EyeWorld India June 2019 Issue

EWAP JUNE 2019 45 CATARACT years, with as high as 60% of the «>̈i˜Ìà ՘`iÀ}œˆ˜} Ƃ - ˆ˜ my present practice. One of the major constraints for the patients is the cost of the treatment, wherein 20% of my patients who believe in the technology are unable to afford the treatment. We have to date performed more than 10,000 femtosecond assisted cataracts across our centers. Harvey Uy, MD (Makati City, Philippines): …>Ûi Lii˜ performing Ƃ - ȘVi Óä£ä >˜` Ṏˆâi ˆÌ ˆ˜ Óä¯ œv my cataract and refractive lens iÝV…>˜}i «>̈i˜Ìð Ƃ - ˆÃ potentially applicable for all eyes with clear corneas. Technological Àiw˜i“i˜Ìà i°}° ̜ÀˆV >ˆ}˜“i˜Ì marks, arcuate incisions, nucleus grading) now enable Ƃ - ÃÕÀ}iœ˜Ã ̜ ˆ“«ÀœÛi astigmatism management, œ«Ìˆ“ˆâi ÀivÀ>V̈Ûi œÕÌVœ“iÃ] decrease ultrasonic energy, protect the endothelium better, and improve wound sealability. 1 Ronald Yeoh, MD (Singapore): 7…i˜ Ƃ - wÀÃÌ LiV>“i available in Singapore ˆ˜ Óä£Î] Ü>à i˜Ì…ÕÈ>Ã̈V >LœÕÌ Ãiiˆ˜} ܅i̅iÀ Ƃ - would live up to the promise of more precise incisions, capsulorhexes and lower ultrasound energy usage. With time and experience, we now know that, incision-wise, ̅iÀi ˆÃ ˆÌ̏i ̜ ˜œ Li˜iwÌ ˆ˜ vi“Ìœ>ÃiÀ ˆ˜VˆÃˆœ˜Ã >˜`…>Ûi stopped doing femtolaser incisions when performing Ƃ -° Ƃà v>À >à V>«ÃՏœÀ…iÝià go though, there is little doubt that the femtosecond laser VÀi>Ìià LiÌÌiÀ Èâi` >˜` Å>«i` anterior capsular openings although, disappointingly, this has not translated to more precise refractive outcomes. Finally, there is consensus that Ƃ - Ài`ÕVià ՏÌÀ>Ü՘` energy usage especially in dense nuclei and this is a good thing. ƂvÌiÀ ÕȘ} Ƃ - vÀiµÕi˜ÌÞ ˆ˜ ̅i ˆ˜ˆÌˆ> «iÀˆœ`] ˜œÜ ÕÃi Ƃ - ÃiiV̈ÛiÞ ˆ˜ «>̈i˜Ìà ˆ˜ ܅œ“ Ƃ - “>Žià > È}˜ˆwV>˜Ì `ˆvviÀi˜Vi ̜ outcomes when compared to ÃÌ>˜`>À` «…>Vœi“ՏÈwV>̈œ˜° This is because refractive superiority has not been shown, as well as the higher costs involved and the need for more time and space in the operating room. *>̈i˜Ìà ܅œ ܜՏ` Li˜iwÌ vÀœ“ Ƃ - ܜՏ` ˆ˜VÕ`i those with dense nuclei, posterior polar cataracts, mild lens subluxations, and cataracts ܈̅>˜ÌiÀˆœÀ V>«ÃՏ>À wLÀœÃˆÃ° vii ̅>Ì Ü…ˆi ̅iÀi >Ài ̅iÃi ëiVˆwV ÈÌÕ>̈œ˜Ã ˆ˜ ܅ˆV… Ƃ - ˆÃ > }œœ` œ«Ìˆœ˜] vœÀ ̅i routine cataract patient, it is hard to justify the added cost. Dr. Bissen-Miyajima: ܜՏ` ÀiVœ““i˜` Ƃ - ̜ ÃÕÀ}iœ˜Ã who are interested in involving new technology, which has a high potential to become the standard in the near future. Every new technology has