Cataract: Advances in surgery and whether surgery remains the only treatment in future
Xinyi Chen, Jingjie Xu, Xiangjun Chen, Ke Yao*
Recently, Professor Yao Ke’s team from the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University School of Medicine (Zhejiang University Eye Hospital) published a titled “Cataract: Advances in surgery” in the journal “Advances in Ophthalmology Practice and Research” jointly published by Elsevier and Zhejiang University Press. and whether surgery remains the only treatment in future” review paper. The attending physician Chen Xinyi is the first author of the paper, and Professor Yao Ke is the corresponding author of the paper.
01 Thesis Guide
Cataract is the world's first blind eye disease. So far, surgery is the only definitive and effective way to treat cataracts. With the revolution of cataract surgery, the emergence of precision surgical techniques such as femtosecond assisted cataract surgery (FLACS) has made cataract surgical techniques evolve with each passing day. At the same time, functional intraocular lenses that have emerged at home and abroad are increasingly being used Meet the individual needs of patients, so that patients not only "see clearly" but also "see well and comfortable". Cataract surgery changed from rejuvenation surgery to refractive surgery, and entered the era of refractive cataract surgery. However, there is a huge gap in medical resources between different regions, especially in developing countries. There is still a gap between the rate of cataract surgery and medical resources. Therefore, although cataract surgery is an almost ideal operation and the complications are controllable, both patients and doctors dream of using medications. cataract. So, is surgery really the only way to treat cataracts in the future? Animal experiments have confirmed that the use of lanosterol in rabbits and dogs can reduce the severity of cataracts and partially restore lens transparency. Although there is still a lot of research on cataract reversal drugs, this pioneering work provides new strategies for the prevention and treatment of cataracts.
This article describes the current status of cataract surgery, keeps up with the innovation of cataract surgery, summarizes the latest progress in the application of cataract surgery, summarizes and compares different types of functional intraocular lenses, and at the same time, carries out the latest discoveries of cataract reversal related drugs. introduce.
Cataract is the world's leading cause of blindness. About 51% of blindness is related to cataract. Cataract has caused 52.6 million people with moderate to severe vision loss. Currently, there is no effective method for cataract prevention or drug treatment that has entered clinical practice. Therefore, surgical removal of the cloudy lens and implantation of an intraocular lens (IOL) is still the only means to restore the vision of cataract patients. This review summarizes the latest cataract surgery techniques, recent advances in functional intraocular lenses, and emerging cataract treatment drugs.
With the continuous improvement of surgical equipment and technology, cataract surgery has proven to be one of the safest and most successful operations in the world. With the improvement of living standards, new technologies such as micro-incision cataract surgery and high-end intraocular lenses have emerged one after another, and the demand for cataract surgery has also evolved from restoration of vision to improvement of vision. Cataract surgery changed from rejuvenation surgery to refractive surgery, and entered the era of refractive cataract surgery. Functional intraocular lenses are more and more widely used to meet the individual needs of patients. For example, multifocal intraocular lenses are better than single-focal intraocular lenses in the near vision of the naked eye, and can obtain both distance and short distance lens removal. However, some patients show discomfort such as glare and halo after multifocal lens implantation. At the same time, another new type of intraocular lens-continuous visual range (EDOF) intraocular lens can bridge the gap between single-focal intraocular lens and multifocal intraocular lens by improving mid-range vision and providing better contrast sensitivity. In addition, for patients who need to correct corneal astigmatism, Toric intraocular lenses create new possibilities to meet their individual needs. More than 70% of patients can see far away without glasses.
