EyeWorld Asia-Pacific March 2011 Issue

3 March 2011 Letter from the Editor Dear Friends T his issue of EyeWorld Asia-Pacific is headlined by a report on a symposium on “Minefields and Battles”—a useful metaphor to describe challenging situations which are encountered in ophthalmic surgery. My own contribution to this symposium focused on the importance of achieving an intact curvilinear capsu- lorhexis in cataract surgery. I discussed how to prevent tears in the anterior capsule and also strategies to manage and prevent extending a tear if this should occur. In discussing the topic all members agreed that in the presence of an intact rhexis further complications in cataract surgery were ex- ceedingly rare. Furthermore, a central round rhexis with a consistent diameter was also thought to be important in ensuring a well-centered implant with a predictable location of the principal plane of the optic. In addition to accurate biometry, a consistent position of an implant plays an important role in being able to accurately predict the refractive outcome for an individual patient which has become so important in assessing the success of modern cataract surgery. Perhaps the most attractive aspect of femtosecond cataract surgery therefore is the po- tential for this technology to consistently create a capsulorhexis which fulfils these criteria. The latest updates on femtosecond technology for cataract surgery is also covered in this issue. Currently, there are four suppliers of femtosecond cataract systems: LenSx (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland), LensAR (Winter Park, Fla., USA), Optimedica (Santa Clara, Calif., USA), and Technolas (Munich, Germany). All systems are capable of creat- ing corneal incisions, softening the nucleus and creating a predictable rhexis. It is interesting to speculate on how widespread femtosecond laser cataract surgery will be practiced in the next few years. The technology is fascinating but there are several issues which need to be considered. The increased cost may be a limiting factor in some markets but this did not prove to be a barrier to the widespread use of femtosecond lasers for flap creation for LASIK in the Asia-Pacific region. Femtosecond cataract surgery may initially increase the procedure time and adjustments to patient flow may be required to mitigate this issue. Ultimately, the utility of femtosecond cataract surgery will be judged by the advantages and improved outcomes offered by the tech- nology. A more precise corneal incision may create a more secure wound but modern keratomes are very effective. Although less ultrasound power may be required after femtosecond softening, surgeons require phacoemulsification and I doubt this will be a compelling reason for using this new technology. Pulsed water jets (AquaLase, Alcon) and rotational energy (NeoSoniX, Alcon) also reduce the required ultrasound energy to emulsify a nucleus but have limited appeal. The ability to create a reproducible rhexis with femtosecond technology, however, is quite unique and I believe will ensure that femtosecond cataract surgery will be widely practiced. So in the same issue we have highlighted one of the most critical steps in cataract surgery and included some suggestions as well as new technology which should reduce rhexis-related complications in the future. I hope readers will find the topics discussed thought provoking and also enjoy the many other articles contained in our March issue of EyeWorld Asia-Pacific . Warmest regards Graham Barrett, MD President, APACRS Chief Medical Editor, EyeWorld Asia-Pacific