Modern Cataract Surgery - an Update

Kammann J., Dornbach G.,
St.-Johannes-Hospital, Augenklinik (Dortmund)

Introduction: Modern cataract surgery is characterised by minimal trauma, short operating time, fast rehabilitation and by reaching a target refraction. Quality control is a further important characteristic.
Method: The bimanual phacoemulsification with intraocular lens implantation using scleral, prelimbal or corneal access is the standard method. Cataract surgery is not rarely also glaucoma surgery. Especially under the aspect of correction of astigmatism by specific choice of incision area and / or combined with corneal incision it has more and more become a part of refractive surgery. Operations also include clear lens extraction and increasingly a correction of presbyopia. The basic principle of all modern phacoemulsification techniques is the reduction of ultrasound energy and the additionall mechanic preparation of the nucleus and preparation for phacoemulsification respectively. All the most frequently applied methods, such as divide and conquer, chop, bevel down or manual preoperative nucleus devision have this aim in common before the actual phacoemulsification. The phacoaspiration technique as a further logical development is increasingly often employed. The phacotip and the irrigation are seperately indroduced into the anterior chamber through two 1.5 mm wide paracenteses. A less traumatic preparation of the nucleus can be achieved by a great suction-depth and a noticeable reduction of the phaco-energy in the pulse mode, consequently made possible. Up to now incision sizes of 1.5 mm were reserved for laserphacoemulsification only, with which, however, only low nucleus densities and firmness could be removed. Part of the cataract surgery is also the choice of matching intraocular lenses. There are spheric, toric, bifocal, multifocal and accomodative models on the market. The last three of which can also be employed for presbyopic lens exchange (prelex).
Conclusions: Cataract surgery has developed into small sutureless incision surgery. For this purpose various techniques are available. The choice of the operating method depends, apart from the anatomic condition, on the ability and the experience of the operator. Cataract surgery has been extended into areas which have no connection with the original cataract operation. It can be part of glaucoma surgery and refractive surgery, and by, the choice of specific lenses, also been imployed for the correction of presbyopia.

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