6 EyeWorld Asia-Pacific | March 2025 EDITORIAL Abhay Vasavada Regional Managing Editor EyeWorld India As always, this issue of Eyeworld Asia-Pacific brings us cutting-edge content and discussion. I note two prominent features within this current issue, both of which give us a good guide to consider the future. There is a discussion on a recently-emerging issue of the late decentered IOL. While it is known that pseudoexfoliation and other diseases associated with zonular weakness can cause a subluxation of the entire capsular bag which holds the IOL, dead bag syndrome is being recognized more among surgeons. Here, there is a spontaneous rupture in the posterior capsule in an in-situ capsular bag. Thus, this condition is truly an “IOL decentration” and not a bag decentration. The fact that there is a spontaneous rupture in the posterior capsule is intriguing. The culprit for this is the death of equatorial lens epithelial cells in the capsular fornices, leading to degeneration of the posterior capsule. At this point, unanswered questions include who will develop the disease, why only certain people develop it, why males predominantly develop the disease. The question remains: is there a relation with the kind of surgical technique or IOL choice? This new disease entity also presents an opportunity for us to better understand it, so as to develop better solutions. This issue of late IOL decentration also comes to mind, since we are now operating on cataracts during a much earlier stage. Refractive lens exchange is gaining ground, one of the other features in this issue. Today, there are so many different options for IOL selection, and I am sure the readers will enjoy the up-front practical tips that experts have shared on how to help patients make an informed choice on the type of IOL. What comes up from the experts’ opinions is that although we have all the counseling tools and counselors, it is usually the ophthalmologist who will be pivotal in making that final decision. So, it is equally important that we ourselves remain abreast of the pros and cons of each option we offer in our practice, and of what is coming in the near future. It is interesting to look at the two contrasting realities that present within the space of cataract surgery:one, where we aim to provide the finest quality and quantity of spectaclefree vision, even in clear lenses, and the other, where we have now started seeing remote but definite instances of late decentration of IOLs and particularly, dead bag syndrome. Would this also mean that we should start talking about this rare possibility to our patients undergoing a “routine” lens extraction and IOL implantation? What happens to patients who undergo surgery in their fifties and then have a long, active lifespan ahead of them? I am very hopeful that we will keep thinking laterally, to find answers to new problems and challenges presented to us!
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