Eyeworld

EW CATARACT 44 by Maxine Lipner EyeWorld Senior Contributing Writer a divide-and-conquer quick-chop technique with bimanual disruption of the lens nucleus, the radial cuts provide more maneuverability with less manipulation, Dr. Bowden said. "It's facilitating a familiar technique," he said. With the quick- chop technique, the practitioner is using a second instrument to engage vertical cleavage plane at an 80% depth, which has been estab- lished within the lens nucleus by the femtosecond laser. Pie-shaped nuclear fragments removed therefore require a phaco-assisted aspiration technique, which varies with nuclear density. If those who are used to a quick- chop technique use the cylindrical cut patterns, there may be difficul- ties, Dr. Bowden cautioned. "The problem for the chop surgeon is that the central part of the nuclear material is going to be more easily broken up, emulsified, and removed," he said. "It would create an excavated bowl, which leaves the rim of nuclear material in the periphery." Removal of this rim would require a more challenging, potentially dangerous maneuver of extending the phaco needle further into the periphery, outside of what is regarded as the safe zone, Dr. Bowden explained. This could injure the peripheral capsule. "The physicians who I think would embrace the cylindrical cut pattern are those who tend to do phaco flip techniques, where the emulsification and manipulation of the nucleus is supracapsular and avoids chopping," he said. Dr. Bowden prefers a 6 to 8 radial cut pattern. "I've established that the cylindrical pattern will be the minority of my cases, as I prefer the quick-chop technique," he said. Dr. Schumer started out doing a crisscross radial pattern alone. "Then I went in and did the crisscross pattern and one circular dissection in the center," he said. "Now I have gravitated toward the crisscross pattern, and I'm doing 6 circular Platform (Bausch + Lomb, Bridge- water, N.J.), more practitioners are trying their hand at the laser-assist- ed approach. For those considering adopting this approach, EyeWorld gleaned some important pearls. D. James Schumer, MD, Revision Advanced Laser Eye Center, Columbus, Ohio, first started using the laser shortly after it received Food and Drug Administration clearance in April 2013. Once lens fragmentation with the Victus received FDA approval in July 2014, Dr. Schumer quickly adapted to add- ing this new approach to cataract removal. "I'm finding that to have the lens already segmented in a fraction of the pie shape, as well as multiple circular dissections, is very helpful," he said. Because it is al- ready sectioned, you do not have to go in and chop or flip the nucleus. In some cases the eye can be spared from undergoing the usual phaco process, he said. "In a significant percentage of my cases, I'm doing zero phaco," Dr. Schumer said. Fragmenting the nucleus The Victus has 2 fragmentation patterns, according to Frank W. Bowden III, MD, FACS, founder and medical director, Bowden Eye & Associates, Jacksonville, Fla. One involves concentric cylinder cuts in the nucleus and the other involves radial cuts, Dr. Bowden explained. The radial cuts can be made in patterns of 4, 6, or 8, and combina- tions of cylindrical and radial cuts can also be made. "At this point in [the U.S.], they are approved for 4 (radial) cuts and a pattern of up to 7 or 8 cylinder cuts," he said. Most practitioners are current- ly opting for radial cut patterns, based on data available from Bausch + Lomb, Dr. Bowden said. The fragmentation pattern varies with surgeon preference, which is linked to the phacoemulsification technique that is used. For exam- ple, for those physicians who use February 2015 String of femtosecond pearls for cataract surgery W ith the recent 510K clearance for cataract lens fragmentation using the Victus Femtosecond Laser Mastering new fragmentation patterns and beyond VERION ™ REFERENCE UNIT AND VERION ™ DIGITAL MARKER IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. INTENDED USES: The VERION ™ Reference Unit is a preoperative measurement device that captures and utilizes a high-resolution reference image of a patient's eye in order to determine the radii and corneal curvature of steep and flat axes, limbal position and diameter, pupil position and diameter, and corneal reflex position. In addition, the VERION ™ Reference Unit provides preoperative surgical planning functions that utilize the reference image and preoperative measurements to assist with planning cataract surgical procedures, including the number and location of incisions and the appropriate intraocular lens using existing formulas. The VERION ™ Reference Unit also supports the export of the high-resolution reference image, preoperative measurement data, and surgical plans for use with the VERION ™ Digital Marker and other compatible devices through the use of a USB memory stick. The VERION ™ Digital Marker links to compatible surgical microscopes to display concurrently the reference and microscope images, allowing the surgeon to account for lateral and rotational eye