Controversies, consensuses and guidelines on modern cataract surgery by the academy of Asia-Pacific professors of ophthalmology (AAPPO)

Abstract

Phacoemulsification has revolutionized cataract surgery since its introduction by Charles Kelman in 1967, becoming the gold standard for cataract removal in most parts of the world. Despite its widespread adoption and high success rates, there exist controversies within the ophthalmic community regarding various aspects of the procedure. An international panel comprising 25 experts from 18 countries/territories was established by the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO) to work on this consensus project. A total of 15 sections with 61 consensus statements were evaluated by the panel. Femtosecond laser assisted cataract surgery was not considered better than Phaco. An interferometer was considered essential for measuring the ocular parameters, and the need to choose an appropriate intraocular lens (IOL) formula was stressed. When considering multifocal IOLs, an assessment of the patient's personality profile, and a thorough discussion of the pros and cons of the choice before surgery was essential. Proper informed consent was also essential. The need to address complications like TASS promptly including a reassessment of operating rooms protocols was stressed. Finally, there was general agreement that manual surgeries have a significant role to play in eyes with large, dense nuclei and in populations where low-cost, high-volume surgery was necessary. Manual but sutureless approach was preferred where appropriate. Since there was agreement on about 60 % of the 61 consensus statements, it reflected that there were variations in the real-world practice. Further studies are warranted and a follow-up consensus exercise after more information is available is worth considering.

Keywords: Cataract; Manual Small Incision Cataract Surgery (MSICS); Phacoemulsification; Sutureless Large Incision Manual Cataract Extraction (SLIMCE).