EyeWorld India March 2014 Issue

24 EWAP CATARACT/IOL March 2014 time (EPT), capsulotomy, and centration, among others. “There was a difference between laser and manual procedures in EPT, which was much lower with the laser,” Dr. Holzer said. “That’s mainly due to the use of the laser to produce smaller fragments of the lens, so there is less phaco energy used.” The precision of the laser is indisputable—with an intended diameter of 5.0 mm, the laser produced diameters of 5.03 mm, compared with the manual technique where the average diameter was 4.50 mm. “We were about 10% smaller than intended with our manual technique,” he said. Otherwise, there were no statistically significant differences between the two techniques in VA, intended vs. achieved refraction, IOP, or flare meter measurements. “We had postulated that after using the laser the inflammation may be a bit higher, but that was not the case,” he said. Dr. Holzer said with very few differences between the two techniques, he believes the main advantage of the femto is “the wide field of application in cataract and refractive surgery.” Minimizing ultrasound energy Phaco energy is a well- known cause of endothelial cell destruction, and reducing the effective phaco time with the femtosecond laser has shown promise. “We are very close to totally eliminating ultrasound from Can - from page 21 Hydrophilic acrylic enhanced monofocal IOLs Rayner C- flex ® Aspheric and Super flex ® Aspheric Patients deserve optimal visual quality and functional visual acuity in all light conditions C- flex ® Aspheric and Super flex ® Aspheric IOLs with aberration-neutral technology: • Offer improved contrast sensitivity and visual acuity, particularly in low light conditions compared with spherical IOLs 1,2,3 • Can offer 50% more depth of field than aberration-negative IOLs, by retention of the patient’s natural level of positive corneal spherical aberration 4 • Less susceptible to the effects of tilt and decentration than aberration-negative IOLs 5 An IOL made from optically pure, superior quality material: • Low refractive index (1.46) of Ray acryl ® reduces the risk of glare 6 • Free from vacuoles and glistenings 7 rayner.com 1. Kohnen T et al. Ophthalmologe 2008; 105 (3): 234-40. 2. Nanavaty MA et al. JCRS 2009; 35 (4): 663-71 3. Lyall DAM, Srinivasan S, Gray LS. Optom Vis Sci 2013; 90 (9):996-1003. 4. Johansson B et al. JCRS 2007; 33 : 1565-1572. 5. Altmann GE et al. JCRS 2005; 31 (3): 574-585. 6. Erie JC, et al JCRS 2001; 27 :614-621. 7. Rayner. Data on File. White paper. cataract surgery,” said Tim Schultz, MD, Department of Ophthalmology, University Hospital Bochum, Germany. A study of their initial 650 cases treated with the Catalys femtosecond laser (Abbott Medical Optics, Santa Ana, Calif., U.S.) and the Stellaris phaco system (Bausch + Lomb, Rochester, NY, U.S.) showed that 90% of grade 2 cataracts (based on the Lens Opacities Classification System III scale), 66% of grade 3 cataracts, and 63% of grade 4 cataracts were able to be treated without ultrasound energy. The group changed some of the Stellaris settings as well as the phaco tip, and individualized the grid size for every patient (200 to 500 microns), and were able to further decrease the amount of ultrasound needed. “In our last 400 cases, we were able to treat 99% without ultrasound energy. There were three cases that still needed phaco, all in the LOCS III group 4,” he said. EWAP Editors’ note: Dr. Fisher has financial interests with Alcon. He is a Fellow of the AAO, and a member of ASCRS and ISRS. He is also a consultant to Alcon, and has previously conducted research sponsored by Wavetec. Holzer has financial interests with Bausch + Lomb/Technolas. Dr. Schultz has financial interests related to this article. Contact information Fisher: bfisher@eyecarenow.com Holzer: mike.holzer@med.uni-heidelberg.de Schultz: tim.schultz@kk-bochum.de