Eyeworld

February 2011 by Maxine Lipner Senior EyeWorld Contributing Editor Standing ovation: Upright phaco approach proves as safe as traditional Study shows success for standing phacoemulsification W hen performed by an experienced surgeon, standing phacoemul- sification (phaco) can be as safe as the more conventional approach, according to Charles E. Hugkulstone, F.R.C.S.Ed., F.R.C.Ophth., National Health Serv- ice consultant, Queen Mary's Hospi- tal Sidcup, London. Results published in the October 2010 issue of the Journal of Cataract and Refrac- tive Surgery indicated that patients fared equally well with the tradi- said. He sees the results as an en- couragement for surgeons to try the standing approach. Dr. Hugkulstone recognizes that some have shied away from the procedure. "Going back to the [initial] survey that we conducted, respondents said that they would rather give patients a general anesthetic and lay them down, which of course is not a good idea with this group of patients," Dr. Hugkulstone said. "One person even said that he would do a standing ex- tracap." That was 4 years ago, how- ever, and Dr. Hugkulstone is hopeful that he wouldn't get the same re- sponses today. One unexpected finding was that patients who needed standing phaco tended to be younger than those who underwent treatment with the traditional approach. Dr. Hugkulstone was able to rule out di- abetes as the potential cause here. "There was no difference with dia- betes between the two groups. You ©2009 Alcon, Inc. 6/09 RES908 CAUTION: Federal law restricts this device to sale by or on the order of a phy- sician. INDICATIONS: The AcrySof® IQ ReSTOR® Apodized Diffractive Optic Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, interme- diate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag. WARNINGS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Some adverse re- actions that have been associated with the implantation of intraocular lenses are: hypopyon, intraocular infection, acute corneal decompensation, macular edema, pupillary block, retinal detachment, and secondary surgical interven- tion (including but not limited to lens repositioning, biometry error, visual disturbances or patient dissatisfaction). As a result of the multifocality, some visual effects (halos or radial lines around point sources of light at night) may also be expected due to the superposition of focused and unfocused multiple images. A reduction in contrast sensitivity may also be experienced by some patients, especially in low lighting conditions such as driving at night. In or- der to achieve optimal visual performance with this lens, emmetropia must be targeted. Patients with significant preoperative or expected postoperative astigmatism >1.0D may not achieve optimal visual outcomes. Care should be taken to achieve IOL centration, as lens decentration may result in a patient experiencing visual disturbances under certain lighting conditions. PRECAU- TIONS: Do not resterilize. Do not store over 45° C. Use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solution. Clinical studies with the AcrySof® IQ ReSTOR® IOL indicated that posterior capsule opacification (PCO), when present, developed earlier into clinically significant PCO. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (eg, glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. The long-term effects of filtering blue light and the clinical efficacy of that filtering on the retina have not been conclusively established. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings, and precautions. www.AcrySofReSTOR.com 5(6&B3,(:LQGG 30 tional and the standing approaches. This study was spurred by an earlier survey on standing pha- coemulsification that Dr. Hugkul- stone conducted in 2006 in England and Wales. "That showed that about half of consultants have done stand- ing phacoemulsification," Dr. Hugkulstone said. One of those who reviewed the paper mentioned that it was a pity that he didn't actually have the outcomes of the surgery. It occurred to Dr. Hugkulstone that this would be a good follow-up. "I thought I would do a few and see how they go," Dr. Hugkulstone said. Standing cases There are a variety of reasons why patients need to be treated with the standing approach. "Probably the most common one is being over- weight," Dr. Hugkulstone said. "One wants to have the eye higher than the umbilicus to cut down on the back pressure that patients get from inferior vena cava obstruction with a big tummy laying on it, which raises the pressure in the eye." Other com- mon conditions that can lead to the need for standing phaco include breathing problems, cardiac prob- lems, patients who have a fear of lying flat, as well as those with back problems. Included in the prospective, comparative case series were 20 pa- tients who required standing pha- coemulsification from October 2005 to June 2008. While some needed their second eye done as well, only first eyes were required here. Pa- tients that didn't need standing pha- coemulsification on the same operating list were used as controls. Those that required standing pha- coemulsification were propped against a Stryker trolley (Kalamazoo, Mich.). "This has the ability to bend the back up and ex- tend the neck; you can also tip the table somewhat," Dr. Hugkulstone said. "The combination of those fea- tures of the operating table make it a good thing for these patients." Investigators determined that there was no difference in the rate of complications between the two groups. "The perioperative complica- tion rates were the same, and post- operatively, minor things occurred at the same rate and there were simi- lar visual results," Dr. Hugkulstone EW CATARACT/IOL 50 44-51 Cataract_EW February 2011-dl2_Layout 1 2/4/11 2:20 PM Page 50

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