SEP 2013

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

Issue link: https://digital.eyeworld.org/i/176967

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14 EW NEWS & OPINION September 2013 2013 ASCRS•ASOA Symposium & Congress Best Papers of Session The cataract paper sessions at the 2013 ASCRS•ASOA Symposium & Congress showcased the innovative work of our colleagues and examined a wide spectrum of research in cataract surgery. The following five papers were found to be exceptional and were designated as "Best Paper of Session," offering considerable insight into many different aspects of cataract surgery. Neal Shorstein, MD, found that intracameral antibiotics significantly reduced endophthalmitis rates in a large patient population. Michael Raizman, MD, described a new technique for measuring corneal wound integrity in cataract surgery. Anne Floyd, MD, investigated the link between IOL design and prevention of posterior capsule opacification. A new device for marking the eye for toric IOL alignment was shown by Takayuki Akahoshi, MD, and Rex Hamilton, MD, studied the effect of posterior corneal astigmatism on refractive outcomes with toric IOL implantation. –Mitchell P. Weikert, MD, cataract editorial board member Decreased postoperative endophthalmitis rate after institution of intracameral antibiotics in a Northern California eye department Neal Shorstein, MD, Kevin L. Winthrop, MD, MPH, Lisa Herrinton Faced in 2007 with a rising endophthalmitis rate that had no identifiable, quality-related explanation, cataract surgeons in a Northern California department of Kaiser Permanente initiated injections of intracameral cefuroxime following the successful results of a large, randomized study in Europe.* In 2009, moxifloxacin was adopted for surgical patients allergic to penicillin and vancomycin for the 1% of patients who were allergic to both. For the 16,000 surgeries performed between 2007 and 2011, the endophthalmitis rate dropped 22fold, which was statistically significant.** The conclusion of the study's authors was that the biggest fall in infection rate occurred when intracameral antibiotics were injected in all surgical patients, including those with posterior capsular rupture. The techniques for compounding the antibiotics will be published in an upcoming issue of the Journal of Cataract & Refractive Surgery. Currently, a study funded by the NEI is under way at Kaiser Permanente comparing a broader array of prophylactic treatment in more than 200,000 patients. *ESCRS **The study was published in the January 2013 issue of the Journal of Cataract & Refractive Surgery. Evaluation of clear corneal cataract wound integrity and leakage during simulated patient manipulation in immediate postoperative period Michael B. Raizman, MD, Samuel Masket, MD, John A. Hovanesian, MD Clear corneal wound leaks are considered to be a contributing factor for postoperative complications, however, not much is known about how patient manipulation affects wound integrity. The goal of the study was to develop a standardized method that simulates IOP fluctuations caused by patient manipulation, and to use that method to examine wound leak rates following cataract surgery. A calibrated force gauge (CFG) was developed to apply reproducible external force posterior to the lim- EyeWorld @EWNews Keep up on the latest in ophthalmology! Follow EyeWorld on Twitter at twitter.com/EWNews bus. Using the CFG in healthy patients, it was determined that 1 oz force simulated patient manipulation and created IOP fluctuations in line with those found in the literature (mean 25.95 mm Hg from baseline).1 When using this method to challenge CCIs, 20 out of 30 eyes (67.7%) leaked with ≤1 oz force. Biplane incisions appeared to be more stable than single plane incisions, with leak rates of 43.8% versus 92.8%, respectively. In summary, if a wound leaks under CFG manipulation, this may be an indication that wound architecture is not adequate, and further protection is necessary. 1. McMonnies CW, Boneham GC. Experimentally increased intraocular pressure using digital forces. Eye & Contact Lens 33(3):124129, 2007. Capsular bag opacification with a new accommodating intraocular lens Anne Floyd, MD, Liliana Werner, MD, Erica Liu, MD, Shannon Stallings, MD, Andrew Ollerton, MD, Lisa Leishman, MD, Zachary Bodnar, MD, Caleb Morris, BA, Nick Mamalis, MD Prevention of capsular fibrosis is particularly important for accommodating IOLs that are designed to move within the bag and alter the optical shape in response to accommodating stimuli. We evaluated capsular bag opacification (ACO and PCO) with a new accommodating IOL that incorporates large haptic elements. Bilateral phacoemulsification was performed on six rabbits with implantation of the accommodating IOL and a control (one-piece hydrophobic acrylic) IOL. After six weeks, PCO clinical score was 0.5±0.3 (SD) in the study group and 3.0±0.9 in the control (P=.001). ACO was practically absent in the study group and mild in the control. After enucleation, Miyake-Apple view analysis showed mean central PCO scores of 0±0 in the study group and 3.0±1.1 in the control (P=.001). The study IOL maintains an expanded capsular bag secondary to the large haptic size, which appears to prevent capsular bag opacification. New toric markers Takayuki Akahoshi, MD For the precise marking of the toric axis, an electronic toric marker was developed. The horizontal position is indicated by five LEDs of different colors and beeping sounds. The surgeon can concentrate on the patient's eye as the position is indicated by the LED and sound. The accuracy of the marking is 0.2 degrees. For the cases with narrow lids or deep-set eyes, the intraoperative axis gauge, which is placed on the cornea rather than the limbus as in conventional models, is useful. For this gauge, an electronic reference marker can mark the 0 and 180-degree positions quite easily and precisely. With these new toric devices, the accuracy of the axis marking was improved remarkably. Effect of posterior corneal astigmatism on refractive outcomes after cataract surgery with toric IOL implantation D. Rex Hamilton, MD, Mary Ellen A. Sy, MD, Harry Mai Forty-six eyes of 35 patients that received toric intraocular lens implantation following cataract extraction were studied retrospectively to determine the prediction error of three different methods of determining corneal astigmatism. Total corneal power using ray tracing (TCP) and total astigmatism by vector addition of anterior and posterior astigmatism (TA) as measured by dual rotating Scheimpflug imaging (Galilei, Ziemer Ophthalmic Systems, Port, Switzerland) were used to calculate astigmatism and compared to automated keratometry (AK) as measured by IOLMaster (Carl Zeiss Meditec, Jena, Germany), which was used for IOL selection. Seventy-eight percent of eyes had with-the-rule posterior astigmatism, which subtracts in magnitude from anterior with-therule astigmatism. Automated keratometry had a bias toward overcorrecting with-the-rule astigmatism and undercorrecting against-the-rule astigmatism. Total corneal power and total astigmatism methods did not suffer from this bias. Consider choosing the next lower astigmatic power toric IOL in with-the-rule cases if calculated residual astigmatism is close to zero. Consider choosing the next higher astigmatic power toric IOL in against-the-rule cases if calculated residual astigmatism is close to zero.

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