Recent developments in cataract surgery

Abstract

Recent developments in cataract surgeryAs guest editor of this special series of the Annals of Translational Medicine (ATM), I would like to share with the readers at large the contributions from invited authors who provided their unique and expert perspectives on the important and critical topics of this focus series titled "Recent Developments in Cataract Surgery".Cataract surgery is the most common surgical procedure performed in medicine. Over 20 million surgeries were carried out worldwide in the 2015, including 3.6 million in the United States of America and 4.2 million in the European Union (1). The technology progress enabled cataract surgery to become the safest and most predictable eye surgery. However, the increase in life expectancy and quality of life result in rise expectations regarding the outcomes. Presently, individuals over 70 years of age still wish to maintain an active lifestyle, including driving a car and often performing sports. Cataract surgery is no longer a procedure to eliminate the obstacle in vision providing some restoration of vision. It became a refractive procedure to eliminate all refractive errors, including astigmatism, but also in many cases managing co-existing presbyopia. Thus, this is a field of many new ideas and new developments. We still can be better and there is a demand for techniques that are even more perfect. Longer life span brings some new encounters, including more surgeries performed on patients with dementia and other comorbidities related with ageing, including glaucoma and retinal disorders. Moreover, the anticipated duration of intraocular lens (IOL) in the eye has significantly increased, thus physicochemical properties and IOL endurance should allow the IOL to keep its optical properties for up to three decades.Congenital cataract is the leading cause of preventable blindness in children (2). Early surgical intervention may prevent deprivation amblyopia and result in good visual prognosis (3). Optimal surgical management includes microincision cataract aspiration combined with posterior capsulotomy, anterior vitrectomy and primary intraocular lens (IOL) implantation (4). Primary IOL implantation is usually performed in children older than 2 years of age. IOL implantation in children younger than 2 years of age remains a matter of controversy (5). The review by Bremond-Gignac and colleagues discusses recent developments in the diagnosis and management of congenital cataract.It is well known that postoperative intraocular inflammation is usually more severe in younger children and it might be explained by an immature blood-ocular barrier and an underdeveloped immunosuppressive microenvironment or anterior chamber associated immune deviation (6,7). Proper understanding of these mechanisms is pivotal for optimal management of inflammatory response to surgical stimuli (8,9). Postoperative complications arising from intense inflammation include formation of posterior synechiae, posterior capsule opacifications, and fibrous pupillary membrane. This, reinforced...

Ocular Surface Changes Associated with Ophthalmic Surgery

“…Conventional phacoemulsification and intraocular lens (IOL) implantation are among the most common procedures of anterior segment surgery performed with over 20 million procedures performed each year globally [ 40 ]. Some patients might subsequently develop DED postoperatively.…”

Microscopic Characteristics of Late Intraocular Lens Opacifications

“…Reprinted with permission from Springer Nature: Springer International Publishing. 2 of the IOL structure hydration leads to a greater degree of ionization of the polymeric functional groups, endorsing calcification by the formation of complexes with ionized calcium. 36 Even though some suggested relationships seem plausible, the exact pathomechanism of IOL calcification is not fully understood.…”

“…Therefore, the physicochemical properties and endurance of IOLs should allow the IOL to maintain its optical properties for long periods of time, in some cases for several decades. 2 Different types of late postoperative IOL opacifications have been reported; they usually develop gradually and eventually affect the vision quality. The main problem is light scattering, which results in subjective symptoms such as glare, halos, and decreased contrast sensitivity; cases in which the opacifications are severe manifest as a decrease in light transmittance and visual acuity.…”

“…Some microvacuoles (glistenings) can also be seen within the optic substance of the lens. Reprinted with permission from Springer Nature: Springer International Publishing 2.…”

Current Challenges in the Postoperative Management of Cataract Surgery

“…1 In 2015, approximately 3.6 million cataract interventions were performed in the United States. 2 In the next few years, age-related diseases are likely to rise in many nations with increasing life expectancy, and cataracts will become more common.…”