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.