Latest Techniques in Cataract Surgery

1. Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Principle: Uses a femtosecond laser to perform key steps of cataract surgery with precision.

Steps:

Laser creates corneal incisions, capsulotomy, and nucleus fragmentation.
Phacoemulsification (ultrasound) removes the fragmented lens.
Intraocular lens (IOL) is implanted.

Advantages: Increased precision, reduced corneal damage, better IOL centration.

Disadvantages: Expensive, longer surgical time.

2. Micro-Incision Cataract Surgery (MICS)

Principle: Uses an incision size of <2.2 mm to remove the cataract lens.
Advantages: Faster healing, lower infection risk, minimal astigmatism.
Disadvantages: Requires advanced skills, difficult for dense cataracts.

3. Phacoemulsification with Advanced Fluidics

Phacoemulsification (Phaco) is the most commonly used modern cataract surgery technique that employs ultrasound energy to break up the cloudy lens (cataract) into tiny fragments, which are then suctioned out of the eye. It is a minimally invasive procedure that allows faster recovery and better visual outcomes.

Phacoemulsification Procedure

Anesthesia:

Performed under topical anesthesia (eye drops) or local anesthesia.

Small Incision:

A small incision (2.2-2.8 mm) is made in the cornea.

Capsulorhexis:

A circular opening is created in the lens capsule.

Ultrasound Phacoemulsification:

A phaco probe emits ultrasound waves to break the lens into fragments.
Fragments are aspirated (suctioned out).

IOL Implantation:

An intraocular lens (IOL) is inserted inside the lens capsule.

Self-Sealing Incision:

The incision is usually self-sealing, so no sutures are needed.

Advantages of Phacoemulsification

✅ Small Incision → Faster healing and reduced astigmatism
✅ No Stitches Required → Lower risk of infection
✅ Minimal Pain → Performed under topical anesthesia
✅ Quick Recovery → Normal vision returns within days
✅ Can Implant Premium IOLs → Multifocal, toric, and accommodative IOLs for better vision

Limitations of Phacoemulsification

❌ Not Ideal for Very Hard Cataracts → High ultrasound energy can damage the cornea
❌ Requires Expensive Equipment → Not available in all hospitals
❌ Surgeon Expertise Needed → Risk of complications if not performed correctly

4. No-Injection, No-Stitch, No-Patch Cataract Surgery

Principle: Uses topical anesthesia with self-sealing incisions.
Advantages: Faster recovery, minimal discomfort, lower complication risk.
Disadvantages: Not suitable for uncooperative patients, difficult for dense cataracts.

5. Intraoperative Aberrometry for IOL Power Calculation

Principle: Measures refractive power after cataract removal for precise IOL selection.
Advantages: More accurate IOL selection, fewer refractive surprises.
Disadvantages: Costly, requires experience in interpretation.

6. AI-Assisted Cataract Surgery

Principle: Integrates artificial intelligence (AI) into surgical planning and execution.

Examples:

AI-powered biometry for precise IOL calculations.
Machine-learning algorithms for predicting complications.

Advantages: Personalized surgical planning, better outcomes.

Disadvantages: Requires AI-integrated systems, high cost.

Conclusion

The latest cataract surgery techniques focus on precision, safety, and better visual outcomes. Medical students should be aware of these advancements as they are transforming cataract management.