FRCOphth Part 2 Written Cataract & Lens

Start with the lens itself, its anatomy, biochemistry and the cataract morphologies, including the congenital, traumatic, metabolic and drug-induced causes. Then the preoperative work: biometry, the formulae and where each one behaves badly, axial length outliers, previous refractive surgery, intraocular lens types from monofocal through toric and presbyopia-correcting designs, and how astigmatism is planned for. Then the intraoperative and postoperative material, covering anaesthetic choice, difficult cases such as small pupils and pseudoexfoliation, posterior capsule rupture and dropped nucleus, suprachoroidal haemorrhage, endophthalmitis and toxic anterior segment syndrome, cystoid macular oedema, posterior capsule opacification, refractive surprise, and the options for a dislocated or exchanged lens. Refractive surgery and its complications sit at the edge of this domain and are worth knowing.

Two patterns dominate. The first is a preoperative planning stem: an unusual eye, a set of measurements, and a question about which formula, which lens or which target. The second is a complication stem asking for immediate management, and these reward knowing the sequence rather than the list. Endophthalmitis, posterior capsule rupture and refractive surprise all recur, and all three are about what you do first.

Do not revise this domain by reading a surgical text, because the exam is not testing technique. Work planning questions until you can say why a formula misbehaves in a short or long eye rather than which constant it uses, and work complication questions until the order of management comes out without hesitation. Use the referenced explanations to check the reasoning, and pay particular attention to the questions where your surgical instinct gave you the right answer for the wrong reason. Those are the ones that will not transfer to a differently worded stem.