EyeWorld India December 2014 Issue

62 EWAP NEWS & OPINION December 2014 Dr. Sachdev performed the rest of the procedure manually with no complications. He implanted Alcon’s AcrySof IQ ReSTOR +2.5 D lens, a distance-dominant lens with 7 rings. Lens implantation was performed using Alcon’s AutoSert injector, a foot-controlled device that gives the surgeon precise control over the speed of lens insertion. Dr. Kurian demonstrated the capabilities of the VERION Image Guided System and the LuxOr surgical microscope in the removal of a posterior subcapsular cataract. He performed a manual capsulorhexis and phacoemulsification and implanted an AcrySof IQ toric lens with the AutoSert injector. Dr. Kurian used the VERION system to guide placement of the side port incisions, center and size the capsulorhexis, and to ensure that the lens was well-centered in the bag. With the VERION System, we are inching closer toward more precisional lens centration, Dr. Vasavada said, which is incredibly important for multifocal and toric IOL implantation. System (AMO) for femtosecond laser-assisted cataract surgery. In addition, in the second of the two live cases presented, Dr. Ganesh, Bangalore, India, demonstrated a singlehanded technique for nucleus removal and a no-touch technique for polishing the posterior capsule. The Catalys, according to S.P.S. Grewal, MD , Chandigarh, India, is changing the perspective of cataract surgeons and creating a new paradigm, setting new benchmarks for cataract surgery. The system is a 120 kHz machine, with a pulse rate of <600 fs. One of the most important technical characteristics of the system is a liquid docking interface, which Dr. Grewal said requires minimal assistance, no speculum, and does not distort corneal tissue. This interface, according to symposium chair Dr. Donnenfeld, Rockville Centre, NY, U.S., allows the machine to deliver energy precisely, resulting in efficient application of energy with minimal collateral damage. As demonstrated in the subsequent live surgery cases— both elderly patients with grade 2+ cataracts—the laser completes the capsulotomy in only 1.6 seconds. The entire laser portion of the surgery, including lens fragmentation and nucleus softening (dividing the nucleus into quadrants and grids as defined by the surgeon), as well as corneal incisions, was completed in under 60 seconds. In the first case, performed by Virendra Agrawal, MD, Jaipur, India, the femtosecond laser time included arcuate incisions to correct astigmatism. The two cases were performed by Dr. Agrawal and Dr. Ganesh at the Dr. Virendra Agrawal Laser, Phaco Surgery Centre, Jaipur, India. Both had completely free-floating capsules and were completed with an effective phaco time of 0:00.00. In the second case, with no astigmatism to correct, Dr. Ganesh used the laser to create only one corneal incision—the primary cataract incision. At the phaco table, he demonstrated his viscochop technique for singlehandedly removing the nucleus. The technique allows him to complete the surgery without a second instrument. When injecting viscoelastic, he embeds the tip between two nucleus quadrants and uses the hydraulic force of the viscoelastic to separate them. He then rotates the nucleus with the tip and repeats the process between another pair of quadrants. “The quadrants were already separated by the laser,” he said. “I just needed to separate the posterior part and that was very easy to do gently.” Dr. Ganesh also demonstrated a no-touch technique to polish the posterior capsule, injecting BSS to gently clear the surface of the posterior capsule. Femtosecond laser technology, symposium co-chair Dr. Barrett, Perth, Australia, said, “is obviously here to stay. “I think we’ve had a taste of how this technology can alter the way we do surgery in the future.” Inspiration, design, and use of surgical instruments main target of symposium Innovation is incredibly important in the field of ophthalmology. As new problems emerge, it’s key to have new devices and designs to address these problems. Adapting and updating already existing designs is also a way to innovate the field. “The Surgical Instruments & Devices: Inspiration, Design & Use” symposium drew from the experiences of a number of surgeons and ways that they innovated within the field. Amar Agarwal, MD , Chennai, India, and Dr. Yeoh, Singapore, chaired the session. Dr. Yeoh presented on surgical instruments and design, and Dr. Agarwal presented on the Agarwal forcep for glued IOL. Other presenters included Dr. Cionni, Salt Lake City, Utah, U.S., who spoke about the Cionni Ring; Dr. Barrett, Perth, Australia, who spoke about the Barrett phaco axe; Donald Tan, MD , Singapore, who spoke about the Tan Endoglide inserter; Keiki Mehta, MD , Mumbai, India, who spoke about the Hema Lifeboat; Boris Malyugin, MD , New one-hand, no-touch femto cataract techniques at AMO live surgery At yesterday’s AMO live surgery symposium, surgeons touted the Catalys Precision Laser Jewels - from page 60