Power and Precision: The New Era of Phacoemulsification Technology

Thomas KOHNENGermany Speaker Power and Precision: The New Era of Phacoemulsification TechnologyModern phacoemulsification technology has evolved into a precise, efficient, and customizable system that supports both standard cataract surgery and refractive visual outcomes. Contemporary devices integrate intelligent fluidics, responsive energy delivery, and enhanced intraoperative control, aiming to improve safety and reduce corneal trauma. Femtosecond laser platforms contribute by standardising capsulotomies, fragmenting the nucleus, and enabling astigmatism-neutral corneal incisions, which supports predictable refractive results and facilitates the use of advanced IOL designs. Astigmatism management remains central to postoperative quality, with digital marking systems improving axis alignment and complementing toric IOL implantation. Sustainability is gaining relevance as reusable tubing, cassettes, and blades reduce environmental burden without compromising safety. Across these domains, innovation focuses on precision, patient-centred refractive planning, and resource-conscious implementation. The new era of phacoemulsification combines technological refinement, optical optimisation, and sustainable strategy to advance cataract surgery outcomes.Bridging Cornea and Lens: The Modern Role of Phakic IOLs in a Myopic WorldPhakic intraocular lenses provide a valuable refractive option for patients with myopia extending beyond the safe limits of corneal laser procedures. Positioned either in the anterior or posterior chamber, they preserve the natural crystalline lens and maintain corneal structure, making them particularly suitable when optical quality, contrast vision, or biomechanical stability must be prioritised. Current guidelines support their use from low to high myopic ranges, with toric designs enabling simultaneous astigmatism correction. Compared with laser-based approaches, phakic IOLs deliver strong visual performance and high patient satisfaction, especially in moderate and high myopia. Long-term outcomes highlight the need for monitoring endothelial cell behaviour and cataract formation as part of routine follow-up. When cataract develops later in life, bilensectomy combines IOL explantation with cataract surgery to preserve refractive goals. Phakic IOLs bridge the space between corneal and lenticular refractive strategies and remain central in modern myopia management.From Awareness to Action: Stepwise Learning to Manage Capsular Rupture During Cataract SurgeryPosterior capsular rupture remains a decisive intraoperative challenge during cataract surgery, most often occurring during lens removal, cortical aspiration, or IOL implantation. Successful management requires early recognition, maintenance of chamber stability, and prevention of nuclear descent into the vitreous. This work presents a structured escalation strategy guiding surgeons from awareness of risk factors to practical intervention. Key steps include controlled viscoelastic support, careful manipulation of remaining lens material, and appropriate anterior or pars plana vitrectomy when vitreous prolapse occurs. IOL selection must be adapted to capsular integrity, allowing placement in the bag when stable or in the sulcus with or without optic capture when support is limited; alternative fixation methods remain essential fallback options. Case examples illustrate that even multifocal IOL implantation is achievable despite rupture if capsular support is preserved and decision-making remains systematic. The stepwise approach aims to enhance intraoperative safety, reduce complication impact, and preserve refractive goals in modern cataract surgery.