Eyeworld

After y C A two step process. A two step pr o e EW CATARACT 28 June 2014 by Maxine Lipner EyeWorld Senior Contributing Writer A clear-eyed view of subconjunctival hemorrhages continued on page 30 Avoiding seeing red with femtosecond lasers N o one wants an unsightly red eye after uncompli- cated cataract surgery, especially when they have paid for the privi- lege of a femtosecond upgrade. Yet subconjunctival hemorrhage can be a common side effect of using the femtosecond laser. With femtosec- ond laser use for cataract surgery on the rise, EyeWorld asked experts to share their strategies for decreasing the risk of developing subconjuncti- val hemorrhages. "All of the femtosecond lasers have some degree of subconjunctival hemorrhage," said Kendall E. Donaldson, MD, associate professor of ophthalmology and medical director, Bascom Palmer Eye Institute, Plantations, Fla. However, some lasers have a greater chance of causing these than others based on their patient interface. Because applanating interfaces are pressing on the cornea, the pressure does go up a bit higher, she explained. "The applanating interfaces of the LenSx [Alcon, Fort Worth, Texas] and the VICTUS [Bausch + Lomb, Bridgewater, N.J.] are going to cause more subconjunctival hemorrhage than a liquid optics interface like the Catalys [OptiMedica/Abbott Medical Optics, Santa Ana, Calif.] or the LENSAR [Orlando, Fla.]," Dr. Donaldson said. Meanwhile, with most of the femtosecond laser platforms, Dr. Donaldson finds that any subcon- junctival hemorrhages tend to resolve in just a few days. Still, she said, there is a significant difference from traditional cataract surgery. "Our traditional cataract pa- tients who are just having ultra- sound come in the next day after surgery and their eyes are always white and quiet," she said. "My technicians joke that they can tell who paid for the upgrade since they come to their postop day 1 visit with a red eye." She has also noticed a difference between the two lasers she currently uses—the LenSx and the Catalys. "The LenSx is going to have a bit more subconjunctival hemorrhage than the Catalys," she said. But the A liquid optics interface like the Catalys tends to be more forgiving on the eye but can still cause subconjunctival hemorrhage. F emtosecond laser use for cataract surgery continues to increase both in the U.S. and worldwide. The advan- tages and disadvantages are debated at nearly every cataract meeting. However, one common side effect of the femtosecond laser that may not be medically important but can be very important to the patient is the associated subconjunctival hemorrhage. The patient interface platforms vary from laser to laser, and therefore the incidence of the subconjunctival hemorrhage formation also varies. Regardless, most would agree that the development of this red, unsightly blob after uncomplicated cataract surgery, especially in conjunction with a refractive IOL, is undesirable. We reviewed the litera- ture to find out the background of subcon- junctival hemorrhages and asked experts to share their strategies to decrease the risk of developing a subconjunctival hemorrhage associated with the femtosecond laser. Bonnie An Henderson, MD, cataract editor Cataract editor's corner of the world 20-31 Cataract_EW June 2014-DL_Layout 1 6/3/14 12:21 PM Page 28

• Cover