Eyeworld

EW CATARACT 33 3 classifications: type I floaters are well-defined and suspended floaters; type II are multiple floaters dispersed in the vitreous; and type III float- ers are well-defined floaters for the patient that are invisible for the cli- nician. In any case, when faced with floaters, Dr. Lam said, intervention is worth considering. Dr. Lam went on to describe his method for treating floaters: 2-port pars plana vitrectomy (partial PPV). This method is performed under topical anesthesia—a great advan- tage for treating floaters since it al- lows direct communication with the patient throughout the procedure; the surgeon can ask the patient to confirm clearance of floaters. Dr. Lam said this method is a cost-saving procedure compared with full PPV and can be performed with or without cataract surgery. The initial results are very encouraging, though Dr. Lam and his colleagues continue to refine and enhance the technique. Meanwhile, Dr. Tassignon rec- ommended using the YAG laser on type I floaters—although, she said, she is "not convinced YAG only is enough." She thinks the best solu- tion will be a blended approach to homogenize the vitreous. Finally, Boris Malyugin, MD, Moscow, and Amar Agarwal, MD, Chennai, India, offered different approaches to cataract surgery cases with poor capsular support. For Dr. Malyugin, the capsule remains his "favorite IOL support," to which end his preferred approach is to use capsular tension rings—in- cluding his own Malyugin capsular tension ring. Dr. Agarwal, on the other hand, demonstrated a technique in which he inserts a glued IOL under a subluxated lens, using the IOL as a scaffold. This way, he said, "I have created my own posterior capsule." Dr. Agarwal also demonstrated one of the advantages of using tissue glue instead of sutures to fixate IOLs. Presenting slow motion vid- eos of sutured and glued IOLs, Dr. Agarwal demonstrated the absence of pseudophacodonesis in glued IOLs. EW Editors' note: The physicians have no financial interests related to their comments. All Dr. Packard said, admitted John Chang, MD, Hong Kong, is true. However, Dr. Chang's per- spective paints the picture "slightly brighter." "We are in our infancy with femtosecond laser technology," Dr. Chang said. He compared femtosec- ond lasers today with phacoemul- sification technology at the height of ECCE—at the time, phaco, too, seemed to many unjustifiably expen- sive with questionable advantages over the established procedure. Dr. Chang reiterated the pre- cision of the capsulorhexis with femtosecond lasers, highlighting its effect on (and the value of) effec- tive lens position. Controlling the size allows surgeons to position the lens the way they want inside the capsular bag. Moreover, precision in the capsulorhexis and so also lens position in terms of tilt minimizes the risk of posterior capsule opacifi- cation (PCO). In terms of cumulative dissi- pated energy (CDE), Dr. Chang said that the energy used after femto- second laser fragmentation of the cataract is significantly less than the conventional group, though only in Grade 2 cataracts. This translates into a significant reduction in loss of endothelial cells. Finally, Dr. Chang cited a soon- to-be-published study by Chee Soon Phaik, MD, Singapore, in which the number of patients achieving uncorrected visual acuities (UCVA) of 20/20 or better was found to be significantly higher (p=0.002) using the femtosecond laser. This, he said, will be the first study showing better visual out- comes with the femtosecond laser. He believes it is indicative of a future in which femtosecond lasers in cataract surgery finally outstrip phacoemulsification the way the latter technology outstripped ECCE. In the same symposium, Dennis Lam, MD, Hong Kong, and Marie-Jose Tassignon, MD, An- twerp, Belgium, considered differing views on the treatment of floaters. According to Dr. Lam, floaters are more of a symptom than a dis- ease per se, and are mostly harmless. However, he said, in some cases they are warning signs of serious underly- ing conditions that must be treated. In terms of just what floaters are, Dr. Tassignon said there are

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