Eyeworld

EW CATARACT/IOL 25 Pearls to getting it right The learning curve in my observa- tion is the younger the surgeon, the easier it is for him or her to learn. Older ophthalmologists have a little bit of difficulty because it's a differ- ent approach from what they're used to. There are some crucial as- pects of the procedure that surgeons need to take note of. For example, because both cap- sules have to be positioned within the groove of the lens after having done anterior and posterior capsu- lorhexis, both capsules have to stay very close to each other; otherwise, the surgeon is never going to get both capsules within the groove. Surgeons must perform posterior continuous curvilinear capsulorhexis according to very precise protocol, perforating the posterior capsule only when the capsule is in the hori- zontal position. The risk of harming the anterior hyaloids is lower when the capsule is loose in the horizontal position instead of bent posteriorly with a filled capsular bag. In addi- tion, never fill the capsular bag after having emptied it of its contents. I always perform the procedure under topical anesthesia; this way, the vit- reous has no pressure and the eye is very quiet. I have had no incidences of vitreous loss. Potential complications of the procedure are the same as that of the traditional lens-in-the-bag implanta- tion technique. The reason I use this technique routinely is because the posterior capsule is absent, allowing full transparency of the anterior seg- ment of the eye and avoiding for- ward scatter of the incoming light completely. The lens can still be improved, of course, as can the lenses used in the traditional implantation tech- nique. However, if optimal quality of vision is the goal, it cannot be ob- tained with classic lens implantation because patients will find decreases in visual acuity or contrast sensitiv- ity with time as the capsular bag becomes more opaque due to condi- tions such as fibrotic reaction, cap- sular contraction, and proliferation of the lens epithelial cells. Further developments I'm currently developing the bag-in- the-lens technique to work where there is no capsule by creating an ar- tificial capsule that can be posi- tioned at the level of the sclera, and the bag-in-the-lens can be inserted in the middle. EW Editors' note: The bag-in-the-lens is ap- proved for use in Europe and is under- going trials for FDA approval in the U.S. Dr. Tassignon has a proprietary interest in the bag-in-the-lens IOL. Contact information Tassignon: +32 3821 3377, marie-jose.tassignon@uza.be w w w. m a rc o . c o m | e m a i l : i n f o @ m a rc o . c o m | 8 0 0 . 8 7 4 . 5 2 7 4 Manufactured by Nidek Connect with Marco on Facebook Catchthe and Optimize Patient Outcomes The next in enhanced diagnostics, optimized refractions, and patient satisfaction Captured in 10 seconds: 1 SA Cornea for Aspheric IOL selection 2 Lenticular – residual astigmatism 3 Angle Kappa 4 Pre/Post Toric IOL measurements 5 Pathologies (Keratoconus, Pellucid) 6 Mesopic/photopic pupil size 7 Retro illumination image 8 Zernike Graphs: total, cornea, internal 9 Corneal Refractive Power map 10 IOL tilt or decentration • Fully Automated ARK • WF Visual Acuity Map • Up to 9.5mm Measurement Area • CT Blue Light (1 sec) • EHR Compatibility OPD-Scan III 265 OPD3 Intro Ad -Isl Half-EW :Island Half-EW 4c 3/8/11 9:55 AM Page 1 April 2011

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