NOV 2013

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

Issue link: https://digital.eyeworld.org/i/220233

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Page 10 of 122

November 2013 THE CATARACT REFRACTIVE SUITE BY ALCON IMPORTANT SAFETY INFORMATION 2013 ASCRS•ASOA Symposium & Congress Best Papers of Session CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. As part of a properly maintained surgical environment, it is recommended that a backup IOL Injector be made available in the event the AutoSert® IOL Injector Handpiece does not perform as expected. INDICATION: The CENTURION® Vision System is indicated for emulsification, separation, irrigation, and aspiration of cataracts, residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intraocular lens injection. The AutoSert® IOL Injector Handpiece is intended to deliver qualified AcrySof® intraocular lenses into the eye following cataract removal. The AutoSert® IOL Injector Handpiece achieves the functionality of injection of intraocular lenses. The AutoSert® IOL Injector Handpiece is indicated for use with the AcrySof® lenses SN6OWF, SN6AD1, SN6AT3 through SN6AT9, as well as approved AcrySof® lenses that are specifically indicated for use with this inserter, as indicated in the approved labeling of those lenses. WARNINGS: Appropriate use of CENTURION® Vision System parameters and accessories is important for successful procedures. Use of low vacuum limits, low flow rates, low bottle heights, high power settings, extended power usage, power usage during occlusion conditions (beeping tones), failure to sufficiently aspirate viscoelastic prior to using power, excessively tight incisions, and combinations of the above actions may result in significant temperature increases at incision site and inside the eye, and lead to severe thermal eye tissue damage. Good clinical practice dictates the testing for adequate irrigation and aspiration flow prior to entering the eye. Ensure that tubings are not occluded or pinched during any phase of operation. The consumables used in conjunction with ALCON® instrument products constitute a complete surgical system. Use of consumables and handpieces other than those manufactured by Alcon may affect system performance and create potential hazards. AEs/COMPLICATIONS: Inadvertent actuation of Prime or Tune while a handpiece is in the eye can create a hazardous condition that may result in patient injury. During any ultrasonic procedure, metal particles may result from inadvertent touching of the ultrasonic tip with a second instrument. Another potential source of metal particles resulting from any ultrasonic handpiece may be the result of ultrasonic energy causing micro abrasion of the ultrasonic tip. ATTENTION: Refer to the Directions for Use and Operator's Manual for a complete listing of indications, warnings, cautions and notes. © 2013 Novartis 9/13 CNT13017JAD Early visual outcomes of the first 100 cases of femtosecond laser-assisted cataract surgery in an ophthalmic institution in Singapore Soon-Phaik Chee, Younian Yang, Seng-Ei Ti Our experience with the first 100 consecutive cases of femtosecond laser-assisted cataract surgery (FLACS) at the Singapore National Eye Centre is described. We compared the results with the conventional cataract technique (random sample from previous year's audit data). We targeted a 5.0 mm capsulotomy and performed nuclear fragmentation using the Victus (Bausch + Lomb, Rochester, N.Y./ Technolas, Singapore). All eyes were successfully docked and safely treated without suction loss. This series included eyes with corneal opacity, brunescent, white/intumescent and subluxated cataracts. The capsulotomy was complete in 66 eyes, seven had bridges, 21 had tags and six had both. Nucleus fragmentation using radial cuts was effective in 86% eyes. Complications included two anterior and one posterior capsule tear occurring during cortex aspiration. One eye sustained a minor limited iris hemorrhage due to patient movement during laser treatment. Unaided visual acuity of 20/40 or better was achieved in 98.9% eyes. The unaided 20/25 or better rate was significantly higher among the FLACS (66.7%) than non-FLACS (52.0%) group (Fisher's Exact Test, P=0.04). However, their refractive accuracy was comparable. Preoperative, intraoperative and postoperative wavefront aberrometry and internal astigmatism in a cataract population Joseph J.K. Ma, MD, FRCSC, Cindy Law The concept of internal astigmatism (IA) is well known and is the reason keratometry and topography often do not accurately reflect refractive astigmatism. Nevertheless, they are the metrics commonly used for planning astigmatic correction in cataract surgery. We wanted to know with modern wavefront aberrometry (pre-, intra-, postop), Placido-based topography, Scheimpflug and slitbased tomography: 1) What is the average postoperative internal astigmatism? and 2) Can we predict this accurately? We reviewed a sample of a surgical population of monofocal non-toric IOL patients and studied the correlation between different metrics. We found that in this population, the average amount of IA was +0.39 D x 169. There was weak correlation between preoperative and postoperative IA, suggesting a significant magnitude and prevalence of lenticular astigmatism. Surprisingly, there was also a low paired correlation between posterior corneal astigmatism (PCA) and postop IA. PCA accounted on average for only 61.5% of total IA, suggesting either that lens tilt and other factors are more important than previously recognized, or that our current method of measuring posterior astigmatism is simply not accurate enough. Interestingly, intraoperative aberrometry had a poor correlation with postoperative IA. In theory, intraoperative measurements after lens removal should be able to provide us with the best measure of IA. However in practice, the artificial intraoperative environment may not be the most conducive for minute astigmatic measurements on the order of IA. It appears at this time that the simplicity of adopting an average IA value for the population may still be the best method for estimating internal astigmatism. Further improvements in technology and technique may eventually allow us to better predict this value more accurately between individual patients. Femtosecond laser-assisted technique for performing the bag-in-the-lens intraocular lens implantation Ana Paula Canto, MD, Tim Schultz, MD, William W. Culbertson, MD, H. Burkhard Dick, MD The purpose of this paper was to report a new technique for bag-inthe-lens (BIL) intraocular lens (IOL) implantation using femtosecond laser-assisted cataract technology. In this technique the anterior capsulotomy, nucleus fragmentation, and the posterior capsulotomy are created using the femtosecond laserassisted cataract technology. A fluidfilled interface makes it possible to redock the laser to the eye for posterior capsulotomy after the eye has been opened for lens aspiration without complications. The BIL IOL has its posterior haptics placed behind the posterior capsulotomy and the anterior haptics on the top of the anterior capsulotomy. At the time, the technique had been performed in 31 patients and no complications were observed within a one-month follow-up. Femtosecond laser-assisted cataract surgery facilitated the BIL technique. EW EyeWorld factoid Keratoconus is the most common corneal dystrophy in the U.S., affecting one in every 2,000 Americans. It is more prevalent in teenagers and adults in their 20s. Source: National Eye Institute

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