Eyeworld

EW NEWS & OPINION 18 complex to the anatomical position. If AAL fails, PAL is the last option. Any vitreous strands tangled with the grasped IOL are severed using intraocular microscissors be- fore the IOL is brought forward as OVD is simultaneously injected to tamponade the vitreous. When pres- ent, I prefer removing the capsular bag of a bag-IOL complex manually by cutting the capsulorhexis rim of the bag with microscissors, then tearing and stripping each half off with microforceps while the optic is held by the lens micrograsper. A sleeveless automated anterior vitrec- tor with an AC maintainer is then introduced to remove the capsular remnants, accompanying Soemmer- ing's ring, and any presenting vitre- ous (Figure 1). Alternatively, the entire bag can be removed using only the anterior vitrector, transfer- ring the grasp of the optic from one lens grasper to another to ensure a complete clearance of intervening vitreous. If the haptics are not con- veniently positioned for placement of fixation sutures, the naked IOL can be rotated clockwise hand-over- hand between a pair of lens micro- graspers. Thereafter, the pupil is constricted while the optic is main- tained above the iris plane by the lens micrograsper. Suturing to the iris Next, a prolene 10-0 with a curved needle (CIF-4, Ethicon Inc., Somerville, N.J.) is inserted into the nasal paracentesis near the haptic. The IOL optic is lifted by the lens micrograsper as the needle is passed behind the haptic through the pe- ripheral iris and intact cornea (Fig- ure 2). This maneuver enhances the outline of the haptic (even through a thick, heavily pigmented iris) and places the iris-haptic complex in a readily accessible plane for passing of the needle. The optic is released after the procedure has been re- peated for the other haptic. A Siepser slipknot is used to se- cure the haptic to the iris after en- suring that the IOL is centered. OVD is first introduced to deepen the AC over the iris fixation sites. The Chee Suture Retrieving Hook (ASICO), which is inserted into the paracente- sis alongside which the suture has been introduced into the eye, is used to hook the segment of prolene su- ture between the iris and the cornea exit point (Figure 3). Because the November 2011 LenSx® Laser Indication: The LenSx® Laser is indicated for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, phacofragmentation, and the creation of single plane and multi-plane arc cuts/incisions in the cornea, each of which may be performed either individually or consecutively during the same procedure. Caution: United States Federal Law restricts this device to sale and use by or on the order of a physician or licensed eye care practitioner. United States Federal Law restricts the use of this device to practitioners who have been trained in the operation of this device. Restrictions: t 5IJTEFWJDFJTOPUJOUFOEFEGPSVTFJOQFEJBUSJDTVSHFSZ t 1BUJFOUTNVTUCFBCMFUPMJFnBUBOENPUJPOMFTTJOBTVQJOFQPTJUJPO t 1BUJFOUNVTUCFBCMFUPVOEFSTUBOEBOEHJWFBOJOGPSNFEDPOTFOU t 1BUJFOUTNVTUCFBCMFUPUPMFSBUFMPDBMPSUPQJDBMBOFTUIFTJB t 1BUJFOUTXJUIFMFWBUFE*01TIPVMEVTFUPQJDBMTUFSPJETPOMZVOEFS close medical supervision. Contraindications: t $PSOFBMEJTFBTFUIBUQSFDMVEFTBQQMBOBUJPOPGUIFDPSOFBPS transmission of laser light at 1030 nm wavelength t %FTDFNFUPDFMFXJUIJNQFOEJOHDPSOFBMSVQUVSF t 1SFTFODFPGCMPPEPSPUIFSNBUFSJBMJOUIFBOUFSJPSDIBNCFS t 1PPSMZEJMBUJOHQVQJMTVDIUIBUUIFJSJTJTOPUQFSJQIFSBMUPUIF intended diameter for the capsulotomy t $POEJUJPOTXIJDIXPVMEDBVTFJOBEFRVBUFDMFBSBODFCFUXFFO the intended capsulotomy depth and the endothelium (applicable to capsulotomy only) t 1SFWJPVTDPSOFBMJODJTJPOTUIBUNJHIUQSPWJEFBQPUFOUJBMTQBDF into which the gas produced by the procedure can escape t $PSOFBMUIJDLOFTTSFRVJSFNFOUTUIBUBSFCFZPOEUIFSBOHFPG the system t $PSOFBMPQBDJUZUIBUXPVMEJOUFSGFSFXJUIUIFMBTFSCFBN t )ZQPUPOZHMBVDPNBPSUIFQSFTFODFPGBDPSOFBMJNQMBOU t 3FTJEVBMSFDVSSFOUBDUJWFPDVMBSPSFZFMJEEJTFBTFJODMVEJOHBOZ corneal abnormality (for example, recurrent corneal erosion, severe basement membrane disease) t 5IJTEFWJDFJTOPUJOUFOEFEGPSVTFJOQFEJBUSJDTVSHFSZ Attention: 'PS*NQPSUBOU4BGFUZ*OGPSNBUJPOBOE'VMM%JSFDUJPOTGPS6TFQMFBTFSFGFSFODFUIF-FO4Y¥-BTFS%JSFDUJPOTGPS6TF Warnings: The LenSx® Laser System should only be operated by a physician trained in its use. The LenSx® Laser delivery system employs one sterile disposable LenSx® -BTFS1BUJFOU*OUFSGBDFDPOTJTUJOHPGBO BQQMBOBUJPOMFOTBOETVDUJPOSJOH5IF1BUJFOU*OUFSGBDFJTJOUFOEFEGPSTJOHMFVTFPOMZ5IFEJTQPTBCMFTVTFEJO DPOKVODUJPOXJUI"-$0/¥JOTUSVNFOUQSPEVDUTDPOTUJUVUFBDPNQMFUFTVSHJDBMTZTUFN6TFPGEJTQPTBCMFTPUIFS than those manufactured by Alcon may affect system performance and create potential hazards. The physician should base patient selection criteria on professional experience, published literature, and educational courses. Adult patients should be scheduled to undergo cataract extraction. Precautions: t %POPUVTFDFMMQIPOFTPSQBHFSTPGBOZLJOEJOUIFTBNFSPPNBT the LenSx® Laser. t %JTDBSEVTFE1BUJFOU*OUFSGBDFTBTNFEJDBMXBTUF AEs/Complications: t $BQTVMPUPNZQIBDPGSBHNFOUBUJPOPSDVUPSJODJTJPOEFDFOUSBUJPO t *ODPNQMFUFPSJOUFSSVQUFEDBQTVMPUPNZGSBHNFOUBUJPOPSDPSOFBM incision procedure t $BQTVMBSUFBS t $PSOFBMBCSBTJPOPSEFGFDU t 1BJO t *OGFDUJPO t #MFFEJOH t %BNBHFUPJOUSBPDVMBSTUSVDUVSFT t "OUFSJPSDIBNCFSnVJEMFBLBHFBOUFSJPSDIBNCFSDPMMBQTF t &MFWBUFEQSFTTVSFUPUIFFZF ª/PWBSUJT -49+"% LSX11503JAD_PI EW.indd 1 10/13/11 7:01 PM Managing continued from page 17 Figure 2. The lens grasping forceps supports and lifts the IOL as the iris fixation sutures are passed, enhancing the outline of the haptic beneath the iris Source: Soon-Phaik Chee, F.R.C.Ophth. Figure 3. The Chee Suture Retrieving Hook easily slips into the paracentesis incision to engage and withdraw the prolene suture without suture slippage Source: Soon-Phaik Chee, F.R.C.Ophth. continued on page 22

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