Advances_in_Cataract_Surgery_Undergraduate_Lecture.pptx

Advances in ophthalmology

1. Advances in Cataract Surgery Undergraduate Lecture Dr. Trupti Bhesaniya Assistant Professor, GMC, Surat

2. Learning Objectives Describe the evolution of cataract surgery techniques. Explain the principles and advantages of small incision and phacoemulsification surgeries. Understand the types and advances in intraocular lenses (IOLs). Outline newer technologies in cataract surgery (femtosecond laser, AI-assisted systems).

3. Introduction Cataract = Opacity of the lens leading to visual impairment. Surgery is the only definitive treatment. Goal: Restore vision rapidly, safely, and accurately. Evolution: Large incisions → microincisions + premium IOLs.

4. Historical Perspective Ancient: Couching – dislocation of lens into vitreous. 18th century: ICCE – entire lens removed, aphakia resulted. Mid-20th century: ECCE – posterior capsule preserved. 1990s: Phacoemulsification – ultrasonic fragmentation. 2000s onward: SICS, Femtosecond, AI-guided systems.

5. Manual Small Incision Cataract Surgery (MSICS) Self-sealing scleral tunnel (5.5–6.5 mm). No sutures, low cost, faster healing. Popular in developing countries. Advantages: less astigmatism, faster recovery than ECCE.

6. Phacoemulsification Gold standard modern technique. Principle: Ultrasonic energy emulsifies the nucleus, aspirated out. Small incision (2.2–2.8 mm), capsulorhexis, hydrodissection, IOL implantation. Advantages: small incision, minimal astigmatism, rapid recovery.

7. Microincision Cataract Surgery (MICS) Incision < 2.0 mm. Reduces surgically induced astigmatism. Allows injection of foldable IOLs.

8. Femtosecond Laser–Assisted Cataract Surgery (FLACS) Uses ultra-short laser pulses for incisions, capsulotomy, and lens fragmentation. Advantages: precision, reproducibility, reduced phaco energy. Limitations: high cost, learning curve.

9. Image-Guided & AI-Assisted Systems Real-time intraoperative guidance (e.g., Verion, Callisto). Assist in IOL alignment and astigmatism correction. AI-based preoperative planning and smart operating microscopes.

10. Advances in Intraocular Lenses (IOLs) Foldable Acrylic IOLs – small incision use. Aspheric IOLs – improved contrast sensitivity. Toric IOLs – correct astigmatism. Multifocal / Trifocal IOLs – spectacle independence. EDOF IOLs – extended focus range, fewer halos. Accommodative IOLs – mimic accommodation (limited).

11. Future Directions Smart IOLs with adjustable power. Robotic-assisted cataract surgery. Nanotechnology and lens regeneration research.

12. KERATOPLASTY DSEK /DSAEK DMEK

13. TYPES OF KERATOPLASTY 1. PENETRATING KERATOPLASTY 2. LAMELLAR KERATOPLASTY Anterior lamellar – SALK , DALK Posterior lamellar – DSEK /DSAEK , DMEK.

14. DSEK/DSAEK Descemet’s Stripping (automated) Endothelial Keratoplasty Common indications- Fuchs endothelial dystrophy, Pseudophakic endothelial dystrophy. Advantage – easier Disadvantage –interphase haze more common. DMEK Descemet’s membrane endothelial keratoplasty (no stroma). Indications are same but for clear stroma cornea. Advantage –thinner graft , fast recovery. Disadvantage –technically demanding.

15. GLAUCOMA SURGERY minimally invasive glaucoma surgery (MIGS) glaucoma drainage devices (GDDs)

16. MIGS – shunts Trabecular stenting devices iStent , Hydrus Suprachoroidal devices iStent supra , CyPass , MINIject Subconjunctival Xen Gel Stent

17. GLAUCOMA DRAINAGE DEVICES A fibrous capsule forms a bleb around the external portion. IMPLANTS – Valvular( flow restricted) – Ahmed Krupin Non- valvular (open tube) – Barveldt , Molteno , Aurolab Aqueous drainage implant.

18. Summary Cataract surgery has evolved from vision restoration to vision enhancement. Small incision + advanced IOLs = modern standard. Technology integration → safer, faster, more predictable outcomes.