Incremental Improvements

Patient safety the winner as cataract surgery continues to innovate. Dermot McGrath report.

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A spectrum of ongoing incremental improvements to technologies and surgical techniques has completely transformed cataract surgery and improved outcomes and patient safety over the past decade, according to Ewa Mrukwa-Kominek MD, PhD. Speaking during a special session organised by the Cataract and Refractive Surgery Section of the Polish Ophthalmological Society at the 25th ESCRS Winter Meeting, Dr Mrukwa-Kominek said advances in phacoemulsification equipment allied to improved intraocular lens design and implantation devices have taken cataract surgery to new levels of safety and comfort. “All of these advances in technology have enabled us to perform surgery with greater precision, efficiency, and with a reduced risk of complications for patients. More recent innovations such as intraoperative OCT and 3D visualisation systems will further enhance our outcomes and raise the bar for safer and more efficient surgery,” she said. The postoperative visual acuity attained by a patient depends not only on surgical experience but also on the available equipment and rigorous preoperative assessment of the eye, noted Dr Mrukwa-Kominek. “Phacoemulsification technology has evolved over time with improvements in phacodynamics and advanced fluidics to reduce the amount of energy being delivered into the eye. The goal is to minimise trauma to the cornea and ocular tissues. Other developments in viscoelastics, torsional phacoemulsification, and enhanced tip design have also helped to enhance efficiency,” she said. Dr Mrukwa-Kominek highlighted some of the recent enhancements to phacoemulsifcation systems such as the Centurion Vision System (Alcon), which enables surgeons to maintain anterior chamber stability and dynamically control intraocular pressure. “The innovative design and occlusion surge reduction supports safety, consistency, and control. There is also improved responsiveness as the handpiece is equipped with a fluidics pressure sensor and the tip incorporates polymer technology to reduce damage to the capsular bag and other tissues,” she said. In terms of intraocular lens design, Dr Mrukwa-Kominek said preloaded IOL systems have made life easier for surgeons. “Fully preloaded and disposable IOL systems have enhanced safety as there is no need to touch or manipulate the lens. We can deliver the IOL quickly and easily into the capsular bag with less pressure on the eye. The market trend towards fully preloaded disposable IOL systems will account for up to 40% of all IOLs for the western European market by 2022 compared to 23% in 2018,” she said. Other recent advances highlighted by Dr Mrukwa-Kominek included intraoperative guidance systems for toric lenses, as well as 3D visualisation devices, intraoperative OCT imaging, and digital microscopes for enhanced surgical comfort. “As well as allowing us to perform surgery with greater precision and efficiency, many of these new tools are also excellent for training young ophthalmologists, which is very important in university centres,” she concluded.
Tags: cataract and refractive