CATARACT 28 EWAP SEPTEMBER 2022 Figure 7. YAG-induced posterior capsule rupture. Figure 9. Intraoperative OCT finds retained nuclear lens fragment. Figure 8. Anterior radial tear extending posteriorly across the whole posterior capsule. Figure 10. FLACS fragmentation pattern imaged with intraoperative OCT. Source (all): Ronald Yeoh, MD to the rescue when a patient was brought back to the OR with a retained nuclear lens fragment. Intraoperative OCT was able to find the fragment in the angle for successful removal (Figure 9). Dr. Yeoh used imaging from intraoperative OCT to show why less ultrasound energy is needed in FLACS with dense cataracts. “I prefer to use a laser grid pattern with two horizontal cuts, which effectively softens the nucleus for easy division and removal using less ultrasound energy. In Figure 10, we can see how the grid pattern with horizontal cuts results in little rectangular ‘chips,’ explaining why less ultrasound energy is needed,” he said. Dr. Yeoh said that while intraoperative OCT was initially considered a “nice to have” feature for cataract surgery, he thinks it’s finding a bigger role in training, surgical decision making, research around wound construction and integrity, IOL positioning, and removal of OVD. “From an institutional point of view, having cataract surgeons use this technology in cataract surgery makes its acquisition a more economical proposition than just being for corneal or vitreoretinal surgeons’ use,” he said. EWAP References 1. Pujari A, Sharma N. The emerging role of anterior segment optical coherence tomography in cataract surgery: current role and future perspectives. Clin Ophthalmol. Ó0ӣƣx\Înq40£. 2. Wang X, et al. OCT application before and after cataract surgery. OCT Applications in Ophthalmology. 2018. 3. Asam JS, et al. Chapter 13: Anterior segment OCT. High Resolution Imaging in Microscopy and Ophthalmology: New Frontiers in Biomedical Optics. 2019. Editors’ note: Dr. Miller is Kolokotrones Chair in Ophthalmology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, and disclosed no relevant financial interests. Dr. Vasavada is Director, Raghudeep Eye Clinic, Ahmedabad, India, and has interests with Alcon. Dr. Yeoh is Medical Director, Eye & Retina Surgeons, Singapore, and has interests with Alcon, Carl Zeiss Meditec, and Johnson & Johnson Vision.
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