EyeWorld Asia-Pacific June 2021 Issue

REFRACTIVE 48 EWAP JUNE 2021 iDesign (Johnson & Johnson Vision), as well as an aberrometer and OPD-Scan III (Nidek). “The YAG laser is your friend with premium lens patients,” Dr. Walter said of postop interventions. “I think too often we shy away from the YAG treatment for fear that it might not help and will make the IOL exchange more difficult.” Dr. Walter has found that if the patient tolerated the typical dysphotopsias initially but then had more or reduced reading vision, a YAG capsulotomy can turn them into a happy patient. Dr. Nikpoor’s practice uses the Alcon WaveLight Refractive Suite for enhancements. She said it’s important to make sure any ocular surface disease is under control and refraction is stable before proceeding with laser vision correction. She finds the PanOptix (Alcon) to be more sensitive to any PCO or residual refractive error than prior lenses, so she has a low threshold to YAG and enhance if it is going to ben efit the patient. EWAP Editors’ note: Dr. Nikpoor practices at Aloha Laser Vision, Honolulu, Hawaii, and declared no relevant financial interests. Dr. Walter practices at Wake Forest Baptist Health, Winston-Salem, North Carolina, and has relevant interests with Johnson & Johnson Vision. Dr. Williamson practices at Williamson Eye Center, Baton Rouge, Louisiana, and has relevant interests with Johnson & Johnson Vision. Yao Ke, MD Chief & Professor Second Affiliated Hospital of Zhejiang University School of Medicine 88 Jiefang Road, Hangzhou, China xlren@zju.edu.cn ASIA-PACIFIC PERSPECTIVES R efractive cataract surgery requires higher precision and has higher requirements in every aspect. At our eye center, preoperative examination of all the cataract patients includes biometry (A-ultrasound, Quantel Medical; IOLMaster700, Carl Zeiss Meditec), corneal topography (Pentacam, Oculus Optikgerate GmbH), macular OCT (Carl Zeiss Meditec) and dry eye assessment (Lipiview, Johnson & Johnson Vision). Although the IOLMaster is considered the new standard for biometry examination, we prefer to do both A-ultrasound and IOLMaster700 to double check IOL power calculation. Measurement will be repeated when there is a big difference between the two results. Likewise, corneal curvature and astigmatism measured by the Pentacam and the IOLMaster700 will be carefully compared, especially for patients who intend to be implanted with toric IOLs. Since the ocular surface state has quite a lot of impact on visual quality, we routinely perform dry eye assessment before surgery, and patients with severe dry eye need to undergo preoperative examination after treatment and reevaluation. Macular OCT is usually linked to the potential postoperative vision. For patients with dense cataract whose fundus examination is not available, premium IOL implantation would also be considered when the preoperative macular OCT is normal, as long as there is neither history of fundus diseases nor diabetes. We recommend femtosecond laser-assisted cataract surgery (FLACS), which increases the surgical safety and provides a consistently well-centered and properly sized capsulotomy with greater precision, thereby ensuring IOL centration and optimizing refractive outcomes 1 . However, our study found that FLACS may lead to a higher risk of postoperative fluorescein staining and dry eye symptoms when compared to conventional phacoemulsification, especially for patients with preexisting dry eye 2 . Therefore, active intervention should be taken at multiple stages, including application of artificial tears preoperatively and postoperatively, use of corneal protectants to avoid frequent rewetting with balanced salt solution during operation, etc. We also stated that FLACS clear cornea incisions (CCIs) caused more surgically induced astigmatism (SIA) compared with manual CCIs 3 , which could have resulted from possible inaccurate or uncertain corneal incision positioning of the LenSx machine. In addition, for post-LASIK patients, laser CCI has a high risk of interfering with the corneal flap; therefore, we recommend manual CCIs in FLACS. For patients with relatively mild cataracts and high hyperopia, lens removal with multifocal IOL implantation can be used to improve visual effects. Especially for preclinical angle closure patients with shallow anterior chamber and partial angle closure (PACS), we perform lens removal combined with chamber angle separation and multifocal IOL implantation 4 and have achieved good surgical outcomes and patient satisfaction. References 1. Chen XY, et al. Clinical outcomes of femtosecond laser–assisted cataract surgery versus conventional phacoemulsification surgery for hard nuclear cataracts. J Cataract Refract Surg . 2017;43:486–491. 2. Yu YH, et al. Evaluation of dry eye after femtosecond laser–assisted cataract surgery. J Cataract Refract Surg . 2015;41:2614–2623. 3. Zhu S, et al. Morphologic features and surgically induced astigmatism of femtosecond laser versus manual clear corneal incisions. J Cataract Refract Surg . 2017;43:1430-1435 4. Yan CX, et al. Effects of lens extraction versus laser peripheral iridotomy on anterior segment morphology in primary angle closure suspect. Graefes Arch Clin Exp Ophthalmol . 2019; 257:1473–1480. Editors’ note: Dr. Yao declared no relevant financial interests.