EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
June 2012 EW NEWS & OPINION 11 In the journal … June 2012 Macular segmentation after femtosecond laser–assisted cataract sur- gery Zoltán Z. Nagy, M.D., D.S.C., Monika Ecsedy, M.D., Ph.D., Illés Kovács, M.D., Ph.D., Ágnes Takács, M.D., Erika Tátrai, M.D., Gábor Márk Somfai, M.D., Ph.D., Delia Cabrera DeBuc, Ph.D. In this case-controlled study, investigators considered how the vari- ous retinal layers of the cornea compared when using the femtosecond laser together with phacoemulsification versus in cases involving tradi- tional phacoemulsification. They determined that between those that underwent femtosecond phacoemulsification versus traditional, when it came to the outer nuclear layer thickness and the relative outer nuclear layer thickness in the inner and outer macular rings, there were statisti- cally significant differences. While both groups had detectable macular edema particularly in the outer nuclear layer, when the femtosecond laser was used this was found to be significantly less than with the tradi- tional approach. After cataract surgery, macular edema was detectable mainly in the outer nuclear layer in both groups but was found to be significantly less in cases using the femtosecond laser platform. Bac-assisted transepithelial crosslinking Carina Koppen, M.D., Kristien Wouters, Ph.D., Danny Mathysen, M.Sc., Jos Rozema, Ph.D., Marie-José Tassignon, M.D., Ph.D. Investigators here set out to determine whether progressive kerato- conus patients undergoing transepithelial collagen crosslinking without epithelial debridement fared better or worse when proparacaine 0.5% drops preserved with benzalkonium chloride–assisted (BAC) were used prior to irradiation. When the 53 eyes that had undergone the transep- ithelial crosslinking procedure with proparacaine preserved BAC were evaluated, investigators found that the only statistically significant im- provement was in distance visual acuity at the 6- and 12-month marks. There was significant progression during the 18 months of the study of maximum K and pachymetry. Meanwhile, during the study sphere, cylinder, maximum keratometry, simulated steep K, flat K, and astigma- tism all remained stable here. Investigators concluded that when it came to stabilizing progressive keratoconus it was more effective to perform standard crosslinking than to use proparacaine drops preserved with BAC 0.005%. Visual quality after phakic IOL implantation in keratoconus Mathew Kurian, M.S., Somshekar Nagappa, M.D., Ridhima Bhagali, M.S., Rohit Shetty, F.R.C.S., Bhujang K. Shetty, M.S. The aim in this case series was to consider just how those with kera- toconus that is stable or stabilized fare after posterior chamber phakic IOL implantation for refractive correction, with regard to quantifiable image quality. In the series the V4 Visian PC pIOL was implanted in 10 eyes of 7 patients, with a pre-op mean spherical equivalent of -7.21 D. At the 6-week mark the refractive error had decreased to -0.55 D and at 6 months was at -0.44 D. However, when it came to the mean modula- tion transfer function this was at just 18.96 on a scale where 30 cycles per degree is considered good. Likewise the Strehl ratio, in which a 1 is considered perfect, was just 0.11 here. When it came to the objective scatter index this was significant at 4.45. Investigators found that sec- ondary coma, secondary trefoil, total aberrations, and higher-order aber- rations all directly corrected with the objective scatter index. They concluded that while the pIOL could be used to correct refractive errors in keratoconus cases the visual quality was hampered by associated aber- rations, which needed attention. Bonnie An Henderson, M.D., and John I. Loewenstein, M.D, two of the medical doctors who developed the Cataract Master. Photo courtesy of Massachusetts Eye and Ear New computer-based simulation technology allows users to safely practice phaco cataract surgery in real-world scenarios by Cindy Sebrell ASCRS Director of Communications Massachusetts Eye and Ear Cataract Master bridges the gap between wet lab training and patient surgery P hacoemulsification cataract surgery is one of the most frequently per- formed eye surgeries in the U.S., with 1.5 million procedures performed each year. It is also one of the most complex proce- dures to learn. A new, highly inno- vative, computer-based simulation tool, the Massachusetts Eye and Ear Cataract Master, bridges the learning gap that residents and ophthalmolo- gists new to phaco must navigate prior to performing actual surgery. Ophthalmology residents typi- cally train in wet labs and on pha- coemulsification simulators that supplement motor skills training before moving on to live patients. This is a challenging leap for sur- geons-in-training, even with the most careful oversight by attending physicians. The Cataract Master offers a unique approach for making the transition more successful. Nearly a decade in the making, the Cataract Master was co-devel- oped by Bonnie An Henderson, M.D., ophthalmology residency training program director, Harvard Medical School, John I. Loewenstein, M.D., Adam Neaman, Ph.D., and several colleagues. The English version of the program is available worldwide through the ASCRS Foundation, the research and charitable arm of ASCRS dedicated to improving the education and skill sets of anterior segment surgeons. "The Cataract Master aims to minimize clinical risk while provid- ing residents and practicing ophthal- mologists with the most authentic cataract surgical experience possible outside the OR," Dr. Loewenstein said. "The goal is to boost skills and confidence, to better prepare resi- dents for the surgical experience, and to raise the quality of patient care everywhere." Computer-based simulation technology has been used in medical training since the early 2000s, but these tools often did not take into account the hundreds of decision- making requirements that arise dur- ing surgery. The Cataract Master is different in that it offers a self- continued on page 12