Recent advances in cataract surgery

From days of Sushruta where cataracts were couched with red hot needle (practically a stitchless , even smaller than keyhole ) we have come back to the era of “ sutureless” tunneled surgery. In the past cataract surgery with traditional sutures( stitches) and lenses needed the patient to be lying still in bed for a week, one month of rigorous restrictions and the outcomes for the vision were not predictable. The use of an operating microscope techniques to dissolve the lens and insertion of injectable lenses has revolutionized cataract surgery to an outpatient day care procedure , where the patient can resume work in less than a week.

The newer improvisation aim at emmetropic or perfect uncorrected vision. This does away with the need of any visual aids (eg. Spectacles).Phacoemulsification technique has become the gold standard of cataract surgery, where the cataract is emulsified with ultrasonic energy and then aspirated or sucked out with high vaccuum systems, though self sealing valved incisions. This closed eye surgery prevents any leakage or ingress of infections or bleeding, hence minimizing risks. Routine phacoemulsification is performed through 2.2 mm tunnel. Further advances include sub 0.9 mm incision (or the microphaco or MICS-minimally invasive cataract surgery).It also enables patients to get back to their routine , almost immediately.

The so called ‘LASER CATARACT ‘ surgery is performed by using a ‘ femtosecond laser’ system to perform cataract surgery. This laser ensures very precise cuts without damaging surrounding structures and reduces the risk to the minimum.

As important as the technique of removing the cataract ,is the lens that is implanted during surgery. Intraocular lenses of appropriate power (calculated with sophisticated instruments)are inserted in place of the original lens to restore the sight.

Emmetropia or achieving 6/6 visual acuity is the aim of a perfect surgery. Intraocular lenses can be rigid (inserted through larger incision), foldable (injectable)injected through 2.2 or 0.9 mm tunnel incisions. The materials are polymers with UV blocking properties. Toric lenses neutralize astigmatism ensuring sharp and clear vision for distance or near. Monofocal lenses IOLs correct the power either for distance or near while multifocal lenses and accommodative ensure sharp focused vision for near, distance and intermediate vision.

Research edges towards the development of a ‘ no touch’ technique and restoration of perfect and crisp vision. However the technological sophistication comes at a price. The escalating costs of surgery are due to the expensive and technologically advanced equipment that the surgery demands .

Cataract blindness is the second most common cause for visual deprivation. Techniques like small incision cataract surgery , which use minimum instrumentation and indigenously produced intraocular implants aim to make this surgery affordable . NGOs and Government sponsored National programs , also ensure that cataract surgery is within the reach of one and all.

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