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Invited Commentary
June 24, 2021

What Is So Complicated About Defining Surgical Complications?

Author Affiliations
  • 1Institute for Vision Research, Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City
JAMA Ophthalmol. 2021;139(8):864-865. doi:10.1001/jamaophthalmol.2021.1091

Recently, a seemingly simple question arose during our department’s retinal surgery rounds: what constitutes a complication? Not surprisingly, rapid agreement was reached regarding severe, unexpected events (eg, hypotony with suprachoroidal hemorrhage, high intraocular pressure after intravitreal gas overfill, or inadvertent instrument strike of the macula). However, other intraoperative events generated much more discussion. For example, if an iatrogenic break is created near preexisting peripheral tears during vitreous shaving for retinal detachment repair, is that considered a complication? Does the definition depend on the size and location of the break, or is it only a complication if it alters management or threatens outcome? Do these thresholds change when the case is more complex and breaks are more likely to be encountered?

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