γγI remember back in the early 1990s, a leading German vitreoretinal specialist gave an academic lecture in Beijing. His opinion was that patients over 50 years old with complex fundoplication requiring vitreoretinal surgery should have their lens removed even if the lens was only mildly cloudy. It was somewhat incomprehensible at the time, but over the past 20 years, we have gone from not understanding it very well at the time, to us doing it now. The reason is relatively simple, once the vitrectomy is performed, especially if the intraocular filling (whether it is long-acting gas or silicone oil) is needed, this change in the intraocular environment, the onset and development of crystal clouding is much earlier and faster than the natural clouding. Even some young patients with originally clear crystals have a fairly high rate of postoperative cataracts, with cataracts occurring within a few months of removing the silicone oil in fast cases, and irreversible gas cataracts can occur in long-acting gas-filled patients, which is a very embarrassing thing and can lead to disputes if the explanation is not done properly beforehand. Worse still, in today’s world, even if the explanation is done properly, there are still people who use it to seek trouble in retrospect. A similar incident that recently happened to me and several other colleagues prompted me to write this article for our fellow physicians and for our patients.γγIt is very appropriate to compare the eye to an advanced camera. When there is a problem with the fundus of the eye, it is like a problem with the film of the camera we used in the past, but the difference is that the film of the eye, that is, our retina, cannot be replaced. The lens of a camera can be replaced. The cataract surgery that we usually hear about is equivalent to repairing the lens of a camera, and an IOL is like replacing the lens of a camera. However, once the fundus condition is complicated, such as retinal detachment for a long time, proliferative changes in the retina, retinal thickening and shortening, surgery must be performed to loosen the retinotomy, which usually refers to anterior proliferative vitreoretinopathy, and other cases are complicated advanced proliferative diabetic retinopathy and open eye trauma. The centerpiece of this type of surgery and the focus of the procedure is to ensure that intraocular manipulation is in place and that the quality of the procedure is assured for a successful outcome. Without sacrificing the lens, it is difficult for the surgeon to perform some of the necessary intraocular maneuvers, and the failure to reset the retina means that the surgery cannot be successful. Sacrificing the lens for a successful fundoplication is a matter of throwing away a pawn to save a car. It is very wise to have a second-stage IOL implantation after a successful fundoplication depending on the optometry results. Therefore, it is very important for preoperative explanations and detailed documentation by fellow ophthalmologists to be signed by the patient in order to allow good results for good people and to prevent villains from having unpredictable intentions. For our patients, they should trust the surgeon who is treating you that their preoperative decisions are made based on their condition. Another feature of fundoplication is that often problems are discovered during surgery that were difficult to anticipate prior to surgery, and the decision to remove the lens is based on the complications found during surgery. In case of temporary removal of the lens during local anesthesia surgery, it is best to explain the condition and the patient’s signature, and any family members should also be informed and not be bothered.