Changing techniques in cataract surgery: how have patients benefited?

Cataract surgery is one of the most frequently performed operations in the world. Recent advances in techniques and instrumentation have resulted in earlier intervention, improved surgical outcomes, and reduced dependence on spectacles

IOLs for cataract surgery

In low- and/or middle-income countries, manual small-incision cataract surgery (MSICS) using rigid polymethylmethacrylate (PMMA) monofocal intraocular lenses (IOLs) has remained the default option for decades, as MSICS can be performed in basic clinical settings, and because these are the most affordable type of lens, costing around USD 17 in Africa and as little as USD 3–4 for a locally manufactured IOL in India. However, in recent years, an increasing number of IOL types have become available worldwide (see panel). In low-resource settings, the challenge is to balance good clinical practice with patient needs, costs, and infrastructure. In resource-limited settings, a pragmatic approach, focusing on monofocal and advanced monofocal lenses, selective use of toric lenses, and efficient inventory management, can help to ensure cost effective personalised care with the best possible refractive outcomes

IOLs in India: How and where they are used

A wide variety of IOL types are now available in India

Antibiotic prophylaxis in cataract surgery – An evidence-based approach

Various protocols are being followed for endophthalmitis prophylaxis in cataract surgery, and this subject continues to be a matter of debate. We summarize the most recent evidence-based studies on this topic with additional stress on intracameral (IC) antibiotic prophylaxis. Here, we discuss several large, international clinical studies which discuss the efficacy, adoption, safety, cost, and newer trends in antibiotic prophylaxis. Majority of these studies report a significant reduction in endophthalmitis rates with IC antibiotic prophylaxis. Efficacy data have been reported for IC cefuroxime, vancomycin, and moxifloxacin. Surgeons are now looking for alternatives to vancomycin for IC prophylaxis because of its association with the rare but sight-threatening complication of hemorrhagic occlusive retinal vasculitis. A recent large clinical study shows convincing efficacy with IC moxifloxacin prophylaxis. Two large studies have also reported significant endophthalmitis reduction following use of IC antibiotic prophylaxis, in eyes with posterior capsule tear which are at highest risk for infection. Except for one randomized controlled trial, there is a lack of prospective data on this subject; however, considering the complexity of performing such studies, surgeons have to rely on the mounting evidence from other recent big data studies. Availability of approved intraocular antibiotic formulations will see a much higher adoption in the future