Dr Liu and colleagues address an important topic concerning the limitations of intraocular cataract surgery and implantation of a visual prosthesis in an eye with an opaque cornea. Indeed, the surgical strategy remains one of the major limiting features in the field of bioengineering and undergoes a constant change following the design of the prosthesis. One possible future strategy might be the endoscopic visualization of the anterior chamber. Uka et al1 impressively demonstrated the feasibility of endoscope-aided cataract surgery in severe corneal opacity. However, as long as the implant is not foldable and therefore requires an incisional diameter of more than 13 mm, a 180° open-sky extracapsular lens extraction and implantation under direct visualization2 will be a more appropriate approach. In the long term, a small-incision technique would be a great improvement.
Szurman P, Warga M, Bartz-Schmidt KU. Experimental Implantation and Long-term Testing of an Intraocular Vision Aid in Rabbits—Reply. Arch Ophthalmol. 2006;124(4):610. doi:10.1001/archopht.124.4.610