EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/511377
EW CATARACT 35 May 2015 routine cases, I have found capsulo- tomy with the Catalys system to be an extremely reliable part of the pro- cedure, and this was no exception. One nice aspect of a pre-softened lens is that it is much easier to grasp the capsule on top of the dense nucleus with forceps or needle be- cause I don't have rock hard anterior cortex right beneath the capsule. But because of the overall difficulty of the case, it was a great relief to get through this step with no radial tears or other issues. Hydrodissection was still chal- lenging, as one would expect with any dense lens in either a manual or femto procedure. Without the red reflex to help identify the mobil - zation of the nucleus, I had to look for other cues, such as a rise in the capsule and gentle rotation of the lens. There seemed to be minimal cavitation, with very little gas escap- ing from the lens during hydrodis- section and rotation. Phaco As one gets beyond the femto por- tion of the procedure, it is important to follow best practices for a very dense nucleus. I periodically recoat- ed the endothelium with dispersive viscoelastic, was careful to achieve good cleavage of the nuclear pieces before attempting emulsification, and used a modulated pulse or non- linear ultrasound modality to reduce the amount of energy delivered into the ocular environment. Although it is difficult to o - jectively 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. I implanted a Tecnis 1-piece monofocal IOL (AMO). On the first postoperative day, the cornea was fairly clear, with far less edema than I would normally expect in such a case. The patient ultimately had excellent recovery of vision, achiev- ing 20/25 uncorrected vision in the presence of slight posterior capsular opacity, as well as mild epiretinal membrane. Femtosecond lasers allow us to enhance precision and predictability in the full range of nuclear densities. It is encouraging to me that when I most need technology to perform in a complex or challenging case such as the one described here, I can de- pend on it. A black cataract is never going to be an easy case, but the femtosecond laser certainly made it easier. EW Editors' note: Dr. Jones is in practice at Jones Eye Clinic in Sioux City, Iowa. He has financial interests with AMO Contact information Jones: jasonjonesmd@mac.com TUTOPLAST®PROCESSED Clear Cornea PATCH GRAFTS Why Clear Cornea from IOP? Aesthetics • Excellent cosmesis • Can be used for inferior or exposed placement Tutoplast ® = Safety • Trusted Tutoplast® process achieves 10 - 6 sterility assurance levels. • 3,000,000+ grafts implanted without any implant associated infections. Flexibility & Storage • Available in ¼, ¹⁄ ³ and ½ sizes. • Includes scleral rim for more surgical options. • 5 year room temperature storage. Contact us today to learn more: 714-549-1185 • 800-535-3545 • www.katena.com