Î Symptomatic cataract is a surgical disease. Dietary intake and
nutritional supplements have demonstrated minimal to no effect in the
prevention or treatment of cataract. (III, G, S)
Î The standard of care in cataract surgery in the United States is a
small-incision phacoemulsification with foldable intraocular lens (IOL)
implantation. It is a standard of care that has withstood the test of
time.
Î Refractive cataract surgery has the potential to reduce a patient's
dependence on eyeglasses and contact lenses for distance,
intermediate, and near vision.
Î Intraocular lens technologies and surgical approaches to implanting
lenses continue to improve.
Î 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.
Î 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.
Î Increasing evidence demonstrates that intracameral antibiotics
reduce the risk of postoperative bacterial endophthalmitis.
Î 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.
Î 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.
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