From Routine to Risk: Medical Liability and the Legal Implications of Cataract Surgery in the Age of Trivialization

Nioi, Matteo

Conceptualization

;Napoli, Pietro Emanuele

;Nieddu, Domenico;Chighine, Alberto;Carai, Antonio;d'Aloja, Ernesto

2025-01-01

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Abstract

Cataract surgery is the most common eye operation worldwide and is regarded as one of the safest procedures in medicine. Yet, despite its low complication rates, it generates a disproportionate share of litigation. The gap between excellent safety profiles and rising medico-legal claims is driven less by surgical outcomes than by patient expectations, often shaped by healthcare marketing and the promise of risk-free recovery. This narrative review explores the clinical and legal dimensions of cataract surgery, focusing on complications, perioperative risk factors, and medico-legal concepts of predictability and preventability. Particular emphasis is given to European frameworks, with the Italian Gelli-Bianco Law (Law No. 24/2017) providing a model of accountability that balances innovation and patient safety. Analysis shows that liability exposure spans all phases of surgery: preoperative (inadequate consent, poor documentation), intraoperative (posterior capsule rupture, zonular instability), and postoperative (endophthalmitis, poor follow-up). Practical strategies for risk reduction include advanced imaging such as macular OCT, rigorous adherence to updated guidelines, systematic video recording, and transparent perioperative communication. Patient-reported outcomes further highlight that satisfaction depends more on visual quality and dialogue than on spectacle independence. By translating legal principles into clinical strategies, this review offers surgeons actionable “surgical–legal pearls” to improve outcomes, strengthen patient trust, and reduce medico-legal vulnerability in high-volume cataract surgery.