EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/511377
Cruciate (starting superiorly and incise from 12 to 6 and then incise from 3 to 9 creating a Maltese cross) 26% Star (linear incisions creating 5 or more "flaps") 5% Spiral (start centrally and work your way around until opening the desired width) 24% Hinged (circular opening with a hinge on one side to avoid a free-floating circular capsule in vitreous) 5% Circular (round opening with free capsular circle to descend into vitreous) 20% Other, don't use Crystalens 20% Yes 53% No 47% Yes 52% No 45% Do not use silicone IOLs 3% Note the higher frequency of using the "spiral" method with the Crystalens. This probably has to do with carefully titrating size lest the lens position and the refractive error change, and to avoid passing over the edge of the small optic and caus- ing vitreous prolapse. It is possible to later make a larger opening to exploit any posterior shift that may occur in cases of undesired myopia or to obtain a larger entrance pupil. A pitfall of this method is the possi- bility of damaging the central lens with the initial laser shots, so careful titration of power should be used. Third question "Do you use a contact lens in most cases for an acrylic or collamer lens?" Yes 46% No 44% Other: Do not use Crystalens 10% Fourth question "Do you use a contact lens in most cases for a silicone lens other than Crystalens?" The Abraham contact lens has the advantage of stabilizing the globe, preventing blink, and fo- cusing laser energy, allowing lower energy settings to disrupt the poste- rior capsule, thus minimizing lens damage and pressure issues. Disad- vantages are the time required, need for topical anesthetic, postoperative blur and stickiness, and potential for iatrogenic corneal abrasion. Interesting that the results are the same with silicone lenses, suggesting the main reason to use a contact lens is not the greater sensi- tivity to damage with silicone. It is also possible that the use of contact lens is habit, i.e., many or most nev- er having tried it without a lens. For those who have not tried capsulot- omy without a contact lens, partic- ularly with the intraocular lenses that are more resistant to pitting, do consider trying it. Fifth question "Do you use a contact lens in most cases for a Crystalens? Again, there are very similar results with Crystalens. The purpose of the question was to determine if more surgeons use a lens for Crystalens because of the potential- ly more significant repe cussions with compromised vision from the pitting or greater finesse required to do a perfect "Crystalens capsuloto- my." This conjecture may be in part cancelled by a desire to avoid post- operative blur in the possibly more discerning Crystalens patient. See the June issue of EyeWorld for part 2 of this article. EW Editors' note: Dr. Gossman is in private clinical practice at Eye Surgeons & Physicians, St. Cloud, Minn. The physicians have no financial interests related to their comments. Contact information Gossman: n1149x@gmail.com Gullapalli: vgullapalli@centralmnretina.com