pros and cons in its early stages, but someone needs to try it in œÀ`iÀ ̜ ˆ“«ÀœÛi ˆÌ° Ƃ - ˆÃ already well established and the outcomes are equal or better compared to conventional «…>Vœi“ՏÈwV>̈œ˜° `œ ˜œÌ Ãii >˜Þ ÀˆÃŽ ̜ >`œ«Ìˆ˜} Ƃ -° ˜ œÕÀ ",] ̅i vi“ÌœÃiVœ˜` laser system is installed next to the surgical microscope >˜` «…>Vœi“ՏÈwV>̈œ˜ apparatus. The duration of Ƃ - ˆÃ iµÕˆÛ>i˜Ì ̜ ̅>Ì ÜˆÌ… Vœ˜Ûi˜Ìˆœ˜> ÌiV…˜ˆµÕi° Ƃ - works well except in cases with poor dilation and small eyelid. The challenge we have now ˆÃ ̅>Ì Ƃ - `œià ˜œÌ ܜÀŽ for everyone. Dr. Chee: ܜՏ` ViÀÌ>ˆ˜Þ ÀiVœ““i˜` Ƃ à ̜ œÌ…iÀ surgeons. Ƃ - ˆ˜VÀi>Ãià ̅i «ÀiVˆÃˆœ˜ >˜` ivwVˆi˜VÞ œv V>Ì>À>VÌ ÃÕÀ}iÀÞ° ˆ˜ˆÌˆ>Þ perform 2 laser procedures, vœœÜi` LÞ Ì…i wÀÃÌ V>Ì>À>VÌ Ài“œÛ>° ̅i˜ >ÌiÀ˜>Ìi between the laser and phaco. The laser is sited in > Àœœ“ ˜i>ÀLÞ >˜` ÅÕÌ̏i between the rooms. We also have a portable system which is located within the operating room. The laser is done immediately followed LÞ «…>Vœi“ՏÈwV>̈œ˜° œÌ… ܜÀŽyœÜà ܜÀŽ Üi° «iÀvœÀ“ V>«ÃՏœÌœ“Þ and lens fragmentation, generally avoiding corneal incisions and astigmatic keratotomies. Achieving a «ÀiVˆÃi V>«ÃՏœÌœ“Þ Èâi ܅ˆV… is important in determining the effective lens position, can Li `ˆvwVÕÌ Ü…i˜ `i>ˆ˜} ܈̅ highly myopic eyes which we commonly manage. Having a precut nucleus facilitates surgery in these eyes with deep anterior chambers. Soft cataracts can be challenging to rotate and crack. The precut nucleus enables the surgeon to remove the pieces without rotation. Once one is familiar with these standard cases, one can move on to manage the Vœ“«iÝ V>Ãià ܈̅Ƃ -° >ۜˆ` Ƃ - ˆ˜ iÞià ̅>Ì >Ài `ˆvwVÕÌ Ìœ `œVŽ] iÞià ܈̅ advanced glaucoma where the suction pressure may compromise a delicate optic nerve, or media opacities which prevent laser passage e.g. large pterygium or corneal scar. Dr. Hutauruk: >“ ˜œÌ trying to convince others to ÕÃi Ƃ -] LÕÌ ˆv Üi vœVÕà œ˜ ̅i Li˜iwÌà œv Ƃ -] it will certainly have more advantages compared to phaco in four points: intraoperative OCT, precise capsulorhexis, pre-softening the cataract to reduce ultrasound energy, and accurate position and depth for astigmatism correction. ÕÃi Ƃ - ˆ˜ >ÀœÕ˜` Çä¯ of my cataract patients for the Li˜iwÌà “i˜Ìˆœ˜i` >LœÛi° œÀ patients with low endothelial cell counts, dense cataract, and shallow anterior chamber depths, who require precise capsulorhexes for multifocal " Ã]…>Ûi ÛiÀޅˆ}…“Þœ«ˆ> ܈̅>Ã̈}“>̈Ó LÕÌ ÌœÀˆV " is not available, it is certainly