MAR 2014

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

Issue link: https://digital.eyeworld.org/i/276058

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Page 119 of 210

eyes still for 1.5 seconds. Even though the eye is coupled to the laser, there's still potential for a little movement. A little movement can make a big difference in making the capsulotomy," he said. He tells his patients that under- going the capsulotomy is like having a chest X-ray: They should take a deep breath, hold their breath, and not move. While he has not had an incom- plete capsulotomy in more than a year of using the Catalys, it could occur, so he always acts as though the capsulotomy is incomplete, he said. He uses the capsulotomy for- ceps to grasp it, then moves it in a curved way, as though performing a regular curvilinear manual capsulo- tomy. "I think the problem that peo- ple get into is that they don't recog- nize it, and they start pulling the capsule half away and start to get a radial tear. It can result in a wrap- around capsulotomy, where the tear in the capsule goes from the anterior surface of the capsule all the way around to the posterior surface. Then you can lose lens material and have to do a vitrectomy, and it's a mess," he said. For hydrodissection, Dr. Cionni said aggression is unnecessary. Sur- geons should be aware of the gas that can expand the lens, he said. "I suggest injecting just enough fluid to begin to move some of the gaseous bubbles found behind the nucleus and no more. Once the bub- bles move, use the hydrodissection cannula to advance the bubble/ hydrodissection wave around the equator by rotating the nucleus from the opposite pole from where you injected [balanced salt solution] and at the same time push gently poste- riorly," he said. Dr. Culbertson said that he depresses one corner to burp out the gas. For those patients who have corneal opacities, including patients who have undergone radial kerato- tomy, Dr. Cionni also suggests in- creasing the energy level in the capsulotomy to approximately 10 mJ. Postop Postoperative complications with femtosecond laser-assisted cataract surgery are not significantly differ- ent than with manual techniques— one of the main selling points of the devices, according to the experts who spoke to EyeWorld. Besides pos- sible mild, temporary subconjuncti- val hemorrhage, Dr. Cionni said that he has not found many, if any, minor or significant postoperative complications. The main complications happen intraoperatively, Dr. Culbertson said. "There's nothing that the laser has created by virtue of using the laser that shows itself postopera- March 2014 xxx See more patients in the same amount of time without increasing staff . Varitronics, the leader in Non-Verbal Interoffice Communications for over four decades, offers the most feature-rich systems on the market today. Our custom designed Call Systems will streamline the way you work so that you can decrease your patient's waiting time while increasing your staff's efficiency. Call, email, or visit our web site today to see how easy it is to benefit from the efficiency of Varitronics' Call System. 800.345.1244 email:varimed@varitronics.com www.varitronics.com Increase patient flow and overall practice efficiency. Increase profits. Varitronics can show you how! of Var Inte fou sy s des the d Call Systems are available for both new and existing construction. Leading the way in Interoffice Communications Wa l l p a n e l a n d p a g e r C S 2 0 0 0 W i r e l e s s S y s t e m SEE US AT ASCRS AT BOOTH 122 Verion toric alignment tool with LenSx capsulotomy and LuxOR Q-Vue microscope Source: Robert J. Cionni, MD continued on page 118 Visit us at ASCRS Booth 1301 108-125 Feature_EW March 2014-DL2_Layout 1 3/6/14 3:59 PM Page 117

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