EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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E W MEETING REPORTER 1 61 highlighting the pros and cons. The pros include that they are inexpen- sive, easy to perform, there is mini- m al instrumentation involved, they can be done at the time of cataract surgery, there is no impact on cataract healing and can be re- peated. Some of the cons are the need for topography and being able to interpret the topography; they may induce irregular astigmatism when greater than 2 D; there is a risk o f perforation; and they are less precise than laser vision correction. Where to put the LRIs was also dis- cussed, and Dr. Donnenfeld high- lighted www.lricalculator.com. He also said that when using LRIs, physicians need to press hard because one of the most common problems with LRIs is the lack of d epth. Laser incisions are the future, Dr. Donnenfeld said, although there are still some variable effects. He concluded that LRIs and arcuate in- cisions are now playing an increas- ingly important role in refractive cataract surgery; manual LRIs can be performed in the office; femtosec- ond arcuate incisions may now be made at the time of cataract surgery with increased precision and safety; and intrastromal arcuate incisions will play an important role in astig- matism management. Laurence T.D. Sperber, MD, New York, discussed PRK, particu- larly highlighting the technique for this procedure. In terms of laser vi- sion correction, Dr. Sperber said that PRK is probably the best choice, es- pecially since physicians are usually correcting lower values of residual refractive error. Important tech- niques for PRK include preoperative preparation, topical antibiotics, topical anesthetic, and oral benzodi- azepines. There needs to be sterile preparation, topical anesthetics, epithelial removal, centration of the laser, engaging pupil tracking, engaging iris registration, use of ex- cimer laser treatment and post-laser topical drops. Dr. Sperber also cov- ered his post-laser regimen, which includes bandaging the contact lens until the epithelial defect heals, using topical drops, and using oral pain control for patients who express significant discomfort. On the topic of intraoperative aberrometry, Dr. Donnenfeld cov- ered several things that make this t echnology very exciting. He said that intraoperative aberrometry takes into account factors that you can't get preoperatively, such as measurement of the true refractive power of the cornea including the posterior surface; it incorporates surgically induced astigmatism; it compensates for ocular cyclotorsion; it measures the visual axis; it notes the center of the cornea; and finally, intraoperative aberrometry provides i mproved refractive results in post refractive eyes, toric IOLs, high myopes and hyperopes. Tips for the piggyback IOL Bonnie An Henderson, MD, B oston, offered perals and tips for piggyback IOLs. Physicians want to avoid acrylic-acrylic piggybacking, she said. The best option would be with the acrylic in the bag and the silicone in the sulcus. She added t hat it's helpful to place the higher power IOL in the bag and the lower in the sulcus. Choose the rounded anterior surface of the IOL for piggy- backing, Dr. Henderson said. Addi- tionally, she emphasized a formula from Jonathan B. Rubenstein, MD, Chicago, that she finds particularly helpful for piggyback IOLs. In this Ophthalmology Inpatient and outpatient care for medically complex patients The Department of Ophthalmology improves lives by creating, teaching, and delivering unsurpassed innovative care in a unique integrated and collaborative patient-focused environment. More than 60 ophthalmologists More than 180,000 patient visits annually More than 30 active grants Continuing Medical Education Courses: — Mayo Clinic Neuro-Ophthalmology in Clinical Practice September 19 - 21, 2014 Orlando, Florida — Mayo Clinic Retina Update and Case Conference October 31 - November 1, 2014 Rochester, Minnesota Please visit us at mayoclinic.org/ophthalmology continued on page 162 March 2014 160-163 MR ReACT_EW March 2014-DL_Layout 1 3/6/14 4:27 PM Page 161