EyeWorld India March 2015 Issue

38 EWAP CATARACT/IOL March 2015 Prechopper (Asico, Westmont, Ill.) to complete the fragmentation performed by the laser. This device allows the air bubbles to exit between the fragments. “Then just gently hydrodissect,” she said. “I’ll put the prechopper between where the laser has already cracked the nucleus and gently open the prechopper up and those bubbles automatically come through the nucleus fragments.” Likewise, Dr. Shamie said that hydrodissection can’t be done the same way as in traditional cataract surgery. “It needs to be a gentle injection of fluid,” she said. “The wave that we expect in our traditional cases should not be expected in these cases and should not be the goal in the hydrodissection.” Instead, practitioners should aim for gentle spurts of balanced salt solution (BSS, Alcon, Fort Worth, Texas) around the capsulotomy to essentially break any adhesions between the capsule and the lens, but not necessarily to expect or want a fluid wave across the posterior lens, she said. The sub-incisional cortical removal tends to be more challenging than traditional cataract surgery because the laser cuts the cortical fibers flush to the edge of the capsule, so Dr. Shamie urges practitioners to consider bimanual surgery, which she finds helpful in these cases. Dr. Epitropoulos said one complication that is unique to the femtosecond laser is computer system failure. “For this reason surgeons have to be prepared to revert to traditional phacoemulsification at any time,” Dr. Epitropoulos said. “Surgeons shouldn’t rely entirely on the femtosecond laser to perform all of their cases.” Ideally, consent forms should carefully state that the surgeon might revert to traditional phaco if needed, she said. “However, that problem is also improving with newer software,” Dr. Epitropoulos said. When it comes to making clear corneal or side-port incisions, there has been some criticism of the quality of these with the femtosecond laser. “I think that the technology is still evolving with some platforms more than others,” Dr. Epitropoulos said. “It’s not completely consistent at this point.” She finds that in some cases she has to work to get the incision open because there are some adhesions. Others work well. Miosis is another femtosecond laser complication. “That is very frustrating to the surgeon because usually after the pupil comes down, you can’t do anything to bring it back up completely like it was,” Dr. Epitropoulos said. “This makes what should be a straightforward cataract treatment more difficult, with higher risks of complication.” One thing that practitioners should keep in mind is using an NSAID preoperatively to help prevent this. “Using a nonsteroidal drop prior to cataract surgery is essential in these cases to counteract the prostaglandin release as a result of the femtosecond treatment,” Dr. Epitropoulos said. Despite unique complications, Dr. Shamie said that femtosecond technology is here to stay. “Patients are asking for it, and the precision that it offers is exciting in that you can perform cataract surgery in very dense cataracts with little collateral damage to the cornea,” Dr. Shamie said. “It minimizes the risk of creating capsulotomies in not only routine cases but also challenging cases.” EWAP Editors’ note: Dr. Epitropoulos has financial interests with Bausch + Lomb (Bridgewater, NJ). Dr. Shamie has no financial interests related to her comments. Contact information Epitropoulos: aepitrop@columbus.rr.com Shamie: nshamie@yahoo.com OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk OCULUS Pentacam ® / Pentacam ® HR 欧 洲 科 学 之 路 Advance your IOL power calculation and Premium IOL selection with Pentacam ® The Pentacam ® Cataract Pre-Op Display Evaluate the cornea’s optical quality prior to cataract surgery to select the right patients for premium IOLs in four simple steps: • Step 1: Evaluation of corneal irregular astigmatism • Step 2: Detection of abnormal corneal shape • Step 3: Evaluation of corneal spherical aberration • Step 4: Evaluation of corneal cylinder Finessing - from page 37