Cataracts in the Adult Eye

Refractive cataract surgery has the potential to reduce a patient’s dependence on eyeglasses and contact lenses for distance, intermediate, and near vision.

Intraocular lens technologies and surgical approaches to implanting lenses continue to improve.

Femtosecond laser-assisted cataract surgery (FLACS) increases the circularity and centration of the capsulorrhexis and reduces the amount of ultrasonic energy required to remove a cataract. However, the technology may not yet be cost-effective, and the overall risk profile has not yet been shown to be superior to that of standard phacoemulsification.

The use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) is controversial, with evidence suggesting that NSAIDS only be used for the prevention of cystoid macular edema (CME) in patients with diabetic retinopathy or other high-risk ocular comorbidities.

Increasing evidence demonstrates that intracameral antibiotics reduce the risk of postoperative bacterial endophthalmitis.

Surgeons should recognize and prepare to manage high-risk characteristics that may complicate cataract surgery. New risks may become apparent as new technologies come to market. One example is capsular damage with rapid development of a complicated cataract associated with intravitreal injections.

Toxic anterior segment syndrome (TASS) may be confused with infectious endophthalmitis. However, TASS has an earlier onset, is associated with limbus-to-limbus corneal edema, and responds to corticosteroids.