CATARACT SURGERY AND LENS IMPLANTATION: Edited by Natalie Afshari
In recent decades, ophthalmologists performing cataract surgery have witnessed the successful application of technological gains that have honed surgical technique, advanced standard of care, and, most importantly, given rise to better patient outcomes. Today, cataract surgery is the most commonly performed surgical procedure in the USA. And while these aforementioned developments help to further refine cataract surgery and to bolster its already widely accepted reputation as a reliable surgical intervention with gratifying results and minimal complications, risks as grave as total blindness or loss of eye, although exceptionally rare, remain a reality. In this issue of Current Opinion in Ophthalmology, we have sought to provide our readership with an up-to-date interpretation of cataract surgery, emphasizing associated postoperative complications as well as new technological advancements that collectively describe not only the current professional opinion toward cataract surgery, but also the direction in which the field is headed.
From intracapsular cataract extraction to extracapsular cataract extraction to phacoemulsification to femtosecond phacoemulsification, cataract surgery has continued to maintain its own subset of potential complications, such as retinal detachment and endophthalmitis, that warrant special attention. In this edition, Drs Sara J. Haug and Robert B. Bhisitkul provide a thorough review of recent literature exploring both incidence and associated risk factors for rhegmatogenous retinal detachment during the postoperative period. They report that high myopia, younger age, and male gender, in addition to surgical complications, impart greater risk of pseudophakic retinal detachment. Drs Parisa Taravati, Deborah Lam, Thellea Leveque, and Russell Van Gelder investigate the literature to describe and differentiate the pathogenesis, appropriate workup, and necessary therapeutic intervention for acute versus chronic postcataract surgery inflammation. In doing so, they discuss additional considerations for those patients with pre-existing uveitis, specifically addressing both optimal intraocular lens selection, as well as the efficacy of perioperative steroid treatment. Drs Charles Q. Yu and Christopher N. Ta document the most current findings published in the literature detailing endophthalmitis prophylaxis for those patients undergoing cataract surgery. They conclude that both topical povidone–iodine and intracameral cefuroxime are prophylactic steps that may be taken to effectively reduce risk of postoperative endophthalmitis. Drs Yoshihiro Yonekawa and Ivana Kim examine pseudophakic cystoid macular edema (PCME) as yet another cause of decreased vision following cataract surgery, while clarifying the clinical phenomenon's incidence, risk factor profile, and treatment protocol. They delineate the use of optical coherence tomography for diagnosis, determine efficacy of NSAIDs and corticosteroids as first-line therapy for PCME, as well as bring to light novel treatment modalities like intravitreal administration of corticosteroids and anti-vascular endothelial growth factor therapies.
Physicians and scientists, alike, are motivated to pursue technological advances that enable cataract surgery to be performed with even greater exactitude. In keeping with this philosophy, Dr Harvey Uy, Dr. Keith Edwards (OD), and Nick Curtis introduce femtosecond phacoemulsification and describe its application to cataract surgery. They go on to assess the technology's practicality from a business economics point of view, taking into account variables like cost, space for equipment, personnel, and patient acceptance. Drs Alejandro Lichtinger and David S. Rootman review the literature to both further explore intraocular lens technologies for presbyopic patients and specify the benefits and drawbacks of the multifocal, diffractive, and accommodative lenses available on the market. Additionally, they provide a more historical perspective of intraocular lens development accompanied by a description of promising, future developments in accommodative lenses that may lead to even better results for patients.
However, in order for these new technologies to successfully optimize patient outcomes, they must be adapted to the individual patient and his/her needs. Drs Afsun Sahin and Pedram Hamrah affirm that attention to individuals’ postoperative target refraction is paramount for successful cataract surgery. To support their stance, they discuss new developments in optical biometry, keratometry, and intraocular lens power calculations and present them as core principles to consider for optimal results. Drs Mayank A. Nanavaty (DO) and Sheraz M. Daya review the literature concerning refractive lens exchange and phakic intraocular lens implantation in effort to further refine cataract surgery by deciding when to employ refractive lens exchange versus phakic intraocular lens placement. In doing so, they develop a set of recommendations that focuses on individualizing the patient and his/her visual needs. Dr Derick G. Holt, Brian Stagg, Dr Jason Young, and Dr Balamurali K. Ambati review the literature describing the indications, surgical options, and surgical outcomes corresponding to extracapsular fixation of the intraocular lens for those patients with weakened lens capsules. They find anterior chamber fixation, scleral (sutured or sutureless) fixation, and iris (sutured or iris claw) fixation of surgically placed intraocular lenses to be useful techniques with advantages and disadvantages specific to the patient. Drs Asadolah Movahedan and Ali R. Djalilian further describe the importance of recognizing individual variability within the patient population and provide a review of cataract surgery performed in patients with pre-existing ocular surface disease. They find that ocular surface disease may lead to complications and advise that pre-existing ocular surface diseases be worked up and appropriately managed preoperatively, perioperatively, and postoperatively to improve patient outcomes.
Cataract surgery is a common surgical procedure with often very gratifying results for patients. Nevertheless, the procedure is not without a slight risk of complication that continues to drive the development and practical application of the most advanced technologies to the field. In this issue of Current Opinion in Ophthalmology, we have collected the insight and expertise from physicians around the world who demonstrate how close we are to achieving our common goal of perfection.
Conflicts of interest
There are no conflicts of interest.