Eyeworld

EyeWorld speaks to experts about the role of combined phaco and LRI to correct astigmatism W hen it comes to man- aging astigmatism at the time of cataract surgery, there are basi- cally two options: use a limbal relaxing incision (LRI) or a toric IOL. by Enette Ngoei EyeWorld Contributing Editor Fixing astigmatism: Toric lens or LRI? DUOVISC ® Viscoelastic System is designed to give two viscoelastic materials with differ- ent physico-chemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DUOVISC ® Viscoelastic System consists of VISCOAT ® Ophthalmic Viscosurgical Device and PROVISC ® Ophthalmic Viscosurgical Device. CAUTION: Federal law restricts this device to sale by or on the order of a physician. Viscoat ® (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device Indications: Viscoat is indicated for use as an ophthalmic surgical aid in anterior seg- ment procedures including cataract extraction and intraocular lens (IOL) implantation. Viscoat maintains a deep anterior chamber during ante- rior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery. Warnings: Failure to follow assembly instruc- tions or use of an alternate cannula may result in cannula detachment and potential patient injury. Precautions: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly puri- fied biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. Adverse Reactions: Viscoat has been extreme- ly well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that Viscoat be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Reference the Physician Labeling/ Directions for Use for a complete listing of indi- cations, warnings and precautions. ProVisc ® (Sodium Hyaluronate) Ophthalmic Viscosurgical Device Indications: ProVisc is indicated for use as an ophthalmic surgical aid in the anterior segment during cataract extraction and intraocular lens (IOL) implantation. Ophthalmic viscoelastics serve to maintain a deep anterior chamber dur- ing anterior segment surgery allowing reduced trauma to the corneal endothelium and sur- rounding ocular tissues. They help push back the vitreous face and prevent formation of a flat chamber during surgery. Precautions: Postoperative increases in intra- ocular pressure have been reported with sodi- um hyaluronate products. The IOP should be carefully monitored and appropriate therapy instituted if significant increases should occur. It is recommended that ProVisc ® be removed by irrigation and/or aspiration at the close of surgery. Do not overfill anterior chamber. Although sodium hyaluronate is a highly puri- fied biological polymer, the physician should be aware of the potential allergic risks inherent in the use of any biological material; care should be used in patients with hypersensitivity to any components in this material. Cannula assembly instructions should be followed to prevent patient injury. Adverse Reactions: Postoperative inflamma- tory reactions such as hypopyon and iritis have been reported with the use of ophthalmic visco- elastics, as well as incidents of corneal edema, corneal decompensation, and a transient rise in intraocular pressure. ATTENTION: Reference the Physician Labeling/ Directions for Use for a complete listing of indi- cations, warnings and precautions. ©2011 Alcon, Inc. VIS512 9,6B3,(:LQGG 30 AT A GLANCE • When it comes to managing astig- matism at the time of cataract surgery, most doctors prefer to use a toric implant and then LRI as a second choice • Some doctors don't believe in LRIs because they think that they regress and are unpredictable. However, there is 10- to 15-year data that shows how well these work, but it is a specific surgical technique that one cannot take too lightly. It has to be done properly • When implanting a patient with a multifocal lens, surgeons manage the astigmatism with LRIs. Addi- tionally, in cases of high astigma- tism where a patient's astigmatism exceeds the power of the toric lens, LRI is combined with toric lens im- plantation • The main points when performing LRIs are careful positioning, careful placement, and careful measure- ment such that one obtains accu- rate depth incisions with a high- quality diamond. If all of that is adhered to, the results of LRIs are excellent At present, most doctors would prefer to use a toric implant and then an LRI as a second choice, said Louis D. "Skip" Nichamin, M.D., medical director, Laurel Eye Clinic, Brookville, Pa. LRIs have less predictability and efficacy when compared to toric lenses, according to Ed Holland, M.D., professor of ophthalmology, University of Cincinnati, and direc- tor, cornea service, Cincinnati Eye Institute. There is also regression with LRIs. Tissue response to the continued on page 100 When performing LRIs, the main points are careful positioning, careful measurements, and careful placement Source: Louis D. Nichamin, M.D. March 2011 COMBINED SURGERY

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