EyeWorld Asia-Pacific September 2018 Issue

that could be adopted by those us- ing femto technology today. “The research is at a level where this basic differentiation should be done. For general divi- sion in the very dense cataract and moderate or low cataract levels, [optimized lens fragmentation] is something we can do,” Dr. Shajari said, noting that further research should be done to refine pattern selection. Dr. Shajari thinks the lower EPT with FLACS is especially useful in specific cases. “When you have a patient with endothelial dystrophy and you know you shouldn’t use too much ultrasound power because this will reduce the cell count and lead to further side effects … when we know a way to decrease the ul- trasound energy that we are giving to the eye, I think it makes a lot of sense for them. This would be for me a clear reason to shift from con- ventional cataract surgery to femto cataract surgery,” he said. Lowering ultrasound energy delivered to the eye, Dr. Shajari said, could lead to less inflamma- tion and a lower rate of cystoid macular edema. Overall, Shajari et al. wrote, “more studies that assess the cor- relation between different frag- mentation patterns and their effect on measurement outcomes such as EPT and cumulative dissipated energy are necessary.” As a final point, Dr. Shajari mentioned that conventional phacoemulsification cataract surgery has had decades to im- prove, while FLACS is still in its relative infancy. Contributing to the “evolution of femto phaco” is something Dr. Shajari hopes more physicians will join in. “It would be best if colleagues start to think about ways to not just use the technology as given but how we can improve the processes,” he said. “We should not wait until a company is coming out with a new laser, but [think of] how we as physicians can optimize what is given. Then I think we will be in a situation where we can compare or see the benefits of the technology because I think there is a lot still to it.” EWAP References 1. Chen H, et al. Visual and refrac- tive outcomes of laser cataract surgery. Curr Opin Ophthalmol. 2014;25:49–53. 2. Manning S, et al. Femtosecond laser-assisted cataract surgery versus standard phacoemulsifica- tion cataract surgery: Study from the European Registry of Quality Outcomes for Cataract and Refrac- tive Surgery. J Cataract Refract Surg. 2016;42:1779–1790. 3. Day AC, et al. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev. 2016;7:CD010735. 4. Shajari M, et al. Comparison of 2 laser fragmentation patterns used in femtosecond laser-assisted cata- ract surgery. J Cataract Refract Surg. 2017;43:1571–1574. 5. Hida WT, et al. Outcomes study between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery using an active fluidics system. Clin Oph- thalmol. 2017;11:1735–1739. Editors’ note: Dr. Shajari has finan- cial interests with Oculus (Wetzlar, Germany), Oertli Instrument AG (Berneck, Switzerland), and Santen Pharmaceutical (Osaka, Japan). Contact information Shajari: gms400@gmail.com First-in-human – from page 27 EWAP CATARACT/IOL 29 September 2018 miLOOP for more than a year and is figuring out what cases to use it on—the majority of cases, includ- ing routine, or just more compli- cated situations. “I can make an argument for either strategy, and we’ve been doing an evaluation to see if we should use it on every case,” he said. At the very least, Dr. Wiley said he sees value in using it in cases of small pupils, thicker or dense cataracts that the femtosec- ond laser can’t soften, cases where the patient might not be able to afford to upgrade but would benefit from decreased use of phaco en- ergy, and as a rescue tool in chop cases where the first crack proves difficult. He has done research (not yet published) that found use of mi- LOOP to prechop the lens reduces the amount of time the phaco handpiece is in the eye and that the I/A tip is in the eye by 20% and 30%, respectively. “miLOOP takes 20–30 seconds to bisect the nucleus, but you gain a lot of that back by having less phaco and less I/A in the eye, over- all decreasing the risk of complica- tions,” Dr. Wiley said. Dr. MacDonald said she looks forward to larger studies involving miLOOP that evaluate its effect on efficiency in the OR, case times, and surgical times, as well as en- dothelial cell counts compared to traditional cataract surgery. In the future, Dr. Wiley thinks miLOOP will be a tool that some surgeons find indispensable in certain situations. Just like some surgeons find iris expansion rings a must-have in certain situations, so too Dr. Wiley said they’ll consider miLOOP. “I think there will be cases where almost every surgeon will have the opportunity to benefit from it,” Dr. Wiley said. EWAP Reference 1. Ianchulev T, et al. Microinter- ventional endocapsular nucleus disassembly: novel technique and results of first-in-human randomized controlled study. Br J Ophthalmol. 2018 Apr. Epub ahead of print. Editors’ note: The physicians have financial interests with Iantech. Contact information Ianchulev: tianchul@privatemedi- calequity.com MacDonald: susanmacdonal- deyecorps@gmail.com Wiley: wiley@cle2020.com