gms | German Medical Science

Modern cataract surgery is characterized by minimal trauma, short operation time, fast rehabilitation and in most cases emmetropia as aimed refraction. Another important characteristic is quality management.

The bimanual phacoemulsification with implantation of an intraocular lens via sceral, pre-limbal or corneal approach is the standard procedure. Cataract surgery is often also glaucoma surgery. But it is also getting more and more part of the refractive surgery especially from the aspect of astigmatism correction via choice of approach and/or in combination with corneal incisions, or clear lens extraction. Furthermore cataract surgery is used more and more as presbyopia correction. The main aim of all modern phaco techniques is to reduce the ultrasound energy required and to prepare the nucleus mechanically for phacoemulsification. All commonly used methods such as divide and conquer, chop, bevel down, phacoaspiration and manual pre-operative nucleus division have this same goal. Phacoaspiration is increasingly applied as logical further development. This technique makes it possible to extract the lens under simultaneous separate fluid addition via a 1.5 mm small incision due to its high suction values and small diameter of the needle, this being a technique which used to be reserved for laser phacoemulsification which, however, could only be used in cases with low nucleus density and hardness.

Part of the cataract surgery is choosing the right intraocular lens. There are spheric, toric, bifocal, multifocal and accommodative models on the market. The last three models named being used for presbyopic lens exchange (prelex).

The choice of operation method is not only dependent on the anatomical situation of the lens but also on the ability and experience of the surgeon.