Eyeworld

38 | EYEWORLD | MARCH 2020 ATARACT C "Relaxing incisions placed close to the limbus are tangential to these stabilizing fibers and have less chance of causing progressive irregular astigmatism than those placed within the central 10 mm of the cornea," Dr. Safran said. "This is why we abandoned AKs for LRIs in the first place." With all new technologies, Dr. Safran said surgeons have to answer these ques- tions: Is it going to benefit my patients? Is it going to benefit me? Is it something we need? "Unless it's going to provide some- thing for me that I cannot do without, … unless it is cost effective, unless it's going to make money for me, why should I buy that?" he said. For those interested in incorporat- ing FLACS into their practice, Dr. Trattler offered the following pearls to young eye surgeons: • Make sure the patient is still to get good images and when preparing to treat with the laser. • Make sure the capsulotomy is complete (incomplete capsulotomies can occur if the patient moves). • Don't overfill the eye or the capsular bag. During lens fragmentation there is some gas produced. This can impact the ability of fluid to egress out of the eye. Release gases behind the lens by jiggling the nucleus a bit. • Take advantage of the landmarks femto fragmentation provides during phacoemulsifi- cation (visualize how deep you are). • Engage the cortex and gently hold it with vacuum, then strip. There is a different mo- tion and a different amount of force used in FLACS cases. skills and judgment learned from good training and experience." When FLACS emerged as a new tech- nology, Dr. Safran evaluated its capabilities and, in the end, said he thought it would be like "putting training wheels on a 10-speed bike." "If you need training wheels, you need them, but if you don't, they're just going to slow you down," he said. As for the laser's ability to create arcuate incisions, Dr. Safran said he thinks limbal relax- ing incisions are preferable to corneal relaxing incisions because the central 8–9 mm of cornea where most femtosecond arcuate incisions are placed is less stable in its healing compared to the cornea within 1–2 mm of the limbus. This is due to the circumcorneal annulus of collagen fibrils in the limbus that stabilizes the cornea in this region, he said. 4 continued from page 37 Relevant disclosures Donaldson: Alcon, Bausch + Lomb, Johnson & Johnson Vision Safran: None Trattler: Alcon, Bausch + Lomb, LENSAR, Johnson & Johnson Vision Screen image showing the plan for femto, with the fragment pattern, capsule, capsular toric marks, and corneal marks for aligning the toric IOL Source: William Trattler, MD

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