Srinivas Sanjeev P, Young Alvin L, Behndig Anders, Chang David F, Dhubhghaill Sorcha Ní, Eom Youngsub, Fan Alex Hoi, Findl Oliver, Gundersen Kjell Gunnar, Khanna Rohit C, Kohnen Thomas, Mah Francis S, Miller Kevin M, Nanavaty Mayank A, Nuijts Rudy, Oshika Tetsuro, Pardianto Gede, Reus Nicolaas J, Ruit Sanduk, Sharma Namrata, Venkatesh Rengaraj, Zhang Mingzhi, Zheng Ke, Rao Srinivas K, Alió Jorge L
Consultant Cataract Cornea and Refractive Services, Darshan Eye Care, Chennai, Tamil Nadu, India.
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China.
Asia Pac J Ophthalmol (Phila). 2025 Jul-Aug;14(4):100224. doi: 10.1016/j.apjo.2025.100224. Epub 2025 Jul 6.
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.
自1967年查尔斯·凯尔曼引入超声乳化白内障吸除术以来，该技术彻底改变了白内障手术，成为世界上大多数地区白内障摘除的金标准。尽管该技术被广泛采用且成功率很高，但眼科界在该手术的各个方面仍存在争议。亚太眼科教授学会（AAPPO）成立了一个由来自18个国家/地区的25名专家组成的国际小组，致力于这个共识项目。该小组对总共15个部分的61条共识声明进行了评估。飞秒激光辅助白内障手术并不被认为比超声乳化手术更好。干涉仪被认为是测量眼部参数必不可少的工具，同时强调了选择合适的人工晶状体（IOL）公式的必要性。在考虑使用多焦点人工晶状体时，评估患者的个性特征以及在手术前对选择的利弊进行充分讨论至关重要。适当的知情同意也必不可少。强调了需要及时处理像TASS这样的并发症，包括重新评估手术室规程。最后，大家普遍认为，手动手术在处理大而致密核的眼睛以及在需要低成本、高量手术的人群中具有重要作用。在适当的情况下，首选手动但无缝合的方法。由于在61条共识声明中约60%达成了一致，这反映出实际临床实践中存在差异。有必要进行进一步研究，并且在获得更多信息后进行后续的共识研讨是值得考虑的。
