EyeWorld Asia-Pacific September 2013 Issue

63 EW PHARMACEUTICALS Septemebr 2013 Brian Huss, director of global marketing, LenSx lasers, discussed the LenSx machine, while Michael Knorz, MD , Germany, discussed being an early adapter of the technology, first using it in 2011. He learned it from Dr. Nagy, who was the first to use and publish about the machine. Dr. Knorz said that personally, he does not like pitting the four systems against each other as all four offer reproducible cataract surgery. “I do believe all the other laser systems are very reliable and work well. You’ll hear about Optimedica soon, we heard about LensAR, you’ll hear about the Victus. You won’t hear about the Zeimer [machine] because it’s not on the market yet, but we do have four systems. I do like competition. Competition for me as a customer guarantees faster evolution,” he said. Physicians presenting and the chairs debating emphasized that each system has unique benefits and negative aspects. Dr. Henderson asked each physician to name the main critique of the machines that they use, and each had a different answer – for instance, Dr. Knorz said the LenSx machine is still “very expensive” in his opinion, while Soon Phaik Chee, MD , Singapore, who spoke about the Victus machine, said that she has been waiting for more options to be introduced into the market for it. For the benefits, Dr. Knorz said the LenSx machine creates a perfect capsulorhexis, while Dr. Chee said the Victus creates accurate capsulotomies and is easy to dock and plan for treatment, among other benefits. Rob Eno, vice president, global marketing & international sales, Optimedica, spoke about the Catalys, while Robert P. Rivera, MD , U.S., said he first used an older version of the LenSx machine in 2011, but after issues with it, switched to the Catalys machine in August 2012, and it has proven to be an excellent machine for both him and his staff. “It’s time to say goodbye to phaco and hello to laser. This is a great innovation,” Dr. Rivera said. Finally, Frieder Loesel, PhD , chief strategy officer, Technolas Perfect Vision (which has formed a joint venture with B+L to develop the machine), and Dr. Chee spoke about the Victus and her experience with the femtosecond laser. Phaco tips for everyone The final session of the APACRS meeting in Singapore highlighted “Top Phaco Pearls” from a number of surgeons. They presented on tips on different skills or how to handle certain situations in this video-based symposium. The session’s panelists were Pannet Pangputhipong, MD , Thailand, Ronald Yeoh, MD , Singapore, Graham Barrett, MD , Australia and Roger Steinert, MD , U.S. Presenters at the session included Amar Agrawal, MD , India, Michael Knorz, MD , Germany, Mohan Rajan, MD , India, , Damien Gatinel, MD , France , Dr. Steinert , Chee Soon Phaik, MD , Singapore, Sri Ganesh, MD , India, Hungwon Tchah, MD , Korea, Dr. Pangputhipong , Hiroko Bissen- Miyajima, MD , Japan, Shamira Perera, MD , Singapore, Abhay Vasavada, MD , India, and Dr. Barrett. To kick off the session, Dr. Agrawal talked about the intraocular lens scaffold technique, which he uses to manage a sinking nucleus due to posterior capsular rupture. He said this technique can be helpful if you have fragments in the anterior chamber and are worried that they will fall down when you’re performing phacoemulsification. The technique is something that everyone can perform on their own in a clinic, he added. In addition to giving a presentation on a cataract complication with a small pupil, Dr. Steinert presented for David Hardten, MD , U.S., on the adjustment of a toric IOL. With the advance of the toric IOL, he said, surgeons are doing fewer astigmatic keratotomies. However, he noted that sometimes the toric IOL is not particularly helpful. “Sometimes the preop data misleads you,” he said. This misleading information can come from keratometry, topography and tomography. He said a helpful tool for trouble with a malpositioned lens is astigmatismfix.com , which can help suggest the optimum location to move the lens. You can be more accurate typically when you reposition these than in the initial surgery, Dr. Steinert said. Dr. Gatinel discussed whether or not it is necessary to remove a KAMRA lens before doing cataract surgery. In his case, he successfully performed phaco with the inlay still in the eye. Dr. Ganesh presented a safe, non-contact technique for polishing the posterior capsule he called hydropolishing, in which a 27-gauge cannula attached to a 5-cc syringe is used to clean the capsule. He compared the technique to using a hose to clean pavements. With this technique, he said, there is no need to use viscoelastic; if the surgeon does want to use viscoelastic to protect the cornea, he recommended using a minimal amount to allow the jet of fluid to do its work. He also said that instead of an AC maintainer, the surgeon should let the posterior capsule bulge anteriorly to create a shearing effect between the convex surface of the posterior capsule and the fluid jet. Dr. Pangputhipong presented on the hydrodissection minimal rotation. He said with phaco technique, you really do not have to depend too much on quality of the hydrodissection. Most nuclear disassembly techniques need hydrodissection because they require a good nuclear rotation, he said. To do this, he said you can either use a triangular crack or x pattern phaco technique. Dr. Bissen-Miyajima presented on what she said was a calm technique that people may already continued on page 66