NOV 2013

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

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November 2013 36% reduction in corneal endothelial cell loss when compared with the manual phacoemulsification group," Dr. Vote said. "We also saw a reduction in corneal edema at day one, but this was not statistically significant." He added that at the three-week mark, the visual and refractive outcomes were similar between the groups. While there were no intraoperative or postoperative complications in the femtosecond group, there are some safety signal concerns regarding anterior capsulotomy integrity. After finding an increased anterior radial tear rate in a subsequent prospective group, Dr. Vote has since used scanning electron microscopy to concentrate on the anterior capsulotomy edge. "Microscopy has revealed 'postage stamp' type laser perforations of the capsulotomy edge that are rough and irregular, with aberrant laser pulses most likely due to microscopic eye movements during laser treatment," Dr. Vote said. "These do not appear to be as smooth and strong as a manually torn capsulorhexis." Nonetheless, Dr. Vote remains encouraged by study results attained. "Our conclusion is that significant reduction in phacoemulsification energy is achievable, and a high percentage of patients required no phacoemulsification energy with improvements in surgical technique, lens fragmentation methods, and phacoemulsification equipment and fluidics parameters," he said. "While the technology is not currently cost effective, there is the potential to reduce or even eliminate effective phacoemulsification time and thereby potentially the incidence of complications such as postoperative corneal decompensation." He noted that his subsequent data suggest that he is attaining a 75% rate of zero effective phacoemulsification time. "While there are implications for an aspirationdriven procedure, this is most likely achievable in softer cataracts," Dr. Vote said, adding that they have been working to establish the limits of zero phacoemulsification procedures in concert with cataract grade. Going forward, Dr. Vote said he would like to see improved treatment algorithms and energy settings that provide a smoother anterior capsulotomy edge and re- duce the risk of anterior radial tears further. "Also, in order for the technology to have a significant longterm future, the cost to the patient needs to decrease significantly to around $300 to $500," he said. "At its current cost to the patient, the technology is not cost effective on health economic grounds, taking into account the limited published benefits to date." EW THINK PATIENT SAFETY "LENSAR's collection of imaging technologies makes it possible to precisely image the exact location and contour of the posterior capsule, which is the 'Holy Grail' for performing safe ReLACS." – Kerry Assil, MD EW CATARACT 33 Editors' note: Dr. Vote has no financial interests related to this article. Contact information Vote: eye.vote@me.com At LENSAR™, we're always thinking ahead. That's why we designed the LENSAR Laser System with your patients' safety in mind. LENSAR's rotating camera captures up to 16 images from the anterior cornea to the posterior capsule and reconstructs a 3-D model of the eye. Because you'll see exactly where the relevant anatomy is in the eye for all grades of white or brunescent cataracts, you can feel secure in designing and executing an optimum treatment that will maximize outcomes without putting your patients at risk. The LENSAR Laser System. Designed for patient safety, designed for you. Learn more at LENSAR.com Scan to learn about LENSAR at AAO 2013

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