The Revalia also has additional features such as two screens, a swivel arm, magnetic clutch handles, foot pedal adjustments, and an inbuilt recorder. Dr. Mishra said the microscope has improved his surgical outcomes, by providing better visibility, reduced complications, and the ability to perform more surgeries in a shorter amount of time. He has come to rely on the microscope in more challenging cases, such as hard cataracts, deep sockets, eyes with weak zonules, nystagmus, among others. “What has improved in my practice is that perhaps I am a much more artistic surgeon,” he said. Dr. David LUBECK (United States) said Alcon’s ARGOS provides faster and more accurate biometric and anatomic measurements even through dense cataracts; robust surgical planning; intraoperative data transfer, integration and guidance; and outcomes analysis and nomogram optimization. 10-15 “I’m reluctant to call it a biometer because ARGOS is a surgical management system. It does so much more than just biometry that we're doing it a disservice by calling it a biometer,” Dr. Lubeck said. “We're also doing ourselves a disservice by looking at a device with such immense capabilities and limiting it to just making a few measurements.” Among the advantages the ARGOS offers, Dr. Lubeck said, is the “huge amount” of information available in the analysis mode, complete with adjustability at each step of the procedure. “In less than a second, the ARGOS is capturing axial length, anterior chamber depth, keratometry, corneal diameter, central corneal thickness, aqueous Supplement to EyeWorld Asia-Pacific December 2023 questionnaire, 853/879 patients (97%) reported no or some difficulty with their sight for activities of everyday life, and 91.4% were satisfied with their sight. “More than 91% of patients also reported no halos, glare, or starburst,” Prof. Kohnen said. Complications were also low, with < 5% that needed posterior capsulotomy in either eye. Of the 321 patients in the registry who were implanted with at least one toric lens, outcomes were similar to those who did not need a toric lens, Prof. Kohnen said. The mean uncorrected distance VA for the toric patients was 0.016±0.105 logMAR (about 20/20 Snellen). Most patients did not need spectacles for distance, intermediate, or near in either bright (87.1%, 76.3%, 46.6%, respectively) or dim conditions (85.2%, 65.7%, 30.4%, respectively). Of the 311 patients who answered the Catquest95F questionnaire, 284 (91.3%) were satisfied with their vision. More than 90% of toric patients reported no visual disturbance. Outcomes were similar in the mini-monovision group (n=202) and the post-corneal refractive surgery group (n=26), where uncorrected and corrected VA at study entry was about 20/20 Snellen, most patients did not need spectacles in either bright or dim conditions, and 90% and 88%, respectively, reported no visual disturbance. Outcomes were also similar for patients with dry eye (n=85), glaucoma (n=35), or age-related macular degeneration (n=42), with binocular vision at about 20/20 Snellen, most patients did not need spectacles in either bright or dim conditions, and more than 89%, 91%, and 88%, respectively, reported no visual disturbance. Microscopes and Surgical Management Systems Dr. Anurag MISHRA (Cuttack, India) said Alcon’s LuxOR Revalia microscope has three types of LED illumination, including warm white, cool white, and mixed white. There are three sources for the illumination, one for coaxial and two for oblique. “Coaxial illumination is ideal for helping you see reflective, mirror-like objects, whereas the oblique illumination helps you to see the transparent and the semi-transparent objects like the cornea or posterior capsule,” he said. The Revalia boasts a 6-times larger, more stable red reflex than other microscopes,9 and provides a 33% greater depth of focus compared to conventional microscopes. The microscope places the objective lens above the light source, which produces a divergent coaxial illumination, he explained. “What you lose out on if you use coaxial illumination to the brightest extent possible is that the depth of focus reduces,” he said. “When the light is coming to the patient’s eye, it is not being focused by the objective lens, which means that it is more comfortable to the patient, but also for the surgeon since our eyes also tire out after 20-30 surgeries if the illumination is too bright.” Because the objective lens is placed above the illumination, the Revalia provides 65 mm buffer, meaning surgeons can focus on the cornea and the microscope will provide a view back up to the posterior capsule. Media placement sponsored by Alcon depth, pupil size, lens thickness, limbal registration, visual axis, and pupil centration,” he said. The system uses swept-source optical coherence tomography (OCT), which means that at 20 dB, ARGOS is 100 times more sensitive than the coherence interferometers of other devices. Dr. Lubeck added a valuable component is the enhanced retinal visualization (ERV) mode, “which amplifies the signal 10 times, allowing the device to measure through cataracts of all grades, including grade 4 nuclear and cortical cataracts. The result is that this machine has a 41% higher acquisition rate in grade 4 cataracts than the IOLMaster 700 (Carl Zeiss Meditec) 12,” he said. That, in turn, means an 83% reduction in the need for A-scans. 12 “ARGOS measures each segment of the eye, applies the index of refraction of the cornea or the aqueous or the lens, and then calculates the precise axial length of the overall length by compounding those numbers,” he said. Speed of acquisition is also quicker with the ARGOS than the IOLMaster 700 — 50% faster, 12 in fact, and ARGOS also has a faster acquisition speed than the IOLMaster 500, 13 Dr. Lubeck said. The OCT guidance helps the clinic technicians take more accurate measurements, as ARGOS can detect small degrees of lateral eye movement (technicians can see real-time correction of their eye alignment); vitreous anomalies may be visible (technicians can check the boundaries of the OCT to ensure the anomaly is not mistaken for a boundary). Perhaps one of the best time savers for FIGURE 2. Prof. Kohnen's initial outcomes with the Vivity lens FIGURE 3. The ARGOS in Enhanced Retinal Visualization Mode To view the video from Alcon's Live Surgery Event at APACRS 2023, please scan QR code shown here.
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