Andrew Schimel, MD; Kenneth A. Beckman, MD, FACS , 2025-05-05 14:52:00
Click here to read the Cover Story, “Surgeons share best practices for managing challenging situations, handling stress.”
The retina specialist
When cataract surgery leads to complications, patients arrive at the retina surgeon’s office scared and uncertain.
As specialists, our role is not to dwell on how we got here but to chart the path forward. The priority? Doing what is best for the patient and their eye, starting with managing expectations about outcomes.
These cases are delicate. Patients may hope for a quick fix or a full return to perfect vision, but reality often demands a more measured outlook. For example, a dropped lens will require a surgery in which full recovery could take weeks, and while many regain good vision, some face lingering challenges such as macular edema or IOP issues. The key is to try to explain this up front: “Our goal is to maximize your sight. It will take time, and we will adjust as we go.” Honesty builds trust; overpromising risks despair.
Rather than focus on blame, it is important to emphasize action. Whether it is placing a secondary IOL or reattaching the retina, every step prioritizes the patient’s well-being. Take endophthalmitis, for example: Swift antibiotics and surgery are nonnegotiable; we do not need debates about prior choices. Patients need to hear, “We’re here now, and this is what we’re doing to help.”
Setting realistic expectations also means preparing for uncertainty. We might say, “We’ll know more after surgery, but we’re aiming for stability first.” This keeps hope alive without false guarantees. Frequent follow-ups reinforce progress, letting patients see we are with them for the long haul.
Ultimately, as retina specialists, we are there to bridge a tough moment — offering expertise and empathy when vision hangs in the balance. By focusing on solutions and tailoring care to each eye’s needs, we turn a setback into a chance for recovery. It is not about looking back; it is about seeing ahead together.
- For more information:
- Andrew Schimel, MD, a retina specialist with the Center for Excellence in Eye Care, Miami, can be reached at aschimel@gmail.com.
The cornea specialist
There are a few different scenarios we might have to deal with when a patient is referred to our practice.
One of them is postoperative corneal edema in eyes with an underlying corneal disease such as Fuchs’ dystrophy, and these patients are usually informed that this complication might happen. Sometimes my colleagues send patients to me before surgery, and I tell them to go ahead and have their cataract surgery done; if the cornea survives, great, but otherwise we can always do an endothelial keratoplasty later. In more severe cases, I will take care of the patient myself, doing a combined procedure. These are the easy cases, when patients know up front that they have an underlying problem.
Corneal edema might also develop without an underlying corneal problem in difficult cases such as a mature cataract. When these patients are referred to me, I explain that more energy is required to remove hard lenses, and this can damage the endothelium and lead to swelling. These situations are not difficult to manage from the patient’s standpoint and are easily fixed with medications or a surgical intervention.
Surface-related problems, such as a nonhealing corneal defect, are a little more difficult. These patients are more often referred by retina colleagues because they scrape the epithelium to get a better view. They may be patients with diabetes or other eye diseases with an unhealthy surface that does not heal; they are usually not hard to deal with because they know they have sick eyes and often have poor vision.
The most difficult cases are the unhappy cataract patients, typically those who got a premium lens and have surface disease such as basement membrane dystrophy or dry eye. Sometimes they may also have Fuchs’ that was not identified or was identified but the decision was made to go through with multifocal lens implantation despite contraindications. You do not want to throw the other surgeon under the bus because one presumes that they had a nice conversation with the patient before surgery and made an informed decision. In these cases, I try not to jump into the idea of changing the IOL because that is not an easy and risk-free procedure. In addition, in many of these patients, the surgeon initially tries to do a YAG capsulotomy, hoping that it may solve the problem. That makes it even harder to do an IOL exchange, with an open capsule and likely the need for vitrectomy.
I start by treating the tear film, and the response is often quick and good. If there is basement membrane dystrophy, I can perform superficial keratectomy or apply an amniotic membrane or just a bandage contact lens to get the surface to heal. But I explain to patients that they will have to get used to a vision that is never going to be as good as with the natural lens, just as somebody who undergoes hip replacement does not go running the same way they did before. This is not telling the patient that they have to suffer with this outcome, and it is not to say that I would not try anything else. It is merely informing the patient that they can still do well and that further intervention may not be beneficial. Sometimes, we can only do so much. By taking time to communicate with patients and empathize with their situation, they often find relief in the explanation and become much happier with their outcome.
- For more information:
- Kenneth A. Beckman, MD, FACS, a Healio | OSN Board Member and director of corneal services at Comprehensive EyeCare of Central Ohio, can be reached at kenbeckman22@aol.com.
