Eyeworld

EW MEETING REPORTER 56 November 2011 part Clinical Research Symposium, which covered topics ranging from advanced optics of the eye to biotreatment of the cornea and new corneal surgical treatments. Cataract and the endothelium Saturday's main symposium, chaired by Harminder Dua, M.D., U.K., and ESCRS President Jose Guell, M.D., Barcelona, Spain, focused on cataract and the endothelium. En- dothelial keratoplasty combined with cataract extraction and IOL lens implantation is an effective way to treat patients who have both cataract and endothelial disease, ac- cording to Sadeer B. Hannush, M.D., Philadelphia, who spoke at the symposium, which was jointly sponsored by ESCRS and EU- Cornea. The main selling point to the triple procedure is that it avoids additional surgery, Dr. Hannush said. "Command of both of the components of the procedure is es- sential for its success," he cautioned. Dr. Hannush said, based on his 6 years of experience with the newer procedure, visual rehabilitation is very rapid. "Within about 6 weeks the patient is rehabilitated visually," he said. He noted that many sur- geons feel the surgery should be di- vided into sequential parts. Sequential surgery's advantages may include less surgery in each en- counter, greater stability of the ante- rior chamber and lens/iris, and less inflammation. A resolved cataract may mean that the patient won't need endothelial keratoplasty, Dr. Hannush said. Sunday, September 18 The word of the day Sunday was "femtosecond" as ESCRS contin- ued. In addition to several key ses- sions on femtosecond laser-assisted cataract surgery, other highlights of the Sunday lineup included the wel- come from Jose Guell, M.D., ESCRS president, the announcement of the ESCRS Grand Medal of Merit being given to Emanuel Rosen, M.D., and the presentation of the Binkhorst Medal Lecture by Marie-José Tassignon, M.D. Dr. Tassignon invented a novel IOL lens design with a specific im- plantation technique, aimed prima- rily at eradicating posterior capsular opacification. The clinical outcome showed that the goal was achieved, motivating her to continue her work by developing a toric version, ac- cording to a biography on Dr. Tassignon on the ESCRS website. "Spherical aberration could also be done, but that's a more tricky prob- lem," Dr. Tassignon said. She is also working on an artificial capsule al- lowing the implantation of her in- traocular lens in an eye without capsular support. Paper session reveals prelimi- nary data for femtosecond laser-assisted cataract surgery Several clinicians introduced prelim- inary clinical data on femtosecond laser-assisted cataract surgery during a Sunday paper session. Stephen Brint, M.D., Metairie, La., presented the results of a non-randomized, sin- gle-site study performed by Robert Cionni, M.D., at the Eye Institute of Utah, Salt Lake City, in which Dr. Cionni used a LenSx femtosecond laser (Alcon, Fort Worth, Texas) to create a 5.0-mm capsulotomy (n=12), and attempted a 5.0-mm capsulotomy using the manual tech- nique (n=11) using a Mastel (Rapid City, S.D.) 5.75-mm OZ marker. "It is incumbent upon us to have a good capsulorhexis consistent in diameter to have a predictable refractive out- come," Dr. Brint said. "At 1 month out, 83% were within .25 D of the intended refractive value, as com- pared to 64% with the manual rhexis, while 26% more in the LenSx group as compared to the manual group were within 0.50 D of the in- tended value." The results translate to visual acuity results for the pa- tients, Dr. Brint said. At 1 month post-op, 58% of patients were seeing 20/20 with the femto rhexis, com- pared to 27% who underwent the manual procedure. One hundred percent of femto patients were see- ing at 20/25, compared to 36% in the manual group, he said. "There's definitely a 'wow factor' there," Dr. Brint said. In another study, the first case series of arcuate incisions (n=14) with the femtosecond laser platform showed that the technol- ogy provides improved predictability over historical outcomes, with 71% of eyes within 0.25 D of cylinder and 86% of eyes within 0.50 D, ac- cording to Eric D. Donnenfeld, M.D., New York. Dr. Donnenfeld said only about 22% of ophthalmol- ogists in the U.S. perform PCRIs with cataract surgery. "They feel un- comfortable because of the risk of perforation, the variable response, and the fact that these incisions are an art form, not a science. They're imprecise, non-repeatable, with inci- sional architecture that cannot be re- produced," Dr. Donnenfeld said. "The advantage of moving to fem- tosecond laser incisions is that we've now taken this art form and moved it to a science. We place the desired incisions of the exact size, the exact place, and the exact depth every sin- gle time." Douglas D. Koch, M.D., Houston, presented data on the dif- ferences between the two types of femtosecond laser optical inter- faces—liquid and contact. "We know that contact interfaces used in LASIK do raise the pressure inside the eye and create subconjunctival hemor- rhage, but of course, require high pressures in order to successfully fix- ate the eye for safe flap creation," Dr. Koch said. Dr. Koch wanted to see if a liquid interface, which has been shown not to increase pressure during docking, would be a stable mechanism to hold the eye in place during the procedure. He did a di- rect comparison between patients in surgical videos to show the range of fiduciary eye movement. "The re- sults basically show that the liquid optical interface held the eye in a more stable position, despite not ele- vating IOP," he said. Dr. Koch, ex- amining photos taken after the procedures, calculated that eyes treated with the liquid optics inter- face had 40% less subconjunctival hemorrhage than eyes treated with the contact interface. "We think that this offers a clinical performance ad- vantage that will translate very well when treating our patients," Dr. Koch said about the liquid optics in- terface. Reporting live from the 2011 European Society of Cataract & Refractive Surgeons Congress, Vienna, Austria Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2011 ESCRS meeting, Vienna. Meeting Reporter is sponsored by Abbott Medical Optics, Santa Ana, Calif.

• Cover