In addition to the design of the intraocular lens, the improvement of surgical technology may also play a decisive role in further improving the postoperative visual effect. In recent decades, the incision for cataract surgery has been reduced from 11 mm (ECCE) to 1.8 mm or smaller (PCS), and it has effectively reduced surgical trauma, surgical astigmatism, and postoperative inflammation. Although modern cataract surgery has made great progress, patients' expectations for the safety and accuracy of the operation are also increasing, and femtosecond laser-assisted cataract surgery (FLACS) has entered the public eye. Femtosecond laser can assist in pre-chopping nucleus, circular capsulorhexis, corneal incision, astigmatism correction and other steps in cataract surgery. Femtosecond laser assist can accurately execute every step, optimize IOL position and refractive state, and significantly improve the performance of cataract surgery Accuracy, effectiveness and safety provide new options for patients and ophthalmologists. With the accumulation of clinical experience, FLACS has reached a relatively mature state, and it is increasingly used in complex situations, such as hard nuclear cataract, total cataract, Marfan syndrome, lens subluxation, Alport syndrome, and shallow anterior Room and so on.
In recent years, the research on artificial intelligence (AI) in ophthalmology has progressed rapidly, especially in the field of machine learning and deep learning. Artificial intelligence systems have been partially used for glaucoma and retinal diseases. The application of AI in cataracts is increasing. Research shows that compared with professional graders, deep learning is superior to other published automatic cataract grading methods. However, since the research on cataract AI is limited to providing assistance for diagnosis, the next step of research is still focused on whether it is possible to extend its application to surgery.
The emergence of postoperative complications and the limitations of intraocular lenses have prompted people to consider screening cataract treatment drugs. Antioxidants or active oxygen scavengers have been shown to protect the lens from peroxidation and have a positive effect on slowing down the process of cataract formation, but the process of cataract formation cannot be reversed. It is newly discovered that the use of lanosterol in rabbits and dogs can reduce the severity of cataracts and partially restore the transparency of the lens, but its efficacy is strict in vitro and its application is limited. Although we have been looking forward to the drug treatment of cataract, the research of cataract prevention and treatment drugs has also made progress. However, there are no strict clinical controlled studies yet, and drug research is still in laboratory research. Therefore, surgery is still the only effective way to treat cataracts, but future cataract drug treatments are worth looking forward to.
Cite this article:
Xinyi Chen, Jingjie Xu, Xiangjun Chen, Ke Yao. Cataract: Advances in surgery and whether surgery remains the only treatment in future. Advances in Ophthalmology Practice and Research, 2021,1: 100008.
https://doi.org/10.1016/j.aopr.2021.100008
02 about the author
Professor Yao Ke Corresponding Author
Professor of Zhejiang University, tutor of doctoral students, academician of the International Academy of Ophthalmology, current director of the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University, chairman of the Ophthalmology Society of the Chinese Medical Association, and a leader in ophthalmology in China. In addition, he is also a special expert in Zhejiang Province, the leader of the Zhejiang Province ophthalmology innovation team, specializing in ophthalmology. He is currently the dean of the Zhejiang University Eye Hospital, the director of the Institute of Ophthalmology of Zhejiang University, the director of the Eye Center of the Second Affiliated Hospital, and serves as the Asia Pacific Cataract and President-elect of the Society of Refractive Surgery (APACRS), standing director of the International Council of Ophthalmology (ICO), head of the Asia Pacific Academy of Ophthalmology (APAO) China, director of the Asia Pacific Academy of Ophthalmology (AAPPO), and International Intraocular Lens Implantation Club (IIIC) He is the executive director of the Chinese Medical Association, the executive director of the Chinese Medical Doctor Association, the cataract group leader of the Ophthalmology Branch of the Chinese Medical Association, the chairman of the Zhejiang Association for Science and Technology, the chairman of the Zhejiang Medical Association, and the honorary chairman of the Zhejiang Medical Association.
Dr. Chen Xinyi, first author
Graduated from the eight-year ophthalmology program of Zhejiang University School of Medicine, under the Ph.D. under the tutelage of Professor Yao Ke. Long-term commitment to cataract clinical research, stem cell lens regeneration and other fields, published nearly 20 SCI papers, including the first author in Journal of Cataract & Refractive Surgery, The Cochrane database of systematic review and other academic journals published many papers, participated in A number of national, provincial and ministerial projects such as the National Natural Science Foundation of China and the National Key R&D Program.
Editing | Chen Xinyi Arrangement | Ding Simin Review | Yao Ke, Wang Kaijun