EyeWorld India December 2014 Issue

59 EWAP NEWS & OPINION December 2014 MD, PhD , Lima, Peru, discussed the importance of angle kappa in avoiding postoperative surprises. Angle kappa is the angle between the visual axis and the pupillary axis. This has some practical, clinical consequences. For instance, it is assumed that in patients with higher angle kappa, multifocal IOLs induce more aberrations. The bigger the central zone diameter of the IOL, the higher the angle kappa must be to reach the edge of the first ring of the IOL. If a patient has a high (greater than grade 7) positive (the pupillary axis is temporal to the visual axis) angle kappa and a shallow anterior chamber, Dr. Izquierdo said, consider not implanting a multifocal IOL. On the other hand, for IOL decentration, the surgeon need not worry if it is decentered toward the visual axis. Femtophaco symposium compares different laser preferences During the “Facets of Femtophaco” session, advocates for various lasers spoke about why they prefer each product. What’s interesting is that more and more lasers are coming on the market, said Dr. Yeoh, Singapore, one of the chairs of the session, and it’s hard to tell which is the best. Sri Ganesh, MD , Bangalore, India, spoke about why he likes the Catalys (Abbott Medical Optics, AMO, Abbott Park, Ill., U.S.) laser. First, he said, it’s very easy to plan, with a template-based planning software. It also has a liquid optics interface, which Dr. Ganesh said is one of the most important parts. The Catalys also has an integral guidance system, which has a 3D volume OCT and a laser designed specifically for cataract surgery. Unlike some of the other systems, this is specifically for cataract surgery and not for cornea surgery and adapted for cataract surgery, Dr. Ganesh said. Using the Catalys, Dr. Ganesh has treated a total of 262 eyes. John Chang, MD , Hong Kong, discussed both why to use the femtosecond laser and why to specifically use the LensAR (Orlando, Fla., U.S.) system. With femto, he said that the capsulotomy is more precise, it’s particularly good in difficult cases, nucleus splitting is much easier, there is less phacoemulsification power, there is less corneal endothelial cell count loss, there is less IOL decentration, and there are arguably better visual and refractive outcomes. Specifically with the LensAR, Dr. Chang liked that it is a small compact machine the can be easily moved around. It has a small suction ring, with an even smaller one set to come out. The capsulotomy is free floating most of the time, and there is no capsular block syndrome. “It’s very easy to use,” he said. Mahipal Sachdev, MD , Delhi, India, spoke about why he likes the LenSx (Alcon, Fort Worth, Texas, U.S.) laser. He first compared a number of femtosecond laser platforms and then presented 5 key differentiating factors of why he prefers LenSx, which included the variable beam profile, the design, the patient interface, the high definition OCT, and the innovation associated with the system and company. In terms of the variable beam profile, “the laser is optimized for each specific tissue depth,” Dr. Sachdev said, so it gives you effective incisions. The laser is also designed with patient flow, ergonomics and flexibility in mind. It’s more intuitive and user friendly and makes the fixed bed obsolete, he said. The patient interface provides fixation without applanation. The high definition OCT scans the entire anterior chamber in a single scan, and the real time live OCT provides a circle scan plus 3 line scans. Finally, Dr. Sachdev added that the innovation is a very important piece, and LenSx has had 3 hardware and 6 software upgrades in 3 years. Chee Soon Phaik, MD , Singapore, discussed the VICTUS laser (Bausch + Lomb, B+L, Bridgewater, NJ, U.S.). She cited the ease of docking, ease of planning, the effectiveness of CCC, and the effectiveness of nucleus fragmentation as major reasons that she prefers the VICTUS. This laser is easy to dock, especially in eyes with small palpebral apertures, Dr. Chee said, which is important in the population of patients that she treats with small eyes. The default settings and ability to adjust energy make it easy to plan to use the VICTUS. There is also a short learning curve, she said, and Dr. Chee has found superior visual outcomes with the VICTUS laser. Dr. Izquierdo, Lima, Peru, highlighted why he likes the Ziemer (Port, Switzerland) Z8 system. The design of the system is particularly attractive, he said. The imaging aspect offers real time imaging and integrated proprietary state-of-the-art OCT. The femtosecond laser is new and more powerful, with a laser source with Adaptive Pulse Management (APM). This means that it uses lower energy in the cornea, and it also uses higher energy in the lens with fewer gas formation, which helps with less intraoperative complications. There is also a liquid interface with the system. continued on page 60