Technology and needs for tomorrow's treatment of cataract

摘要

Cataract surgery is considered to be the most successful surgery worldwide. However, new developments are ongoing either to improve the surgical stress or to improve the surgical outcome. While restoration of the transparency and optical parameters of the eye were initially the first goals, the need to improve the quality of sight (QOS) and to restore accommodation became evident during the last decades. By introducing the bag-in-the-lens (BIL) intraocular lens (IOL) and technique of implantation (US Patent 6,027,531) in 2000, PCO was no longer a matter of concern. Clinical studies conducted between 2000 and 2004 proved the efficacy of this new IOL with respect to PCO control, but showed additional advantages like surgeon-controlled centration and rotational stability. Surgeon-controlled IOL centration based on the alignment of the first and third Purkinje reflexes is one method to promote IOL centration but future tracking devices will probably enhance the precision by which IOL centration along the line of sight can be achieved. Optimal alignment is a major issue if toric correction and compensation of the spherical aberrations is intended to be incorporated into the IOL optic. IOL optics with toric correction to compensate for regular astigmatism are in development now, but toric correction for irregular astigmatism remains extremely challenging for the manufacturers. Improving the quality of the image by compensating for the spherical aberrations is the next step on our research programme. The BIL offers some opportunities to optimize postoperative accommodation by introducing the capsular accommodation ring.