Eyeworld

EW MEETING REPORTER 96 March 2019 EyeWorld/ASCRS reports from the 2019 Surgical Summit, January 31–February 2, Park City, Utah causing a postage stamp-like edge, and there are questions as to how this could relate to anterior capsule tears. But "smoothness does not nec- essarily equate to strength," Dr. Fram said. Studies and company research have found that higher energy leads to more friability. Thus, 4 mJ is the recommended capsulotomy setting, with a horizontal spot size of 5 µm and a vertical spot size of 15 µm to reduce anterior capsule tags. Dr. Fram finds OCT imaging useful in these cases because it can help predict what could happen in the OR. One of the things that con- cerns her about the use of femto in capsulotomy creation is the loss of a capsular stress sign that occurs while making a manual capsulotomy. She has been looking for another sign and considers it to be ovalization of the capsulotomy in FLACS cases. Editors' note: Dr. Fram has financial interests with Alcon, Johnson & John- son Vision (Santa Ana, California), and Bausch + Lomb (Bridgewater, New Jersey). Cataract surgery in glaucoma patients Nathan Radcliffe, MD, New York, spoke about considerations for cataract surgery in patients with glaucoma. Dr. Radcliffe said that a success- ful cataract surgery can put glau- coma patients on the path toward their disease stabilizing, while anything other than that can put them in a lot of trouble. This path to success starts with the preoperative evaluation. Almost all patients with glauco- ma on prostaglandins have meibo- mian gland dysfunction causing dry eye, which can impact refractive targets and patient satisfaction, Dr. Radcliffe said. He also noted the importance of conducting a preop ate on the nondominant eye first because it's more tolerant of myopic error, and he can again factor in the RPE of the first into the IOL choice for the fellow eye. Dr. Weikert said one question that remains is whether there will be improved results in these cases with segmented axial lengths. Editors' note: Dr. Weikert has financial interests with Alcon (Fort Worth, Tex- as) and Ziemer (Port, Switzerland). Capsule strength in complex FLACS cases Nicole Fram, MD, Los Angeles, discussed femtosecond laser-assisted cataract surgery (FLACS), saying that while she thinks it is comparable to conventional cataract surgery in routine cases, it could be useful in specific eyes and could make com- plex cases more manageable. The controversy, she said, is whether the femtosecond-created capsulotomy is strong enough to handle the hooks and rings that could be needed in these cases. Femtosecond lasers might do a better job of creating predictable, reproducible, round capsulotomies, but there are missed laser spots, IOL calculations Mitchell Weikert, MD, Houston, presented "IOL Calculations: Axial Length to the Extreme." Most modern formulas per- form well "on average," Dr. Weikert said, noting that about 71% of eyes are within ±0.5 D and about 93% of eyes are within ±1 D. However, formulas perform less reliably at ex- tremes of axial length. In short eyes, the formulas tend to overestimate the required IOL power (leading to myopic error), and in long eyes, they tend to underestimate (leading to hyperopic error). In long eyes, his approach is to use the Holladay 1 (with adjust- ed axial length) or Barrett formula and aim for very slight myopia. Dr. Weikert said he will operate on the nondominant eye first because it is more tolerant of myopic error with adjusted axial length, and he will factor the RPE of the first eye into the IOL choice for the fellow eye. In short eyes, Dr. Weikert will use either the Holladay 1 or 2 formula, the Hill-RBF, the Barrett formula, or the Olsen formula. He will lean toward the Olsen when the formulas disagree. In short eyes, Dr. Weikert said he would also oper- EyeWorld/ASCRS reports from the 2019 Surgical Summit continued on page 98

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