Eyeworld

47 EW FEATURE July 2015 Femto cataract clinical update ract surgery platform to offer 2 sizes of patient interfaces, so surgeons can treat more patients with it, Dr. Donnenfeld said. The interface has an inner diameter of 12 mm when undocked. Dr. Donnenfeld said the biggest advantages with the latest Catalys update is that it is user friendly, intuitive, and creates more precise incisions. Surgeons have increased visibility and are able to create a 99% free-floating capsulotomy. The Catalys system has some more plans on the horizon. "The next big innovation will be the abil- ity to recognize the steep axis of the cornea to center arcuate incisions automatically and mark the steep axis for toric IOLs," Dr. Donnenfeld said. LENSAR The LENSAR Laser System (Orlando, Fla.) with Streamline rolled out in April and is reaching laser systems across the country right now, said William Trattler, MD, Center for Excellence in Eye Care, Miami. The current upgrade includes several new or improved features. For one, the Cassini corneal shape analyzer (i-Optics, The Hague, the Nether- lands) will be able to transmit data wirelessly to the actual laser system. This should help prevent data entry mistakes, Dr. Trattler said. The laser upgrade includes the use of iris registration, which integrates preop data into the actual procedure, so surgeons do not have to use manual markings. There is also an arcuate inci- sion planning table to help define the location and depth of planned arcuate incisions, based on patients' individual biometric factors. Arcuate incision planning preferences can be saved for later use. Another feature is cataract density imaging, which classifies the cataract to a fragmentation pattern that surgeons can predetermine and customize, Dr. Trattler said. The upgrade also has custom- ized fragmentation patterns. All of these changes help LENSAR users to work more effi- ciently and cut down on the energy used for certain kinds of cataracts or boost it as needed, Dr. Trattler said. Ziemer LDV 8 A major advantage with the Ziemer LDV 8 (Ziemer, Port, Switzerland) upgrade is the laser can be used universally for refractive, corneal, and cataract procedures, said Jeffrey J. Machat, MD, Crystal Clear Vision, Toronto. Plus, because of the LDV's small size compared with other available lasers, cataract surgery is more efficient, he said. There is no need to switch a patient to different rooms to complete the procedure. "You can have it sitting in the cor- ner, and you can pull it right up to a patient," he said. The laser can be transported in a handicapped minivan between different clinics rather than a larger vehicle with air suspension, and it can be set up in 45 minutes, rather than hours to days as with other systems, Dr. Machat said. Function- ality and transportability directly affect economics. Something else that distinguish- es the Ziemer is the energy used. "The Z8 utilizes 1,000 times less energy per pulse, and has a repeti- tion rate that is about 1,000 times faster," Dr. Machat said, noting that the Ziemer's energy is measured in nanojoules versus millijoules. "Because it uses low energy and an overlapping raster pattern, there is a smoother edge in capsulotomies more aligned with a manual curvi- linear capsulorhexis than the post- age stamp edge of current femto- second lasers. Rather than bells and whistles, this is the key element of femtosecond laser technology that surgeons must understand when deciding which platform they wish to utilize for their patients." Lastly, the Ziemer LDV 8 has a shorter focal length compared with some of the other femto cataract la- sers, and that makes it more precise in hitting the intended plane during surgery, Dr. Machat said. "Ziemer has approached corneal and lenticu- lar surgery differently, and the differ- ences provide clinically significant advantages to surgeons and patients alike." EW Editors' note: The physicians have financial interests with the companies that make the lasers they are using. Contact information Donnenfeld: ericdonnenfeld@gmail.com Lane: sslane@associatedeyecare.com Machat: jeff.machat@crystalclearvision.com Solomon: Kerry.solomon@carolinaeyecare.com Trattler: wtrattler@gmail.com Weinstock: rjweinstock@yahoo.com The low energy and overlapping raster pattern utilized by the Ziemer Z8 laser creates a smooth laser capsulotomy as demonstrated on scanning electron micrograph, far more similar to a manual curvilinear capsulorhexis than the "postage stamp" rough edge noted with other femtosecond lasers, according to Dr. Machat. Source: Jeffrey J. Machat, MD

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