JUL 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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50 EW International July 2013 APX continued from page 49 Pupil diameter is 3 mm. Non-symmetrical placement of the APX dilators creates a trapezoidal pupillary opening. This provides a wide "device-free" area that does not impede the surgical instruments. PC-IOL implantation in-the-bag. ACCC margin is readily visible. The APX is removed at the end of the procedure. The pupil resumes its circular shape. Source (all): Ehud I. Assia, MD well on first attempt, they can be repositioned by maneuvering the external element of the device. No intraocular manipulations are needed for the insertion, positioning, or removal of the APX devices. Removal of the pupil expanders is done by using the same designated forceps. The device is simply closed and pulled out in a manner of a few seconds. The stainless steel APX-100 is cleared for clinical use by the FDA (510K exempt) and was used in 35 patients—15 cases in Israel and 20 cases operated on by several leading surgeons in the U.S. Surgeries were done in a variety of cases including pseu- doexfoliation, uveitic cataract, post filtration surgery, mature and hypermature dense nuclear cataract, patients with clinical IFIS, and for secondary implantation of PC-IOLs in aphakic eyes previously operated on for congenital cataract. In one case surgery included pars plana vitrectomy for removal of the dislocated crystalline lens followed by "glue fixation" of a posterior chamber IOL to the scleral wall. In all cases the operations were successfully performed with effective pupil dilation throughout surgery, and no intraoperative or postoperative device-related complications were noted. Surgeries were done in superior, lateral, or oblique approaches according to surgeons' preference, and the devices were placed perpendicular to the main incision of the phaco tip. In three cases the APX was positioned in an asymmetrical (non-opposite) fashion. This created a trapezoidal-shaped opening with the wide diameter located closer to the surgical incision to allow more "device-free" area that would not impede the access of surgical instruments. The plastic version, APX-200, is now at its final preproduction and regulatory stages. Experimental studies on porcine eyes demonstrated the feasibility, efficacy, and comfortable use of the disposable devices. EW Editors' note: Dr. Assia is professor of ophthalmology, Sackler School of Medicine, Tel Aviv University; director, Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel; and medical director, Ein Tal Eye Center, Tel Aviv, Israel. Dr. Assia is the inventor of the APX and partner in APX Ophthalmology. He has financial interests with Bio-Technology General (Kiryat Malachi, Israel), IOPtima (Tel Aviv, Israel), and Hanita Lenses (Hanita, Israel). Contact information Assia: assia@netvision.net.il

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