EyeWorld Asia-Pacific September 2013 Issue

66 September 2013 EW PHARMACEUTICALS TECNIS ® Monofocal Intraocular Lens (IOL) Warnings: Physicians considering lens implantation under any of the conditions described in the Directions for Use labeling should weigh the potential risk/benefit ratio prior to implanting a lens. Precautions : Do not resterilize or autoclave. Use only sterile irrigating solutions such as balanced salt solution or sterile normal saline. Do not store in direct sunlight or in temperatures over 45°C. Adverse Events: The most frequently reported adverse event that occurred during the clinical trial of the 1-Piece lens was macular edema, which occurred at a rate of 3.3%. Other reported reactions, occurring in less than 1% of patients, were secondary surgical intervention (pars plana vitrectomy with membrane peel) and lens exchange (due to torn lens haptic). TECNIS ® Multifocal 1-Piece Intraocular Lens (IOL) Warnings: Physicians considering lens implantation under any of the conditions described in the Directions for Use labeling should weigh the potential risk/benefit ratio prior to implanting a lens. Some visual effects associated with multifocal IOLs may be expected because of the superposition of focused and unfocused images. These may include a perception of halos/glare around lights under nighttime conditions. It is expected that, in a small percentage of patients, the observation of such phenomena will be annoying and may be perceived as a hindrance, particularly in low-illumination conditions. On rare occasions, these visual effects may be significant enough that the patient will request removal of the multifocal IOL. Under low-contrast conditions, contrast sensitivity is reduced with a multifocal lens compared with a monofocal lens. Therefore, patients with multifocal lenses should exercise caution when driving at night or in poor-visibility conditions. Patients with a predicted postoperative astigmatism >1.0 D may not be suitable candidates for multifocal IOL implantation since they may not fully benefit from a multifocal IOL in terms of potential spectacle independence. Care should be taken to achieve centration, as lens decentration may result in patients experiencing visual disturbances, particularly in patients with large pupils under mesopic conditions. Precautions: The central one millimeter area of the lens creates a far image focus; therefore, patients with abnormally small pupils (~1mm) should achieve, at a minimum, the prescribed distance vision under photopic conditions; however, because this multifocal design has not been tested in patients with abnormally small pupils, it is unclear whether such patients will derive any near-vision benefit. Autorefractors may not provide optimal postoperative refraction of multifocal patients; manual refraction is strongly recommended. In contact lens wearers, surgeons should establish corneal stability without contact lenses prior to determining IOL power. Care should be taken when performing wavefront measurements, as two different wavefronts are produced (one will be in focus [either far or near], and the other will be out of focus); therefore, incorrect interpretation of the wavefront measurements is possible. The long-term effects of IOL implantation have not been determined; therefore, implant patients should be monitored postoperatively on a regular basis. Secondary glaucoma has been reported occasionally in patients with controlled glaucoma who received lens implants. The intraocular pressure of implant patients with glaucoma should be carefully monitored postoperatively. Do not resterilize or autoclave. Use only sterile irrigating solutions such as balanced salt solution or sterile normal saline. Do not store in direct sunlight or in temperatures over 45°C. Emmetropia should be targeted, as this lens is designed for optimum visual performance when emmetropia is achieved. Adverse Events: The most frequently reported adverse event that occurred during the clinical trial of the TECNIS ® Multifocal IOL was surgical reintervention, which occurred at a rate of 3.7% (lens-related: 0.6%; non-lens- related: 3.2%). Surgical reintervention included lens exchange, retinal repair, iris prolapse/wound repair, trabeculectomy, lens repositioning and lens removal due to patient dissatisfaction. The second most frequent adverse event was macular edema, which occurred at a rate of 2.6%. Other reported reactions were hypopyon and endophthalmitis, each occurring at a rate of 0.3%. Caution: Federal law restricts these devices to sale by or on the order of a physician. Do not use the lens if the package has been damaged. The sterility of the lens may have been compromised. Attention: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. Important Safety Information 2013.02.05-CT6339 know about but that she wanted to highlight. She said when doing phaco you may not need a lot of hydrodissection. In cases with a femtosecond laser, hydrodissection should be carefully done if the gas bubble is behind the lens nucleus, she said. Removing the phaco tip and injecting the OVD to allow the lens material to float is another option, Dr. Bissen-Miyajima said. Dr. Perera focused on glaucoma and angle closure. He said you always need to “hope for the best, but prepare for the worst.” “If you fail to prepare, prepare to fail,” Dr. Perera advised. He said to make sure to look out for folds in the anterior capsule and that loose lens syndrome can cause angle closure. If you have imaging, use that to your advantage, he said. And really, th e key is preparation. Abbott Medical Optics - TECHNIS Page: 66, 68 www.AbottMedicalOptics.com Bausch + Lomb and Technolas Page 29, 49 Phone: +65-6592-0792 Fax: +65-6286-0448 www.bausch.com www.technolas.com Carl Zeiss Meditec AG Page 23 www.meditec.zeiss.com/lisa-tri HOYA Surgical Optics Page 34 -35 Phone: 909-680-3900 www.hoyasurgicaloptics.com Moria Page 38, 43 Phone: +33 (0) 146744674 Email: moria@moria-int.com www.moria-surgical.com NOVARTIS – LUCENTIS Page 15, 31 , 36 Phone: +41 61 324 11 11 Fax: +41 61 324 80 01 www.novartis.com Oculus Optikgerate GmbH (Hong Kong) Page 50 Phone: +852-2987-1050 Fax: +852-2987-1090 Email: info@oculus.hk www.oculus.de Pearls - from page 60 Synergetics Inc Page 67 Phone: +636.939.5100 Fax: +636.939.6885 Email: customerservice@synergeticsusa.com www.synergeticsusa.com Shanghai Mediworks Pag e 2 Phone: 86-21-54260421 / 86-13524443833 Fax: 86-21-54260425 www.mediworks.biz Topcon Singapore Medical Pte Ltd Page 56 Phone: +65 6872 0606 www.topcon.com.sg TTI Medical Page 59 Phone: 800-322-7373 Email: info@ ttimedical.com www.ttimedical.com World Ophthalmology Congress (WOC2014) Page 16 www.woc2014.org Ziemer Ophthalmic Systems Page 5 www.femtoldv.com www.ziemergroup.com ASCRS Page 12, 18, 46 www.ascrs.org APACRS Pag e 7, 8, 37 www.apacrs.org To finish the session, the audience voted on the best tip. Dr. Vasavada received the most votes for his tip on managing a rupture in the posterior capsule. When a rupture occurs, he recommended injecting viscoelastic before retracting instruments, and using preservative-free triamcinolone to visualize and assess vitreous prolapse. He said surgeons should remember to manage fluid dynamics—lowering parameters including not just vacuum and flow but the bottle height—and should access the vitreous through a pars placata or pars plana approach since the aspiration forces from a frontal approach, even if you place the tip of the vitrector posterior to the capsule, will cause the vitreous to prolapse anteriorly and enlarge the tear. Also recognized for receiving a high number of votes were Dr. Pangputhipong and Dr. Chee. EWAP INDEX TO ADVERTISERS