Visual outcomes in patients undergoing cataract surgeries in complex situations

Objectives: Cataract is a leading cause of avoidable blindness worldwide. Complicated cataract cases such as those associated with pseudoexfoliation (PEX) syndrome, uveitis and traumatic cataract present significant surgical challenges and variability in visual outcomes. While standard cataract surgeries are well-studied, data on complicated cases remain limited. This study was undertaken to evaluate visual outcomes and assess complications in patients undergoing complicated cataract surgery. Materials and Methods: A prospective observational study was conducted at present involving 93 patients undergoing complicated cataract surgery. Patients with PEX, uveitis, traumatic cataract or other intraoperative risk factors were included. Pre-operative evaluation, phacoemulsification or manual small incision cataract surgery (MSICS) and follow-ups at 1 week, 1 month and 3 months postoperatively were performed. Visual acuity, intraocular pressure (IOP) and post-operative complications were assessed. Results: Phacoemulsification was performed in 80.6% and MSICS in 16.1% of cases. PEX syndrome was the most common risk factor (50.5%), followed by uveitis (22.5%) and traumatic cataracts (16.1%). Intraoperative complications occurred in 10.8% of cases, most frequently posterior capsular rupture. Post-operative complications included corneal oedema (20.4%), raised IOP (4.3%), toxic anterior segment syndrome (4.3%) and pseudophakic macular oedema (3.2%). At 12 weeks postoperatively, 40.8% of patients achieved visual acuity of 6/6–6/9, with significant improvement observed across the cohort. Conclusion: Despite increased complexity and complication risks, favourable visual outcomes can be achieved in complicated cataract surgeries with proper pre-operative assessment, surgical planning and post-operative care. This study highlights the need for tailored strategies in managing high-risk cataract patients to optimise visual recovery.