Aim: To study the incidence, management, and outcome of complex cataract cases in a tertiary eyecare center. Material and methods: Retrospective observational study with analysis of recordsdone for patients who were operated on for complex cataract from December 2019 to February2020. Results: 300/10,000 patients had complex cataracts requiring additional surgical skills,advanced equipment, and better patient counseling. 5.3% (16/300) of patients needed intracameraladrenaline whereas 1.3% (4/300) needed Visco mydriasis. A capsular tension ring was implanted in4.3%(13/300) of patients. 4% (12/300) underwent sphincterotomies whereas 2% (6/300) had toundergo synechiolysis. Iris hooks were used in only 0.6% of patients (2/300). Posterior capsularrent was seen in 1.6%(5/300) which was managed by placing a Posterior chamber IOL in the sulcus.2.6% (8/300) had implantation of the iris-claw lens and 2.3% (7/300) were left aphakic forsecondary IOL to be implanted at a later date. The visual outcome was better than 6/18 in 76% ofpatients. 24% of patients had an improvement in their visual acuity by a line or 2 but was less than6/18 due to corneal degenerations, corneal scarring, Retinal pathologies, and colobomas.Conclusion: Although these cataracts demand more expertise on behalf of the surgeon, theoutcome can be very rewarding if done with proper planning. The knowledge of small incisioncataract surgery is highly valuable in such situations.

Introduction: To scientifically document and understand Leave Against Medical Advice (LAMA) characteristics of the patients selected for comprehensive eye care management from rural eye campsite. Methods: This was a cross-sectional study, where the demographic details, diagnosis, and details of LAMA were documented and then analyzed to find out if any peculiar pattern was seen among them. Results: Out of 840 patients over a period of 7 months, 26 (3.09 %) were seen leaving against medical advice, the majority being females (54 %). Most of the patients were in the age group of 61-70 years (42.3 %) and from long-distance camps (61.5%). They were accompanied by one of the family members (42.2%), with the majority of them leaving due to medical reasons (43.3%), seen mostly in the rainy season and festive months. Conclusion: LAMA is an indicator of the effectiveness of the community health care delivery system. Better insight into the reason requires understanding their social, economic, cultural, and educational status. Reducing the number of LAMA patients can have a positive impact on the optimal utilization of resources and improve the health status of the community.