CATARACT: ETIOPATHOGENESIS, MODERN DIAGNOSTICS, AND MICROINVASIVE SURGICAL TREATMENT METHODS

Abstract

Cataract, defined as opacification of the crystalline lens, is the leading cause of blindness worldwide and a major cause of moderate-to-severe visual impairment, and it is one of the few causes of vision loss that can be fully corrected with a single, well-standardized operation. Lens opacification results from the cumulative effect of oxidative stress, crystallin aggregation and cross-linking, and disturbed lens-cell homeostasis, driven by aging and modified by ultraviolet exposure, diabetes, smoking, corticosteroid use, ocular trauma or inflammation, and genetic predisposition. This narrative review synthesizes current evidence on the etiopathogenesis, diagnostic evaluation, and surgical management of cataract, drawing on the American Academy of Ophthalmology Preferred Practice Pattern, landmark randomized trials and systematic reviews, and the ESCRS endophthalmitis prophylaxis study. Modern diagnosis combines best-corrected visual acuity and functional assessment with slit-lamp grading of lens opacities, dilated fundus examination, optical biometry for intraocular lens power calculation, and macular optical coherence tomography to identify coexisting disease that limits visual potential. Surgery is indicated when visual impairment interferes with daily activities. Phacoemulsification through a small clear-corneal incision with foldable intraocular lens implantation is the global standard, microincision techniques further reduce incision size and surgically induced astigmatism, femtosecond laser assistance has not shown a clear visual advantage over conventional phacoemulsification, and manual small-incision surgery provides outcomes comparable to phacoemulsification in resource-limited settings. Intracameral antibiotic prophylaxis substantially lowers the risk of postoperative endophthalmitis, and posterior capsule opacification is readily treated with Nd:YAG laser capsulotomy. Timely, individualized surgery guided by structured preoperative assessment and matched to local resources offers the greatest opportunity to restore vision and prevent avoidable blindness, including in Uzbekistan, where expanding access to safe, high-quality cataract surgery remains a public health priority.