In this presentation from AAO 2016, Robert J. Cionni, MD, presents his top-5 pearls in managing complicated cataract cases.

• Discuss with the patient before surgery:
• Increased risk of retinal detachment
• Increased difficulty in hitting the refractive target
• IOL style desired might not be available in power needed.
• Anisometropia warnings if only 1 eye planned
• CL removal for preop measurements
• Near vision will require glasses if emmetropia targeted.
• Choose the best formula for eyes with axial length of 26.00 mm or greater.
• Expect reverse pupillary block (RPB):
• Never begin irrigation without first separating the iris from the anterior capsule.
• Warn the patient that they might feel exaggerated pressure changes.
• Relieve RFP whenever performing intraoperative aberrometry and at end of case.
• Always perform trial lenses before proceeding with enhancements of any kind.
• Perform frequent, early postoperative exams to evaluate for anterior capsular phimosis.