EyeWorld Asia-Pacific June 2019 Issue

46 EWAP JUNE 2019 worth it to take the extra time vœÀ LiÌÌiÀ ÀiÃՏÌð >“ Ã̈ `œˆ˜} the main incision and second port incision with a blade for all «>̈i˜ÌÃ] ̅i ˆ˜VˆÃˆœ˜ ܈̅Ƃ - taking more time both for pre- programming and opening the wound. Dr. Sachdev: ܜՏ` `iw˜ˆÌiÞ ÀiVœ““i˜` Ƃ - LiV>ÕÃi LiˆiÛi the technology works. The femtosecond laser affords an unparalleled accuracy and predictability vis-à-vis “>˜Õ> «…>Vœi“ՏÈwV>̈œ˜ in traditional cataracts. The advantages are further pronounced in complex cases. The nucleotomy allows a reduction in effective «…>Vœi“ՏÈwV>̈œ˜ ̈“i in the densest of nuclei. Femtodelineation technique allows safer nuclear removal in eyes with a propensity for capsular dehiscence including posterior polar cataract and eyes with prior vitreoretinal interventions. The œ˜Þ V>Ãià ܅iÀiˆ˜ ܜՏ` ˜œÌ ÀiVœ““i˜` Ƃ - ˆÃ media opacities including i“ՏÈwi` ȏˆVœ˜ œˆ ˆ˜ ̅i anterior chamber and dense corneal opacities which interfere with the laser delivery resulting in incomplete areas of capsulotomy and nuclear fragmentation. My advice to surgeons adopting this technology would be not to Õ`}i] LÕÌ Ìœ wÀÃÌ Õ˜`iÀÃÌ>˜` this technology with an open mind. With increasing experience and use of the technology, the surgeon gets greater comfort to handle complex cases, enhance outcomes in routine cases and overall upgrade one’s practice. Dr. Uy: Vœ˜Ãˆ`iÀ ˜i>ÀÞ > V>Ãià º˜ˆVi ̜ Ƃ -°» would deem some eyes as º Ƃ - «ÀˆœÀˆÌÞ]» ÃÕV…>à eyes with anterior capsular wLÀœÃˆÃ] ܅ˆÌiɈ˜ÌՓiÃVi˜Ì œÀ dense cataracts, a high risk of posterior capsular rupture, and a compromised endothelium. >ÃiÀ >˜ÌiÀˆœÀ V>«ÃՏœÌœ“Þ creates a perfect rhexis despite ̅i «ÀiÃi˜Vi œv wLÀœÌˆV >˜ÌiÀˆœÀ capsules and takes away the risk of capsular tears during “>˜Õ> À…i݈à œv ̅iÃi iÞið ˜ white/intumescent cataracts, the capsule is cut quickly and evenly, thereby lessening the likelihood of the Argentinian y>} Ãޘ`Àœ“i° 7i…>Ûi Ŝܘ ˆ˜ > À>˜`œ“ˆâi` ÌÀˆ> 2 that extensive fragmentation «>ÌÌiÀ˜Ã V>˜ È}˜ˆwV>˜ÌÞ iÃÃi˜ the amount of phacoenergy used and potentially lessen i˜`œÌ…iˆ> `>“>}i° ˜ high risk eyes with posterior capsular compromise, a perfect Ƃ - V>«ÃՏœÌœ“Þ v>VˆˆÌ>Ìià implantation of an anterior based extended-depth-of- focus lens or performance of reverse optic capture using > Ș}i‡«ˆiVi >VÀޏˆV " ° Ƃ - ˆÃ Vœ˜ÌÀ>ˆ˜`ˆV>Ìi` ˆ˜ ̅i «ÀiÃi˜Vi œv È}˜ˆwV>˜Ì VœÀ˜i> œ«>VˆwV>̈œ˜] Ó> «>«iLÀ> wÃÃÕÀiÃ] ՘Vœœ«iÀ>̈Ûi «>̈i˜Ìà or patients with musculoskeletal issues that prevent docking to the laser machine. Wireless ˆ˜Ìi}À>̈œ˜ œv Ƃ - “>V…ˆ˜ià with topographers improves œ«iÀ>̈˜} Àœœ“ ivwVˆi˜VÞ >˜` lessens planning errors. Dr. Bissen-Miyajima: Cataract surgeries have been controlled by surgeon’s eyes and hands. We are in the era of the digital analysis and the automated system. Ƃ - “>Þ ˜œÌ Li ̅i w˜> }œ> œv vÕÌÕÀi V>Ì>À>VÌ ÃÕÀ}iÀÞ] LÕÌ `iw˜ˆÌiÞ ̅i bridge between conventional «…>Vœi“ՏÈwV>̈œ˜ ˆ˜Ûi˜Ìi` by Dr. Charles Kelman and any future technologies. We spent over 20 years to persuade ophthalmologists all over the world to use «…>Vœi“ՏÈwV>̈œ˜° œ“«>Ài` ̜ ̅ˆÃ] Ƃ -…>à ŜÜi` a faster penetration in the ophthalmic society since the wÀÃÌ Vˆ˜ˆV> V>Ãi `œ˜i LÞ *Àœv° <œÌ>˜ >}Þ ˆ˜ Óään° ÀiVœ““i˜` Ƃ - ̜ ܅œiÛiÀ LiˆiÛià Ƃ - ܜՏ` Li ̅i standard technique in 10 years. /…ˆÃ ˆÃ Ü…Þ ÃÌ>ÀÌi` Ƃ - >˜` >“ ÕȘ} Ƃ -° Dr. Sachdev: The femtosecond laser allows precise cuts with minimum collateral damage. The precision of the capsulotomy allows a more precise effective lens position. The advantages are further pronounced in intumescent and subluxated cataracts, wherein initiation and subsequent completion of the rhexis is a challenge. Nucloetomy patterns allow removal of the nucleus with relative ease, even in dense brunescent cataracts. This allows reduced «œÃ̜«iÀ>̈Ûi ˆ˜y>““>̈œ˜ >˜` clearer corneas postoperatively. The integrated anterior segment imaging allows an additional advantage to assess the integrity of the posterior capsule. Anterior penetrating and intrastromal arcuate keratotomies can be planned more centrally vis-à-vis limbal relaxing incisions, allowing a greater keratometric impact and lower risk of regression. Dr. Uy: The main issue is not ܅i̅iÀ Ƃ - ˆÃ ivviV̈Ûi œÀ safe (it is) but whether it adds value for practice and patient. This will have to be decided on a case-to-case basis. For my own eyes, when the time Vœ“iÃ] ̅iÞ ÜœÕ` `iw˜ˆÌiÞ Li `œ˜i LÞ Ƃ -° EWAP References 1. Uy HS, et al. Comparison of Wound Sealability between Femtosecond >ÃiÀ‡ œ˜ÃÌÀÕVÌi` >˜` >˜Õ> i>À œÀ˜i> ˜VˆÃˆœ˜Ã ˆ˜ *>̈i˜Ìà undergoing Cataract Surgery: A Pilot Study. J Refract Surg 2017 Nov 1;33(11):7448. 2. Uy HS, et al. Comparison of Surgical Parameters using Different i˜Ã À>}“i˜Ì>̈œ˜ *>ÌÌiÀ˜Ã ˆ˜ Þià ՘`iÀ}œˆ˜} >ÃiÀ‡ƂÃÈÃÌi` >Ì>À>VÌ Surgery. Int Ophthalmol . 2019 Web https://doi.org/10.1007/s10792- 01901087- CATARACT