EyeWorld Asia-Pacific June 2020 Issue

EWAP JUNE 2020 CATARACT ZZZ KDDJ VWUHLW FRP $UWLƂFLDO LQWHOOLJHQFH ZLWK +LOO 5%) ,2/ GDWD IURP DOO RYHU WKH ZRUOG FROOHFWHG E\ OHDGLQJ FDWDUDFW VXUJHRQV LV WKH IRXQGDWLRQ IRU WKH +LOO 5%) 7KLV ELJ GDWD LV DQDO\]HG E\ SDWWHUQ UHFRJQLWLRQ EDVHG RQ DUWLƂFLDO LQWHOOLJHQFH OHDGLQJ WR KLJKO\ DFFXUDWH ,2/ SUHGLFWLRQV DQG SURYLGLQJ FRQƂ GHQFH WKDQNV WR D XQLTXH UHOLDELOLW\ FKHFN +LOO 5%) 7KH QHZ YHUVLRQ RI 5%) LV EDVHG RQ D ELJJHU GDWDVHW FRQVLV WLQJ RYHU [ WKH DPRXQW RI GDWD FRPSDUHG WR WKH SUHYLRXV YHUVLRQ 7KLV OHDGV WR DQ LPSUHVVLYH RXWFRPH RI ZLWKLQ ' LQ DOO H\HV ,Q DGGLWLRQ WKH +LOO 5%) ZDV FRPSOHPHQ WHG ZLWK WKH ZHOO HVWDEOLVKHG $EXODƂD .RFK DOJRULWKP IRU WRULFDO DSSOLFDWLRQV Q &OLQLFDO 6WXG\ 6SHULFDO (TXLYDOHQW 5HVXOWV 6WHYHQ 9 6FRSHU 6DWHOLWH 6\PSRVLXP $6&56 LENSTAR 900 $, SRZHUHG ,2/ FDOFXODWLRQ create arcuate incisions, Dr. Safran said he thinks limbal relaxing incisions are preferable to corneal relaxing incisions because the central 8–9 mm of cornea where most femtosecond arcuate incisions are placed is less stable in its healing compared to the cornea within 1–2 mm of the limbus. This is due to the circumcorneal >ÕÕÃ v V>}i wLÀÃ Ìi limbus that stabilizes the cornea in this region, he said. 4 “Relaxing incisions placed close to the limbus are tangential to these stabilizing wLiÀÃ >`>Ûi iÃÃ V>Vi v causing progressive irregular astigmatism than those placed within the central 10 mm of the cornea,” Dr. Safran said. “This is why we abandoned AKs for LRIs Ìi wÀÃÌ «>Vi°» With all new technologies, Dr. Safran said surgeons have to answer these questions: Is it }} Ì LiiwÌ Þ «>ÌiÌÃ¶ Ã Ì }} Ì LiiwÌ i¶ Ã Ì something we need? “Unless it’s going to provide something for me that I cannot do without, … unless it is cost effective, unless it’s going to make money for me, why should I buy that?” he said. For those interested in incorporating FLACS into their practice, Dr. Trattler offered the following pearls to young eye surgeons: • Make sure the patient is still to get good images and when preparing to treat with the laser. • Make sure the capsulotomy is complete (incomplete capsulotomies can occur if the patient moves). • ½Ì ÛiÀw Ìi iÞi À Ìi capsular bag. During lens fragmentation there is some gas produced. This can impact Ìi >LÌÞ v yÕ` Ì i}ÀiÃÃ out of the eye. Release gases behind the lens by jiggling the nucleus a bit. • Take advantage of the landmarks femto fragmentation provides during «>ViÕÃwV>Ì ÛÃÕ>âi how deep you are). • Engage the cortex and gently hold it with vacuum, then strip. There is a different motion and a different amount of force used in FLACS cases. EWAP References 1. Yen AJ, Ramanathan S. Advanced cataract learning experience in United States ophthalmology residency programs. J Cataract Refract Surg. Óä£ÇÆ{Î\£Îxäq£Îxx° 2. Visco DM, et al. Femtosecond laser- assisted arcuate keratotomy at the time of cataract surgery for the management of preexisting astigmatism. J Cataract Refract Surg. Óä£Æ{x\£ÇÈÓq£ÇÈ° 3. Roberts HW, et al. Femtosecond laser- assisted cataract surgery: A review. Eur J Ophthalmol. 2019. Epub ahead of print. 4. Newton RH, Meek KM. Circumcorneal >ÕÕÃ v V>}i wLÀÃ ÌiÕ> limbus. Invest Ophthalmol Vis Sci. £nÆÎ\££ÓxqÎ{° Editors’ note: Dr. Donaldson is medical director, Bascom Palmer Eye Institute, Plantation, Florida, and declared relevant interests with Alcon, Bausch + Lomb, and Johnson & Johnson Vision. Dr. Safran practices in Lawrenceville, New ,GTUG[ CPF FGENCTGF PQ TGNGXCPV ƂPCPEKCN interests. Dr. Trattler is director of Cornea at Center for Excellence in Eye Care, Miami, Florida, and declared relevant interests with Alcon, Bausch + Lomb, LENSAR, and Johnson & Johnson Vision.