest size.
The book is divided into three parts: Routine Cataract Surgery; Managing Surgical difficulties and Complications; and The Doctor-Patient Relationship and Medicolegal Matters.
The book follows a logical chronology from the patient's first visit through postoperative care. The first section covers important topics relevant to history and the ophthalmic examination, and defines a surgical risk classification. It also covers important details about the preoperative checklist. There is a discussion of anesthetics, extracapsular and phacoemulsification techniques and complications, as well as their prevention and management. The authors demonstrate that surgical success does not result from “technical perfection” alone and that impeccable surgery does not always guarantee patient satisfaction. The quality of the book's photographs is generally excellent, with the exception of a few slightly blurred images.
In the second part, the authors discuss in detail a wide variety of possible surgical complications, their management, and prevention. These scenarios are clarified with color illustrations and include details of capsulorrhexis, assessment of the vitreous loss, and the management of a dropped nucleus or nuclear fragment. The authors explain anterior vitrectomy technique, IOL implantation in complicated situations, and the appropriate time to convert to extracapsular surgery from phacoemulsification. The authors also discuss postoperative problems with clear and objective explanations for managing residual astigmatism, cystoid macular edema, endophthalmitis, and suprachoroidal hemorrhage.
The final section discusses the basic requirements for surgical competence and comments on medicolegal aspects, including defense strategies in the face of litigation.
I believe the authors have accomplished with distinction their goal of instructing the surgeon-in-training. This book is pleasing to read and an effective didactic tool for the aspiring surgeon.