EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
position, which is affected by the centration, size, and shape of the capsulotomy, as well as capsular healing after surgery, he said. Femtosecond technology addresses some of these concerns because the laser creates the main incision, which helps control astigmatism, and the astigmatic cuts made by the laser allow the surgeon to control the precise length and depth of the cuts. "At the end of the day, about 90% of patients are within .5 D of refraction—very good results," Dr. Hovanesian said. There are three steps for surgeons to improve and possibly meet this accuracy. First, mark the astigmatic axis in advance using a marking pen while the patient is upright. "I like to mark both the horizontal and vertical axis," Dr. Hovanesian said. "This can be done by a well-trained nurse who understands how to get the patient fixated and upright." Second, mark the capsulotomy for size and shape. "You can follow the line. I find that by doing this, I tend to pay more attention to the mark on the cornea and less attention to landmarks like the iris," Dr. Hovanesian said. "When we follow the iris, we tend to stray off from the intended path and intended size of our capsulotomy. Here, we're much more consistent." Third, meticulously clean the lens epithelial cells using a capsule polisher. "No matter how carefully you've done your irrigation and aspiration, I'm always amazed at how many lens epithelial cells remain." Dr. Hovanesian reported that by using these three steps, 92% of the 37 patients he treated were within .5 D of target refraction. Editors' note: Dr. Hovanesian has no financial interests related to this talk. continued on page 156 Watch this video on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.)