35 EyeWorld Asia-Pacific | September 2024 “the astigmatism axis adjustment gives more accurate and more reliable results, making me more comfortable with high astigmatism cases.” Overall, feedback on SMILE Pro was positive, allowing surgeons the comfort and ease in performing their cases. Achieving Excellent Patient Outcomes with the Refractive Workplace® and VISULYZE® Lin Pi-Jung, MD, EMBA, PhD (Taiwan) Lin Pi-Jung, MD, EMBA, PhD (Taiwan) states that about 78% of surgeries at his eye center consist of SMILE Pro procedures. As the founder of Universal Eye Center in Taipei, Taiwan, the first ophthalmology clinic in Taipei, Dr. Lin has been performing laser refractive surgery since 1997. The center currently owns ten VisuMax 500 and eight VisuMax® 800 devices, has completed more than 50,000 surgeries, and currently treats about 30-50 patients a day. SMILE and SMILE Pro procedures account for 80-90% of all procedures done at the eye center. “Since the end of 2019 when we first introduced the VisuMax, we have received excellent feedback from our patients on efficacy and safety,” Dr. Lin said. However, upgrading to the VisuMax® 800 and Refractive Workplace® allowed Dr. Lin and his colleagues to experience many more advantages in laser refractive surgery. In addition, all images and data upload to the FORUM® system, making it easy for the surgeons and patients to communicate as well as reduce human input error. Opportunities for human input error come from all stages of surgery. Before surgery occurs, errors may come up during the examination, transcription, or astigmatism planning phase. During surgery, surgeons may encounter cyclotorsion or positioning error. With the VisuMax® 800 linked to the IOLMaster® 700 and FORUM®, surgeons are able to minimize these errors as well as assess patients’ conditions well before entering the operating room. “The process is much smoother and optimized for efficiency,” Dr. Lin said. “We no longer have to re-enter data. The number of surgeries performed has increased from four patients per hour to eight patients per hour.” From data that Dr. Lin collected at his eye center, he found that surgeons saved 25.3% (75.5 seconds savings) of their time during operation by eliminating the need to input patient data when using the VisuMax® 800 and the Refractive Workplace® compared to using only the VisuMax® 800. Docking, lasering, and lenticule extraction were much quicker using this combination setup. Further, there was a 39.5% decrease in time (145.5 seconds savings) during operation compared to using only the VisuMax® 500. In terms of the total process (planning and operation), surgeons can save up to 175.15 seconds by using the VisuMax® 800 (compared to using the VisuMax® 800 without the Refractive Workplace®) or 250.9 seconds (compared to using only the VisuMax® 500). “I prefer performing SMILE Pro because of the short laser time and not having to manually enter data,” Dr. Lin said. In 2023, he studied clinical outcomes at his eye center, comparing 3,430 eyes using SMILE Pro to 1,316 eyes using SMILE (total 4,746 eyes). Patients were followed up on day 1, week 1, month 1, and month 3 after surgery and analyzed using the VISULYZE® software. The results showed that 97.8% of patients were within 1 D using the VisuMax® 800 and 97.1% of patients were within 1 D using the VisuMax® 500. “Both systems have good clinical outcomes, though the VisuMax® 800 offered better stability, more precise astigmatism correction, and a shorter treatment time,” Dr. Lin said. Overall, Dr. Lin concluded by stating that his surgeries with the VisuMax® 800 have provided a great increase in surgical efficiency and an improved physician quality of life. Unleashing the QUATTRO Pump® in Action Ishtiaque Anwar, MBBS, FCPS, DO (Bangladesh) “Our aim for cataract surgery,” Ishtiaque Anwar, MBBS, FCPS, DO (Bangladesh) said, “is not only to remove the cataract, but to cause less harm to the eye and maintain the stability of the anterior chamber.” There are a number of parameters that surgeons are able to control: flow rate, vacuum, power, and intraocular pressure (IOP). In addition, ultrasonic effects from the surgical procedure can cause damage to various parts of the eye and may result in cavitation, vibratory disruption, mechanical trauma, or free radical injury. “To avoid these ultrasonic effects,” Dr. Anwar said, “we look for ways to reduce power. Another way is to increase the flow rate and vacuum, but it does affect chamber stability.” Conventional methods to prevent surge and remove fluid in cases like these use the peristaltic pump or venturi pump. However, these may not be the best option; for example, peristaltic pumps build vacuum only after occlusion, and flow rate and vacuum act independently from each other. The QUATTRO Pump®, though, provides a method to stabilize the chamber independent of IOP and flow as it is a synchronized fluid-exchange system. It consists of 10 valve plungers, an irrigation pressure sensor, 4 spring-loaded pneumatic ports to control irrigation and aspiration volume, and 4 inductive sensors to measure irrigation and aspiration flow. Two pumps are used for air suction and air pushing. With the QUATTRO Pump®, the system directly measures and synchronously controls infusion and aspiration in real time. Data collected by Dr. Tang showed that patients experienced better visual improvement from postoperative day 1 to month 1 following SMILE PRO procedures compared to SMILE. Occlusion Break Response: Quatera exhibited a quicker recovery. Media placement sponsored by Carl Zeiss Meditec AG
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