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Surgical advancements and innovations in cataract surgery for the complex patient

Gali, Helena E.; Afshari, Natalie A.

Author Information
Current Opinion in Ophthalmology: January 2020 - Volume 31 - Issue 1 - p 1-2
doi: 10.1097/ICU.0000000000000638
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Cataract surgery improves vision for millions of people worldwide every year. This procedure allows for improved quality of life among our increasing aging population. The preparation that goes into evaluating a patient's cataracts, the planning that goes into the best procedure for each individual patient, and the postoperative care plan are continually being refined. In the following pages, the work presented demonstrates the ongoing discussion and the research that helps to improve cataract assessment, best surgical practices for complex cases, and innovative alternatives to current practices.

Assessment and evaluation of cataracts is an important step for the ophthalmologist who plans to perform cataract surgery. Surgeons must take into account the patient's refraction, underlying ocular conditions or disease, and desired visual outcome. Moshifar et al. (pp. 3–9) discuss the considerations of performing cataract surgery on patients with uveitis. They state that while it is a safe procedure, further research must be done to control inflammation in this patient population. Sigireddi et al. (pp. 10–14) investigate the degree of astigmatism correction that can be performed with cataract surgery and recommend the amount of correction that results in optimal visual outcome. When considering the glaucoma patient who undergoes cataract surgery, Young et al. (pp. 15–22) discuss the utility of cataract excision to effectively lower intraocular pressure. Sarnicola et al. (pp. 23–27) look into corneal transplant patients who are to undergo cataract surgery, discussing the special considerations taken in these patients. In preparation for cataract surgery while evaluating the patient in clinic, it is important to keep in mind that the prevention of infection extends beyond the operating room. Abbas et al. (pp. 28–32) emphasize the importance of hand hygiene to prevent nosocomial disease in the clinical setting even before the patient enters the sterile environment for their surgical procedure. Thorough evaluation and preparation for cataract surgery allow for the best possible experience and visual outcome for the patient.

Performing and refining intraoperative procedures and techniques is of equal importance to evaluation of the patient prior to surgery. Continued improvement in managing surgical complications and evolution of standard techniques allows ophthalmologists to operate on complex patients. Evaluating risk factors for small pupil and managing small pupil come with a variety of options. Grzybowski et al. (pp. 33–42) lay out a stepwise approach for best managing small pupil intraoperatively, providing readers with a proposed plan to approach this potential complication. In a similar fashion, Lian et al. (pp. 43–49) investigate the wide array of tools used for iris reconstruction, outlining the variety of techniques at an ophthalmologist's disposal to provide patients with good visual outcome and postoperative appearance. Jacobs et al. (pp. 50–60) discuss the evolution of scleral fixated intraocular lenses and the benefits of sutureless capsular bag fixation. Improvements in surgery technique allow ophthalmologists to provide their cataract patients with the best surgical and visual outcomes.

Innovations in the prevention of cataract and in the current postoperative treatment paradigm will help improve patients’ vision. Lian et al. (pp. 61–66) provide a summary of the research in nonsurgical therapies for cataracts, calling for further research into the medical possibilities for slowing the development of age-related cataracts. Just as evaluation and surgical techniques are important for ensuring good visual outcome after cataract surgery, so too is the postoperative management of cataract surgery patients. Shorstein et al. (pp. 67–73) discuss the use of intraoperative intracameral antibiotic injections in order to provide assured drug delivery and avoid common pitfalls of postcataract surgery care.

As our aging population grows and as life expectancy increases worldwide, it is critical to consider how to best address global cataract blindness. Because phacoemulsification may not always be available, it is important that ophthalmologists are well trained in and know how to perform manual small incision cataract surgery. Bernhisel et al. (pp. 74–79) call for increased training in this technique and its favorable outcomes, emphasizing the essential role of manual small incision cataract surgery in addressing the global cataract burden.

We hope that the following pages provide useful information and encourage thought-provoking discussion among the cataract surgery community. Improvements in the development of surgical techniques and patient care lead to favorable visual outcomes for cataract surgery patients. Thank you for your continued dedication to advancing the field of cataract surgery and for improving patients’ lives.


Natalie Afshari, M.D.

Financial support and sponsorship

Research to Prevent Blindness.

Conflicts of interest

There are no conflicts of interest.

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