novel devices. In Johnson & Johnson’s Early Experience with Elita: Next Generation Laser Vision Correction, Rohit Shetty, MD, said the interface “is something that I really enjoy.” Some pearls: When inserting the cone, pinch it so it fits in the suction ring. Mahipal Sachdev, MD, said he began using the Elita to create LASIK flaps before moving to lenticule extraction. The entire flap creation takes about 15 seconds, he said, and “the flap quality is fantastic.” The benefits of microinvasive glaucoma surgery (MIGS) at the time of cataract surgery are numerous, and include the potential to lower intraocular pressure (IOP) without ocular surface disruption or compliance requirements, a reduction in the relative risk of requiring secondary incisional glaucoma surgery, and the potential to reduce the number of ocular hypotensive medications, said Shamira Perera, MD, during the Alcon Vision Suite: Complete, Connected Care. At Alcon’s surgery video symposium, doctors touted Alcon’s Hydrus Microstent, Clareon extended depth of focus IOL, and Ngenuity 3D Visualization System. Meanwhile, in Zeiss’ New Paradigm in Motion, presenters agreed the VisuMax 800 is similar to the VisuMax 500, “but the optic and clarity is much better on the 800,” said Aadithreya Varman, MS (India). “I am much more confident in my dissection technique.” Preparing for Glitches in Cataract Cases Cataract cases at times may present challenges in various different ways, and in the symposium Glitch in the Matrix: Challenging Cataract Cases, surgeons presented top tips they learned from their experience in the operating room. In the case of white cataracts, Yao Ke, MD, described the benefit of performing femtosecond laser-assisted cataract surgery (FLACS). Because it is difficult to differentiate the capsule in white cataracts, there is increased volume and liquefication of the lens material, and it is possible to rupture the posterior capsule and tear the anterior capsule, Dr. Yao recommends FLACS for these cases. “The incidence of capsular tear is extremely low when using FLACS,” he said. Capsular staining is also a good way to avoid this issue, he noted. Mature intumescent cataracts, presenting as swollen and congested with increased intralenticular pressure, is another situation that may create problems while doing cataract surgery. A surgeon may have difficulty visualizing the anterior capsule, may face a stretched capsule, and may even see the Argentinian flag sign. “What I recommend during surgery is to be dexterous. You should be able to perform capsulorhexis in both right and left hands,” Amit Porwal, MD, said. “My top tip, though, is to do intralenticular decompression because it’s very important when you’re handling this type of cataract.” Rock hard cataracts are yet another complicated cataract a surgeon may encounter. These types of cataracts are similar to a piece of granite inside the eye. Mohan Rajan, MD, said that surgeons can perform phacoemulsifcation on rock hard cataracts and still consistently get good results. One tip Dr. Rajan offered: After making a good preoperative assessment, know where the rhexis margin is by staining it with trypan blue. Hydrodissection should be done carefully, not aggressively, and high phaco power at 80% to 100% should be selected to avoid pushing out the nucleus. Changing Patterns in Refractive Surgery Of all the various refractive procedures — lenticule extraction, LASIK, PRK, phakic intraocular lenses (IOLs) — which would be best for a moderate myope (–5 D)? Michael Knorz, MD, attempted to address that question during the Faster Than the Speed of Light symposium. Each of the techniques has its advantages and disadvantages: surface ablation has a slow visual rehabilitation, and femto-LASIK can result in significant dry eye for several months, although both have good safety and customizable treatments. There are several laser lenticule extraction devices on the market, with Zeiss’ SMILE likely the best known, Dr. Knorz said. Each of the platforms allow for fast visual rehabilitation and fewer dry eye symptoms than
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