EyeWorld India June 2013 Issue

23 June 2013 EWAP FEAturE Stages of bimanual surgical technique of laser cataract extraction. The right tip is laser energy combined with irrigation, the left tip is the transparent tube of the aspirator. Source: Valentina Kopayeva, MD Laser energy in cataract surgery could abolish ultrasound Is eliminating ultrasound from cataract surgery the next logical step? C urrently, the technology of femtosecond laser-assisted phacoemulsification has attracted rising interest among ophthalmologists. Many questions abound, such as: • What sort of negative side effects does ultrasound energy by Professor Valentina Kopayeva, MD, and Elena Vialova, MD have on surrounding tissue? • Is there a difference in the time it takes to perform cataract surgery with an Nd YAG laser, as opposed to ultrasound? • Does this method have any effects on postop recovery time? Is there an increased or decreased incidence of infection or complications? • Would it be possible to combine femtosecond laser with Nd YAG laser to complete cataract surgery without using ultrasound energy? Femtosecond laser lens softening is proven to reduce ultrasound load during phacoemulsification, thus leading to a 50% decrease in negative side effects of ultrasound energy on surrounding tissues. So, it would be logical to reduce such side effects more or even to eliminate them completely. Such a result might be achieved by ultrasound substitution with another type of laser energy Views from Asia-Pacific Keiki R. MEHTA, MD Chief Medical Director, Mehta International Eye Institute Sea Side, 147, Shahid Bhagat Singh Road, Near Colaba Bus Station, Mumbai 400005, India Tel. no. +91-22-22151303 keiki_mehta@yahoo.com T his would seem to the the logical, functional, alternative, or, if I may be so bold as to say, the logical forward extension of ultrasound in the field of cataract surgery. Ultrasound phakoemulsification has reached its virtual zenith of perfection. My old workhorse, the Alcon Infiniti (Fort Worth, Texas, USA/Hünenberg, Switzerland) has reached its limits. Newer machines like the Zeiss Visalis 500 (Jena, Germany), which I acquired 10 months ago, now simply “gild the lily” by variable pulse shaping and enhanced pulse delivery schedules. YAG laser for cataract surgery is not really a new phenomenon having been applied, if not too successfully, in earlier years. Femto-cataract, the next variable, due its cost and its minimal application since ultrasound, still needs to be used if admittedly less, never really was a functional alternative. However going through the article “Laser energy in cataract surgery”, some very salient facts seem to be obvious which might simply change the trend from ultrasound to full laser surgery. The Nd:YAG with its 1.44mcm w/l, its 250 mcsec with a full range of frequency and pulse, I believe is the next step. Its compatibility with the tissues especially the endothelium seems astonishing. Its monochromaticity linearly applied, and hence no dissipation of the energy like ultrasound, its cool tip, spontaneous nuclear cleavage of the nucleus, all seem its great advantages. More so it is not inimical to the tissues. At my institute, our cataract numbers are not large, hardly 6,500 cataracts a year, but I would be very tempted to use the equipment which in hard brown cataracts with weak endothelia, a norm in India, it would prove ideal. Editors’ note: Prof. Mehta declared no financial interests related to his comments. continued on page 24