EyeWorld Asia-Pacific September 2015 Issue

34 Femto cataract clinical update September 2015 EWAP SECONDARY FEATURE Femtosecond cataract - from page 33 of capsulorhexis formation, fragmentation, and bubbles formed and gas released in the nucleus. Surgeons can also watch their corneal incisions created live and get a sense of how dense a cataract is with the OCT technology. “It allows you to be confident with your laser treatments,” Dr. Weinstock said. New software upgrades will identify the pupil edge and the anterior and posterior capsule, so surgeons do not have to mark these areas, Dr. Weinstock added. The laser improvements facilitate a faster procedure. “The whole treatment time has been cut in half. By the time I walk in the room and then leave, it can be 3 minutes or even under 2 minutes,” he said. This year’s Victus upgrade also includes new fragmentation patterns, so surgeons have more elaborate patterns available. “They allow for more aggressive pretreatment to soften the cataract,” he said. Catalys Nearly all Catalys Precision Laser Systems (Abbott Medical Optics, Abbott Park, Ill.) now have the newest operating software, called COS3, and the latest Liquid Optics Interface 12, said Eric D. Donnenfeld, MD , clinical professor of ophthalmology, New York University Medical Center, New York. The upgrade includes a redesigned user interface, streaming real-time OCT images that have enhanced confirmation and incision control, and an enhanced Integral Guidance system that uses OCT to visualize ocular surfaces. “COS3 allows surgeons to make simple adjustments to the treatment plan, customizing to each patient,” Dr. Donnenfeld said. As with other lasers incorporating real-time OCT, this allows better visualization of structures and customization of incisions, he added. The Liquid Optics Interface 12 docking system is the first laser cataract surgery platform to offer two sizes of patient interfaces, so surgeons can treat more patients with it, Dr. Donnenfeld said. The interface has an inner diameter of 12 mm when undocked. Dr. Donnenfeld said the biggest advantages with the latest Catalys update is that it is user friendly, intuitive, and creates more precise incisions. Surgeons have increased visibility and are able to create a 99% free-floating capsulotomy. The Catalys system has some more plans on the horizon. “The next big innovation will be the ability to recognize the steep axis of the cornea to center arcuate incisions automatically and mark the steep axis for toric IOLs,” Dr. Donnenfeld said. LENSAR The LENSAR Laser System (Orlando, Fla.) with Streamline rolled out in April and is reaching laser systems across the country right now, said William Trattler, MD, Center for Excellence in Eye Care, Miami. The current upgrade includes several new or improved features. For one, the Cassini corneal shape analyzer (i-Optics, The Hague, the Netherlands) will be able to transmit data wirelessly to the actual laser system. This should help prevent data entry mistakes, Dr. Trattler said. The laser upgrade includes the use of iris registration, which integrates preop data into the actual The low energy and overlapping raster pattern utilized by the Ziemer Z8 laser creates a smooth laser capsulotomy as demonstrated on scanning electron micrograph, far more similar to a manual curvilinear capsulorhexis than the “postage stamp” rough edge noted with other femtosecond lasers, according to Dr. Machat. Source: Jeffrey J. Machat, MD procedure, so surgeons do not have to use manual markings. There is also an arcuate incision planning table to help define the location and depth of planned arcuate incisions, based on patients’ individual biometric factors. Arcuate incision planning preferences can be saved for later use. Another feature is cataract density imaging, which classifies the cataract to a fragmentation pattern that surgeons can predetermine and customize, Dr. Trattler said. The upgrade also has customized fragmentation patterns. All of these changes help LENSAR users to work more efficiently and cut down on the energy used for certain kinds of cataracts or boost it as needed, Dr. Trattler said.