Objective:

To evaluate the benefits and limitations of performing cataract surgery at physiologic intraocular pressure (IOP) compared to higher IOP levels, emphasizing the comparative outcomes.

Key Findings:

• High IOP during cataract surgery is associated with negative postoperative complications such as inflammation and corneal edema.
• Operating at physiologic IOP improves corneal clarity and reduces complications without increasing surgical time, supported by recent studies.
• Advanced fluidics technology allows for better IOP monitoring and reduces anterior chamber variability, contributing to safer surgical practices.

Interpretation:

The trend towards lower IOP during cataract surgery is supported by evidence indicating improved patient outcomes and reduced complications, particularly for patients with compromised optic nerves, suggesting a need for tailored surgical approaches.

Limitations:

• Lower IOP can reduce anterior chamber depth, limiting working space for the surgeon, particularly in complex cases.
• Reduced fluid flow may hinder lens fragment mobilization, especially for inexperienced surgeons, highlighting the need for training and technique adaptation.

Conclusion:

For most cataract surgery patients, operating at physiologic IOP is recommended due to its associated benefits, particularly for those with optic nerve compromise, while emphasizing the importance of individualized patient assessment.