Cataract surgery today

Due to the enormous developments in the digital optic, the laser technology and the production of instruments in the past years, modern eye surgery has been subject to extreme alterations, which have remarkably exceeded the usual extent of innovations in other medical fields.
Due to fundamental improvements in diagnostic and operative possibilities, over 90% of all eye surgeries nowadays are performed on an outpatient basis. After a successful surgery, many activities can be accomplished by the patient without the need of glasses. This is possible due to the combination of the “small incision technique” and the use of foldable intraocular lenses.

Thus, the former obligatory wound suture, which inevitably led to an increase in irregular curvature of the cornea (astigmatism), is meanwhile omitted. Only a few days after surgery, many patients are nowadays able to see faraway objects clearly without glasses or are generally only in need of standard glasses when reading a newspaper.

A further aspect that has developed modern cataract surgery to an absolutely fear-free keyhole surgery is the introduction of drip anesthesia. For this, in addition to the well-known pupil dilation during preoperative preparation, only the use of topical anesthetic is necessary. This not only allows a safe but also a pain-free surgery without the need of local anesthetic injections next to or behind the eyeball. This local injection, also known as retrobulbar or peribulbar injection, was indeed an improvement towards the endotracheal anesthesia, however revealed some problems: pain of the patients during the injection, possible injuries of the eyeball or the optic nerve up to possible consequences such as a permanent circulatory disorder of the macula. 

With an increasingly reliable calculation of the intraocular lens through the so-called “optical biometry” as well as the availability of different toric and multifocal lenses, it is possible for us to not only treat cataract but at the same time attend to a patient’s higher ametropia, such as myopia or hyperopia and astigmatism.