Advancements Made Possible with ZEISS Workflow Solutions Supplement to EyeWorld Asia-Pacific September 2023 APACRS The news magazine of the Asia-Pacific Association of Cataract & Refractive Surgeons provided good results: he was able to see the surface under the lenticule during surgery. In one example, Dr. Srivannaboon compared the corneal topography of ReLEx small incision lenticule extraction (SMILE) to femtosecond-assisted (femto) laser in-situ keratomileusis (LASIK). Using the same treatment, the optics of the cornea appeared much better with SMILE compared to the optics from the excimer laser ablation. From the image Dr. Srivannaboon provided, one can see that the lenticule extraction induced less spherical aberration when compared to the excimer laser ablation from femtoLASIK, providing the patient with better optics. Dr. Srivannaboon continued to explain that during lenticule extraction, the first refractive cut creates the curve of the cornea. “This first cut is the most important cut of the whole surgery because this is the final curvature of the cornea,” he said. The second cut is done parallel to the front surface of the cornea, and when these two cuts are connected, it becomes the lenticule. A small entrance is created in order for the lenticule to be extracted. The refractive cut from this photo-disruption creates a better corneal curve when compared to the curve from the excimer laser. This difference in the quality of curvature is due to the excimer laser using photo-ablation to remove the tissue. Copyright 2023 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. SMILE Pro: A Journey Spanning 20 Years Sabong SRIVANNABOON, MD, Thailand A journey of twenty years provides a plethora of learning experiences, and Sabong Srivannaboon, MD (Thailand) joined the lunch symposium to share his experiences with lenticule extraction. One of the first cases he performed was in 2010 and Dr. Ursell provided more detail on how to get accustomed to the dual linear foot pedal control if one is used to the traditional foot pedal. “You learn quite quickly how to take the foot off the pedal to control and cut through the nucleus with phaco,” he said. “What you find is that the density of the cataract governs how far down you go [on the pedal]. So a very hard cataract will need quite a bit of juice to get it out, and a softer cataract will need much less. You find the points on the foot pedal for that particular hardness of nucleus that cuts it, and you stay there. Then, you titrate the amount of vacuum needed by going sideways with the foot pedal.” From LASIK to high vacuum and low phaco or high vacuum and high phaco,” Dr. Ursell said. “You can have all four combinations.” The conjunction of not facing post-occlusion surge with a stable anterior chamber gives surgeons the ability to choose how they want to carry out the procedure. Dr. Ursell’s first impressions of the QUATERA 700 were very positive. Having a choice of settings to suit one’s needs and the ability to maximize efficiency through controlling different parameters (vacuum and phaco) of the movement of fluid, Dr. Ursell found a renewed interest in phacodynamics and has seen a higher quality of ease during his surgical cases. The QUATTRO Pump provides a paradigm shift in phacoemulsification fluid dynamics by synchronously controlling infusion and aspiration in real time.
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