EyeWorld India June 2013 Issue

38 EWAP CAtArACt/IOL June 2013 the surgeon needn’t worry about the first leading haptic slipping back into the eye. The focus can be maintained on the task at hand. After the second trailing haptic is externalized the silicone assistant can be easily slid off the haptic and the surgery completed. This is a simple, inexpensive method that can be used by any surgeon with access to a butterfly cannula, a scissor, and a 25-g needle. It takes very little skill and even less time to perform and should reduce some of the anxiety associated with performing the scleral fixated haptic or “glued in IOL” procedure. George Beiko, FRCSC , has advocated taking the silicone sleeve from an MST (Redmond, Wash.) or Mackool capsule retractor and sliding it over the lead haptic to hold it in place during surgery. These retractors can be quite expensive however, and manipulating the silicone sleeve over the haptic can be a bit delicate. The homemade microbulldog silicone assistant method suggested here offers the advantage of being very inexpensive to fashion and very easy to apply to the IOL haptic during surgery as it is “pre” loaded onto a 25-g needle, which serves to guide it over the haptic very gently when needed in order to give a hand to the surgeon born with only two arms. EWAP Editors’ note: Dr. Safran is in private practice in Lawrenceville, NJ, USA. He has no financial interests related to this article Contact information Safran : safran12@comcast.net Microbulldog - from page 34 Patients - from page 36 “I haven’t come across anybody who can do it in a significantly shorter period of time,” Dr. Roque said of lenses implanted via scleral sutures. The Artisan Aphakia lens procedure compares very favorably, at 25-30 minutes, he said. “It’s far simpler and more stable,” Dr. Roque said. “There’s no iris dislocation of the lens into the chamber provided the techniques used are good.” Few implantations One wonders, however, whether the Artisan Aphakia could be used more widely in the Philippines if more eyecare providers were aware of its benefits. Just take into account the following statistics in the Philippines, according to Dr. Roque: • Population: 100 million • Number of ophthalmologists: less than 2,000 • Percent of ophthalmologists in metropolitan areas: 70-80% • Percent of ophthalmologists in other areas: 20% • Number of ophthalmologists implanting the Artisan Aphakia: approximately 10 (assisted by one of two Ophtec-accredited surgeons) Artisan Aphakia surgeries have been performed over the last six years in the Philippines, owing to surgeries undertaken by himself and that of one other surgeon. Dr. Roque said the lenses are more widely used in South Korea. Dr. Roque said it’s easy to obtain the Artisan Aphakia in the Philippines. Stocks are available in the country such that an ophthalmologist could get it within 1-2 days via pickup or courier. It’s also more cost- competitive than other phakic IOLs (although such procedures are paid out-of-pocket in the Philippines and not by insurance). So is the Artisan Aphakia niche really niche? Or might there be more opportunities for this lens in the Philippines and beyond? Jim Simms, director of global sales and marketing for Ophtec, offered some clues. Mr. Simms said Asia is the fastest growing market for the Artisan lens. “In Asia there are a lot of cases—complicated cases— from [many years ago] of surgery,” Mr. Simms said. “Five percent of cataract cases done 20 years ago are complicated cases. The only lens that works in these patients is the Artisan lens.” He also said it even can be used in cases of aniridia. “Doctors can use the iris-fixation concept to clip the lens to some tissue in the eye,” Mr. Simms said. “We only need two pieces someplace in the eye to clip it to. We can work with half an iris, a fourth of an iris, or even a little bit of [other] tissue.” In that case, one also could use the Artisan Iris Reconstruction IOL, indicated for correction of iris defects and available in various dioptric powers. In a 2006 study in the Journal of Cataract & Refractive Surgery, a 50-year-old patient with localized traumatic aniridia underwent secondary implantation using an Artisan aphakic lens. It was placed vertically instead of horizontally. Despite having a perforating injury to the cornea that required corneal wound repair, lensectomy and anterior vitrectomy, three months after Artisan implantation, BCVA was 0.9 and there were no complications. A recent Ophtec course in the UK was instructive on dealing with complicated cataract cases using Artisan lenses and easily filled up, Mr. Simms said. “We got more than 40 people,” Mr. Simms said. “We couldn’t get any more into the course [because it was full]. Courses that teach about complications fill up.” Dr. Roque said he does not use any Artisan lenses in cases of aniridia or when there are only small portions of the iris remaining. Given that he claims to be only one of two Ophtec-accredited surgeons using the Artisan Aphakia in the Philippines, more awareness of Artisan uses in especially complex cases may be warranted there and elsewhere. EWAP Editors’ note: Dr. Roque has no financial interests related to this article. Mr. Simms has financial interests with Ophtec. Contact information roque : +632 8282020, manolette.roque@eyerepublic.com.ph Simms : +3150 5251944, j.simms@ophtec.com