EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/511377
EW CATARACT 34 May 2015 by Jason J. Jones, MD bubble and was told that his eye healed well, but he did not recov- er good vision. Due to the already compromised vision in that eye, he had simply let the cataract progress. His presenting vision to me was light perception. Using the Catalys femtosecond laser system (Abbott Medical Optics, AMO, Abbott Park, Ill.), I was able to obtain good quality imaging, which is by no means a certainty with such a dense nucleus. It is impera- tive to assess the imaging and make sure the surface fits are correct and safety zones are acceptable for the treatment to be safe. In this case, I could readily determine the surface fits were appropriate and correctly aligned so no adjustment was nec- essary. Capsulotomy The loss of red reflex in a black cataract case makes it very difficult to create the capsular opening. The imaging capabilities of the laser provided a significant advantage in being able to visualize the capsu- lar surface. I generally prefer the "scanned capsule" function, which centers the capsulotomy based on an equator derived from the anteri- or and posterior surface fits. In this case, I felt more comfortable with centering on the dilated pupil with a 5.0 mm diameter capsulotomy. Lens treatment Lens softening and fragmentation is the next step of the laser procedure. I departed significantly from my ty - ical FLACS approach. In my first e - perience using the Catalys in a black cataract, I had kept these parameters the same as my routine, but found softening the entire lens made it difficult to split it into segments. So in this case, I opted for a sextant cut, leaving a wide offset around the sex- tants so I had an area of untreated lens material where I could gain pur- chase and achieve good separation of the nuclear pieces. Within each sextant, I tightened the treatment grid from 350-µm to 200-µm cubes to increase the softening effect. I also increased the power setting for the anterior portion of the lens softening. Using the default settings in a typical case, the laser power decreases as it reaches the anterior portion of the nucleus. In this case, I had a much denser, more homogeneous lens, so it was more appropriate to continue at a higher power up through the anterior por- tion of the lens treatment. In the OR The laser had created a nice, round capsulotomy that lifted off easily. In Case demonstrates femtosecond laser can make emulsification of ve y dense nuclei safer and less stressful for the surgeon B lack cataracts are fairly unusual in most practices, but when we do encounter them, these very dense nuclei present distinct clinical challenges at nearly every step of the procedure, from the cap- sulorhexis to nuclear division and phacoemulsification. The amount of energy and fluid in the eye is co - siderably greater than in a normal case, increasing the risk of thermal injury and the degree of trauma and edema. I have now performed femto- second laser-assisted cataract surgery (FLACS) in 2 black cataract cases and think that it is worth considering the use of our most advanced tools in complex situations like these. Here, I describe the second black cat- aract FLACS procedure I performed, including how I incorporated some lessons learned from the first case The patient was a 45-year-old male with a remote history of retinal surgery to his right eye. As a teen- ager, he had undergone repair of a penetrating injury from the spoke of a bicycle wheel. Following the surgery he reported having a gas FLACS simplifies black cataract case At the conclusion of this case, one can see the IOL nicely centered in the bag and a well-formed, round laser capsulotomy. Source: Jason J. Jones, MD " Although it is difficult to objectively compare phaco time and energy with and without femto in these very dense nuclei, my sense is that both were considerably less in this case than they would have been had I been operating manually. " A 200-µm treatment grid was used to effectively soften this very dense nucleus.