Strategies for Dense Cataracts Ronald Yeoh, Singapore There can be many challenges with cataracts, and Ronald Yeoh, MD provided strategies on how to handle such challenges, especially with rock hard cataracts. Dr. Yeoh explained that surgeons should first categorize the hardness of a patient’s cataract. It is necessary to know how dense the cataract is because there may be a diverse range of cataracts that present in the operating room. “Knowing exactly how dense your patient’s cataract is helps a lot in thinking and planning for the surgery,” says Dr. Yeoh. Dr. Yeoh says that nuclear sclerotic (NS) 2 to 3+ cataracts are ideal as they are very soft when handling. When cataracts are hard, surgeons may need to modify their surgical technique. The challenges of hard cataracts include endothelial damage, posterior capsular rupture (PCR), and zonular weakness (as there is the risk of damaging zonules). However, there are ways to reduce the risk of such complications in hard cataract surgery. Dr. Yeoh discussed the different techniques that can be used to perform surgery on hard cataracts which include the direct chop, Akahoshi counter prechop with nucleus sustainer, femtosecond-laser-assisted cataract surgery (FLACS), extracapsular cataract extraction (ECCE), manual small-incision cataract surgery (MSICS), and the use of miLOOP®. The miLOOP® is a type of snare device that allows the surgeon to divide the nuclei, and it is helpful in that it allows for a safe surgery, does not utilize the prechop technique, and avoids the complications of FLACS. Copyright 2022 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. However, the combined implantation of an EDOF IOL and a trifocal IOL (AT LARA® and AT LISA® tri) showed superior outcomes at far, intermediate, and near distances compared to any other studies Dr. Choi has done. In the uncorrected defocus curve, double-L implantation also showed superior visual acuity at all distances. In summary, Dr. Choi explained that the strategy of double-L implantation with AT LARA® and AT LISA® tri IOLs is an effective option for improving near visual outcomes with excellent far and intermediate vision. Not only did visual outcomes improve for far, intermediate, and near distances, but reading speed, contrast sensitivity, and spectacle independence also improved when the double-L implantation technique was utilized. LARA®). At far distance, Dr. Choi explained that one can expect much better outcomes with the AT LISA® tri and the AT LARA® IOLs, but all four IOLs still showed good outcomes. Clinical performance was also measured using a double-implantation technique. In a prospective bilateral consecutive study1, Dr. Choi and his colleagues measured visual acuities and refraction of patients. He also measured the uncorrected defocus curve and contrast sensitivity in patients while testing their digital reading speed (Korean) and giving questionnaires to patients regarding subjective satisfaction and visual functioning. The results showed that the AT LISA® tri IOL nicely preserved vision at far, intermediate, and near distances. The AT LARA® IOL showed good vision at far and intermediate distances. In comparing the different trifocal IOLs while maintaining similar optical properties at a 3 mm pupil size, Dr. Choi found that the ZEISS AT LISA® tri IOL showed good far, intermediate, and near distance peaks while the PanOptix® IOL and TECNIS Synergy™ IOL showed different peaks. The TECNIS Synergy™ showed high far and near peaks but no peak for intermediate distance. Dr. Choi also compared the MTF curves of the IOLs at a 2 mm pupil size. “The AT LISA® tri IOL preserves, very nicely, its peak at 20 diopters independent of pupil size,” says Dr. Choi. Dr. Choi also performed an optical bench test to evaluate the effect of decentration on the optical performance of two different types of IOLS: trifocal IOLs (IQ PanOptix® and AT LISA® tri) and extended depth of focus (EDOF) IOLs (TECNIS Symfony™ and AT New Developments in Mean monocular and binocular defocus curves of eyes implanted with AT LARA®, AT LISA® tri, and double-L implantation (AT LARA® and AT LISA® tri). l i Supplement to EyeWorld Asia-Pacific March 2022 APACRS The news magazine of the Asia-Pacific Association of Cataract & Refractive Surgeons
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