EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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Wait and see Still, for other types of ophthalmic s urgery such as a phacoemulsifica- tion procedure, Dr. Kent takes the tack of simply waiting. In such cases, there's no harm in stopping, unlike with LASIK. "If you've got the flap up during an excimer laser surgery, you don't want to have it up any longer than necessary," he said. "But if you're in the middle of a phaco p rocedure, waiting for 20 seconds is not going to make any difference." Likewise, Dr. Borthwick, who performs delicate vitrectomy surgery, usually waits it out if earth- quakes occur during surgery. "You can feel them in your feet and in the chair before they start to upset the patient," he said. "Basically you pull your instruments out and wait for it to go." In addition, he emphasized that it's important to secure the patient and the machinery. "The other thing that you need to do is lock the bed on the floor," Dr. Borthwick said. "There is nothing more dis- tressing than what happened in one big earthquake—not in my theater: The patient was going in one direc- tion and the anesthetic machine was going in the other." He emphasized it's important to have the anesthetic machine wheels locked as well. Dr. Borthwick recommended putting up the side of the bed so that the patient doesn't get thrown off. He noted that in one big earth- quake that happened to a general surgery patient. Some flexibility in determining when to call it a day is also required. Dr. Borthwick recalled one instance when there were two 5-plus earth- quakes in one day. "We had one big earthquake at around 12:30 p.m.— we talked to the patients and they were all fine," he said. "Then about an hour and a half later we had an- other big one and at that stage we all decided to go home." Dr. Borthwick escorted the patients out of the hospital and down the emer- gency fire escape. For one patient the delay turned out to be a good thing. "He had an epiretinal mem- brane and he came back to see me a year later and the membrane had peeled off," Dr. Borthwick said. "He might have been saved an operation by the earthquake." Given all the earthquakes that have occurred in Christchurch, offering patients reassurance is key, Dr. Borthwick said. "We have a lot of i nformation reassuring patients that they're going to be safe—that we cannot damage the eye while we're operating if an earthquake strikes," he said. O verall, Dr. Borthwick is reflec- tive about the situation. "I hope no one else has to experience what we've gone through," he said. EW Contact information Borthwick: jamesborthwick@southerneye.co.nz Kent: David@lasik.co.nz EW International 79 F ebruary 2014 At LENSAR ™ , we're always thinking ahead. That's why the LENSAR Laser System was specifcally designed with the needs of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR's ability to place laser pulses within 500 µm 1 of the posterior capsule results in a reduction in phaco energy up to 100%. 1 Visit LENSAR Booth #1321 at ASCRS 2014 to learn more. Come see what else we've thought of that makes LENSAR the intelligent choice for cataract surgery. ALWAYS THINKING AHEAD The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, laser phacofragmentation, and the creation of full and partial thickness single-plane and multi-plane arc cuts/incisions in the cornea, each of which may be performed either individually or consecutively during the same procedure. Laser Capsulotomy, laser phacofragmentation and/or corneal incisions surgery is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greater than that of the intended treatment and for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have existing corneal implants, who have previous corneal incisions that might provide a potential space into which the gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsulotomy cut and the corneal endothelium, such as: hypotony, uncontrolled glaucoma, who have corneal disease or pathology that precludes transmission of light at the laser wavelength or causes distortion of laser light, such as: corneal opacities, residual, recurrent, active ocular or uncontrolled eyelid disease or any corneal abnormalities (including endothelial dystrophy, guttata, recurrent corneal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be treated, a history of severe dry eye that has not responded to therapy, a history of herpes zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. WARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy, a history of treated glaucoma, or prior intraocular surgery. 1. Data on fle. LENSAR, Inc. © 2014 LENSAR, Inc. All rights reserved. LENSAR, the LENSAR logo and Augmented Reality are trademarks of LENSAR, Inc. 50-00060-000 01/14 At LENSAR ™ , we're always thinking ahead. That' of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' to place laser pulses within 500 µm Visit LENSAR Booth #1321 Come see what else we've thought of that makes the intelligent choice for cataract surgery The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surger tial thickness single-plane and multi-plane arc cuts/incisions in the cor of full and par s why the LENSAR Laser System was specifcally designed with the needs , we're always thinking ahead. That' of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' to place laser pulses within 500 µm 1 of the posterior capsule results in a reduction in phaco energy up to 100%. LENSAR Booth #1321 at ASCRS 2014 to learn more. Come see what else we've thought of that makes . choice for cataract surgery y. y for removal of the cr The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surger nea, each of which may be per tial thickness single-plane and multi-plane arc cuts/incisions in the cor s why the LENSAR Laser System was specifcally designed with the needs of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' of the posterior capsule results in a reduction in phaco energy up to 100%. at ASCRS 2014 to learn more. Come see what else we've thought of that makes LENSAR y include anterior capsulotomy ystalline lens. Intended uses in cataract surger y for removal of the cr med either individually or consecutively during the same procedure. for nea, each of which may be per s why the LENSAR Laser System was specifcally designed with the needs of cataract surgeons in mind. Automated features and thoughtful ergonomics allow for seamless integration without added s ability time. Superior imaging and precise laser delivery contribute to the safe removal of all cataract densities. And LENSAR' of the posterior capsule results in a reduction in phaco energy up to 100%. 1 , laser phacofragmentation, and the creation ude anterior capsulotomy y, laser phacofragmentation, and the creation med either individually or consecutively during the same procedure. tial thickness single-plane and multi-plane arc cuts/incisions in the cor of full and par , laser phacofragmentation and/or cor Laser Capsulotomy y, laser phacofragmentation and/or cor for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have exis gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsul pathology that precludes transmission of light at the laser wavelength or causes distor neal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be tr rent cor , guttata, recur dystrophy y, guttata, recur zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. ARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy W 1. Data on fle. LENSAR, Inc. © 2014 LENSAR, Inc. All rights reser nea, each of which may be per tial thickness single-plane and multi-plane arc cuts/incisions in the cor y is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greate neal incisions surger , laser phacofragmentation and/or cor for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have exis gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsul tion of laser light, such as: cor pathology that precludes transmission of light at the laser wavelength or causes distor neal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be tr zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. ARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy ved. LENSAR, the LENSAR logo and Augmented Reality are trademarks of LENSAR, Inc. 50-00060-000 01/14 © 2014 LENSAR, Inc. All rights reser med either individually or consecutively during the same procedure. for nea, each of which may be per y is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greate neal incisions that might provide a potential space into which the neal implants, who have previous cor ting cor for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have exis neal endothelium, such as: hypotony otomy cut and the cor gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsul rent, active ocular or uncontrolled eyelid disease or any cor neal opacities, residual, recur tion of laser light, such as: cor y of severe dr eated, a histor neal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be tr . y y of treated glaucoma, or prior intraocular surger , a histor etinopathy y, a histor ved. LENSAR, the LENSAR logo and Augmented Reality are trademarks of LENSAR, Inc. 50-00060-000 01/14 med either individually or consecutively during the same procedure. r than that of the intended treatment and y is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greate neal incisions that might provide a potential space into which the neal disease or , uncontrolled glaucoma, who have cor as: hypotony y, uncontrolled glaucoma, who have cor malities (including endothelial neal abnor rent, active ocular or uncontrolled eyelid disease or any cor y of herpes , a histor y eye that has not responded to therapy y, a histor y of severe dr 78-81 International_EW February 2014-DL3_Layout 1 1/30/14 11:08 AM Page 79