Advances in cataract surgery

Abstract

Recent advances in cataract surgery have increased the safety and efficacy of this common procedure. Cataract surgery has evolved from ‘couching’ with sub-optimal results to phacoemulsification with excellent results. Introduction of the femtosecond laser into cataract surgery may further the safety and predictability of this procedure. In addition, innovations in intraocular lens material have enabled the surgery to be done through a small incision with quicker recovery and more predictable refractive outcome. New intraocular lens design technologies have helped patients minimize their need for glasses at most distances. Further, invention of ophthalmic viscosurgical devices reduced the risk of endothelial decompensation and corneal edema. These innovations have transformed the goal of cataract surgery from purely visual rehabilitation to a refractive procedure as well.

Keywords::

• cataract surgery
• femtosecond laser
• intraocular lens
• ophthalmic viscosurgical devices

Financial & competing interests disclosure

YJ Daoud is a consultant for Bausch and Lomb. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Improvement in cataract extraction technique:

  • – ‘Couching’ had unacceptable results;

  • – Extracapsular cataract surgery was very promising, but had morbidity related to the large corneal incision;

  • – Phacoemulsification is a significant breakthrough in cataract extraction techniques.

• • Invention of ophthalmic viscosurgical devices (OVD):

  • – Introduction of OVD improved the safety of intraocular surgery;

  • – Understanding the features of the OVD types is important not only to get the maximum benefits but also to avoid complications.

• • Innovation in intraocular lens material and design:

  • – Polymethyl-methacrylate (PMMA) intraocular lenses were introduced by Harold Ridley, but were stiff and required large corneal incision;

  • – Visual rehabilitation becomes faster with the introduction of foldable silicone and acrylic intraocular lens (IOLs);

  • – Presbyopia-correcting IOLs represent new advancements in IOL development but patients’ selection for these IOLs is critical;

  • – Reducing spectacles-dependence becomes one of the goals of cataract surgery;

  • – Cataract surgery is converging with refractive surgery.

• • Correction of astigmatism during cataract surgery:

  • – on axis corneal incision, peripheral corneal relaxing incisions and toric IOL are options to correct corneal astigmatism during cataract surgery.

• • Zonular-supporting devices:

  • – Introduction of capsular tension ring and other zonular supporting devices improved the safety of cataract surgery and stability of IOL in complex cases.

• • Femtosecond laser-assisted cataract surgery:

  • – Femtosecond laser can perform anterior capsulotomy, lens fragmentation and corneal wound construction;

  • – Femtosecond laser may improve the safety and outcome of cataract surgery;

  • – The cost is the main issue with this system.