movements. In addition, the planned capsulorhexis position and radius, IOL positioning, and implantation axis from the VERION ™ Reference Unit surgical plan can be overlaid on a computer screen or the physician's microscope view. CONTRAINDICATIONS: The following conditions may affect the accuracy of surgical plans prepared with the VERION ™ Reference Unit: a pseudophakic eye, eye fixation problems, a non-intact cornea, or an irregular cornea. In addition, patients should refrain from wearing contact lenses during the reference measurement as this may interfere with the accuracy of the measurements. Only trained personnel familiar with the process of IOL power calculation and astigmatism correction planning should use the VERION ™ Reference Unit. Poor quality or inadequate biometer measurements will affect the accuracy of surgical plans prepared with the VERION ™ Reference Unit. The following contraindications may affect the proper functioning of the VERION ™ Digital Marker: changes in a patient's eye between preoperative measurement and surgery, an irregular elliptic limbus (e.g., due to eye fixation during surgery, and bleeding or bloated conjunctiva due to anesthesia). In addition, the use of eye drops that constrict sclera vessels before or during surgery should be avoided. WARNINGS: Only properly trained personnel should operate the VERION ™ Reference Unit and VERION ™ Digital Marker. Only use the provided medical power supplies and data communication cable. The power supplies for the VERION ™ Reference Unit and the VERION ™ Digital Marker must be uninterruptible. Do not use these devices in combination with an extension cord. Do not cover any of the component devices while turned on. Only use a VERION ™ USB stick to transfer data. The VERION ™ USB stick should only be connected to the VERION ™ Reference Unit, the VERION ™ Digital Marker, and other compatible devices. Do not disconnect the VERION ™ USB stick from the VERION ™ Reference Unit during shutdown of the system. The VERION ™ Reference Unit uses infrared light. Unless necessary, medical personnel and patients should avoid direct eye exposure to the emitted or reflected beam. PRECAUTIONS: To ensure the accuracy of VERION ™ Reference Unit measurements, device calibration and the reference measurement should be conducted in dimmed ambient light conditions. Only use the VERION ™ Digital Marker in conjunction with compatible surgical microscopes. ATTENTION: Refer to the user manuals for the VERION ™ Reference Unit and the VERION ™ Digital Marker for a complete description of proper use and maintenance of these devices, as well as a complete list of contraindications, warnings and precautions. ORA ™ SYSTEM IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. INTENDED USE: The ORA ™ System uses wavefront aberrometry data in the measurement and analysis of the refractive power of the eye (i.e. sphere, cylinder, and axis measurements) to support cataract surgical procedures. CONTRAINDICATIONS: The ORA ™ System is contraindicated for patients: • who have progressive retinal pathology such as diabetic retinopathy, macular degeneration, or any other pathology that the physician deems would interfere with patient fixation; • who have corneal pathology such as Fuchs', EBMD, keratoconus, advanced pterygiumim pairing the cornea, or any other pathology that the physician deems would interfere with the measurement process; • whose preoperative regimen includes residual viscous substances left on the corneal surface such as lidocaine gel or viscoelastics; • with visually significant media opacity (such as prominent floaters or asteroid hyalosis) what will either limit or prohibit the measurement process; or • who have received retro or peribulbar block or any other treatment that impairs their ability to visualize the fixation light. In addition, utilization of iris hooks during an ORA ™ System image capture is contraindicated, because the use of iris hooks will yield inaccurate measurements. WARNINGS AND PRECAUTIONS: • Significant central corneal irregularities resulting in higher order aberrations might yield inaccurate refractive measurements. • Post refractive keratectomy eyes might yield inaccurate refractive measurement. • The safety and effectiveness of using the data from the ORA ™ System have not been established for determining treatments involving higher order aberrations of the eye such as coma and spherical aberrations. • The ORA ™ System is intended for use by qualified health personnel only. • Improper use of this device may result in exposure to dangerous voltage or hazardous laser-like radiation exposure. • Do not operate the ORA ™ System in the presence of flammable anesthetics or volatile solvents such as alcohol or benzene, or in locations that present an explosion hazard. ATTENTION: Refer to the ORA ™ System Operator's Manual for a complete description of proper use and maintenance of the ORA ™ System, as well as a complete list of contraindications, warnings and precautions. © 2014 Novartis 12/14 ORA14059JAD-A

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