EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1054373
EW MEETING REPORTER 74 December 2018 EyeWorld/ASCRS reports from the 2018 AAO Annual Meeting, October 26–30, Chicago in patients with Fuchs' endothelial dystrophy, though not all studies showed this. Finally, Dr. Ayres highlighted points on astigmatism management, noting no difference in surgically in- duced astigmatism with manual vs. laser incisions. Laser-created arcuate incisions may be more accurate than manual LRI, and it is as effective as a toric IOL for low amounts of astigmatism. Dr. Ayres said that treatment of astigmatism is reliable with the laser, but there is no single nomogram that exists for treatment. The laser does have the advantage of being able to make intrastromal arcuate incisions. Also on the topic of astigmatism management, Dr. Ayres said that the majority of laser platforms have some tracking and planning software, and image-guid- ed systems help to reduce the depen- dence on manual marks. Intrastro- mal marks can be made with the femtosecond laser, he said. On the other side of the argu- ment, Dr. Al-Mohtaseb argued that "FLACS will die a slow death," show- ing study data to support her claim. The laser came out in 2010, and in 2017, market data showed that it has only penetrated about 24%. She then delved deeper into the literature on safety data. There is statistical significance to show that there are actually more complica- tions compared to manual. access to femto to help with cataract surgery, he said. The first femtosec- ond laser was approved in 2010, and now there are five different lasers. What will make doctors/patients flock toward the laser? Dr. Ayres first highlighted safety. Multiple publications support the safety of the FLACS procedure. Experience and technology improve outcomes, he added. Dr. Ayres said there is a reduced amount of ultra- sound energy used, safety in training institutions has been established, and it may be safer than conven- tional surgery in the trained hand. Dr. Ayres continued by discuss- ing the capsulotomy in femto sur- gery. There is better consistency in size and shape with better initial IOL centration and improved refractive results with the laser, he said. There is also a reduced use of OVD, better centration, and reduced use of cap- sular stain. In non-human tests, Dr. Ayres said, the capsulotomy strength has been shown to be stronger than a manual rhexis. Ultrasound energy was another area that Dr. Ayres pointed to in order to show the benefits of the femtosecond laser. It reduces the energy needed for lens removal, and some studies seem to show it is safer for the endothelium and causes less corneal swelling after cataract surgery. Dr. Ayres also pointed to studies showing reduced cell loss cases easy. Start with DMEK in a Fuchs' dystrophy eye that is already pseudophakic. Avoid eyes with prior vitrectomy, an AC IOL, large iris defects, tubes, or trabeculectomies; request tissue that is 60 years or old- er; start with preloaded tissue; use SF6 if it is easily accessible; and learn to rebubble at the slit lamp to have minimal disruption in your clinic. Editors' note: Drs. Mannis and Terry have no financial interests related to their presentations. Action for CyPass Micro-Stent on track The voluntary withdrawal of the CyPass Micro-Stent (Alcon, Fort Worth, Texas) from the market in late August due to endothelial cell loss data over a 5-year period was a shock to ophthalmology. However, Thomas Samuelson, MD, Minneap- olis, president of ASCRS, thinks the moves underway to research what occurred with the CyPass are on the right track. "In my opinion, the process is working," he said. ASCRS formed a task force that includes members from the organization's Cataract and Glaucoma Clinical Committees. The task force recom- mends informing patients about the market withdrawal, examining and performing gonioscopy, and docu- menting the position of the device. Some patients may need more frequent monitoring. "Hopefully, Alcon can partner with the FDA to bring this [device] back to a more suitable population," Dr. Samuelson said. Editors' note: Dr. Samuelson has financial interests with Alcon. Debating the femtosecond laser During the "Cataract Controversies on Trial" session, presenters made point/counterpoint arguments on several topics. Brandon Ayres, MD, Philadelphia, and Zaina Al- Mohtaseb, MD, Houston, advocated for and against, respectively, the use of the femtosecond laser in cataract surgery. Dr. Ayres argued that "FLACS will bring people flocking." For the past several years, we have had View videos from the AAO Annual Meeting: EWrePlay.org David Chang, MD, discusses instrument sterilization and a study testing common practices for this. Sponsored by