EyeWorld India June 2015 Issue

46 EWAP CATARACT/IOL June 2015 Views from Asia-Paci c Ronald YEOH, FRCS, FRCOphth, DO, FAMS Adj Ass Professor, Duke-NUS Grad Med School and Singapore National Eye Centre Consultant Eye Surgeon & Medical Director, Eye & Retina Surgeons #13-03 Camden Medical Centre, One Orchard Boulevard, Singapore 248649 Tel. no. +65-67382000 Fax no. +65-67382111 ersyeoh@gmail.com T his is a timely article discussing femtosecond laser assisted cataract surgery (FLACS) related complications. Incisions can be a challenge but using the appropriately designed FLACS-speci c incision opening spatula (e.g., ASICO AE-2332 double-ended spatula) opens most incisions successfully. Post-FLACS miosis used to be encountered in about 25% of all FLACS cases and this obviously led to more challenging surgery. In a study I conducted, I found that the application of a topical NSAID with the preoperative dilating regimen prevented FLACS related miosis effectively. 1 Drs. Epistropoulos and Shamie quite rightly point out that incomplete FLACS capsulorhexes (CCC) need proper management to prevent radialization and posterior extension. The secret to avoiding these potentially disastrous complications is awareness of the location of uncut portions of the CCC where there may be a tag or bridge. The FLACS surgeon should always inspect the completeness of the CCC before starting the phaco part of the procedure. When removing the round anterior capsule ap, careful observation reveals where there might be adhesions, tags or bridges. Extra care should be taken when doing irrigation aspiration to avoid aspirating at the very edge of the CCC where there might be a problem. Should a radial tear still develop, doing gentle slow-motion phaco as Dr. Osher taught us also means that the likelihood of a posterior extension is reduced. Depressing the nucleus is an easy way of burping out the gas that forms in and around a femtofragmented nucleus. It is essential to do so to create space for hydrodissection failing which hydrorupture of the posterior capsule may result with a dropped nucleus. 2 I agree that the use of a pre-chopper (e.g., ASICO AE-4294) is a useful adjunct to complete the femtofragmentation of the nucleus, certainly in softer nuclei. However, care has to be exercised in denser nuclei as it can be dif cult to insert the prechopper into the lasered groove and there is a risk of zonular dehiscence. Any new surgical procedure is accompanied by complications that may be hitherto unrecognized and FLACS is no exception. References 1. Yeoh R. Intraoperative miosis in femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. May 2014;40(5):852. 2. Yeoh R. Hydrorupture of posterior capsule in femtosecond laser cataract surgery. J Cataract Refract Surg. April 2012;38(4):730. Editors’ note: Dr. Yeoh is on the Alcon (Fort Worth, Texas/Hünenberg, Switzerland) and Abbott Medical Optics (Santa Ana, Calif.) speaker panels but has no nancial interests related to his comments. by Maxine Lipner EyeWorld Senior Contributing Writer On “Finessing femtosecond cataract complications” Erratum: The following comments were provided by Dr. Ronald Yeoh for the article “Finessing femtosecond cataract complications” by Maxine Lipner, EyeWorld Senior Contributing Writer, published in the March 2015 issue of EyeWorld Asia-Paci c. A publishing error led to the omission of these comments from the published version of the article. We apologize for any inconvenience this error may have caused.