Purpose: Complicated cataracts are common in the Top End due to the incidence of trauma and delayed presentations especially in the Aboriginal and Torres Strait Island populations. Often, these go undetected during the pre‐operative assessment due to factors including; low self‐reported trauma, language barriers, poor dilation of dark irises, and low tolerance for delay or wait time.

Methods: This is a case series of 8 complicated cataracts managed by a single surgeon at Royal Darwin Hospital over 18 months.

Result: These 8 patients were aged 30‐70 (median 60), with 5 males and 3 females, 7 identified as Aboriginals or Torres Strait Islanders, and 5 are from remote communities. Pre‐operatively, 3 had reported trauma, 1 had a posterior capsular defect and 3 had phacodenesis; 4 more were identified intraoperatively. A variety of surgical techniques were used; 4 had scleral tunnel with intracapsular extraction (ICCE) and ACIOL, 3 had converted ICCE via limbal wound extension and 1 had routine phacoemulsification. Post‐operatively, all patient's visual acuity (VA) improved and 4 had significant improvement. 1 was lost to follow‐up from day 1 and 5 had missed appointments.

Conclusion: This case series describes a learned experience of cataract managements unique to the Top End including high suspicion of traumatic cataract with zonular dehiscence. The authors also advocate for the use of scleral tunnel incision to mitigate the risks of infection and induced astigmatism in the setting of unreliable follow up. Subconjunctival dexamethasone is also preferred intra‐operatively given difficulties with compliance and accessibility in remote communities.