Eyeworld

EW CATARACT 40 September 2015 Richard Tipperman, MD, highlighted the best cataract papers at the "Hot Off the Press" session at the 2015 ASCRS•ASOA Symposium & Congress. The papers were chosen from the Best Paper of Session winners. Here are the abstracts from the studies, with Dr. Tipperman's comments regarding selection. Comparison of vitreous loss rates between manual phacoemulsification cataract surgery and femtosecond laser-assisted cataract surgery Wendell Scott, MD, Shachar Tauber, MD, Johann Ohly, MD, Rachel Owsiak, MD, Craig Eck, MD, James A. Gessler, MD, MPH Purpose: To evaluate and compare the vitreous loss complication rate of the manual phacoemulsification (MP) cataract surgery technique versus the femtosecond laser-assisted cataract surgery (LCS) technique. Methods: A total of 6,984 cata- ract surgery cases from 2010–2014 performed by four surgeons were audited for rates of vitreous loss. 3,784 cases from 2010–2012 were consecutively performed using MP while 3,200 cases from 2013–2014 were consecutively performed using LCS. Cases in which vitreous loss occurred were determined by CPT coding and review of operative summaries and all cases in which a vitrectomy set was opened. Exclu- sions were made for preoperative planned vitrectomy, traumatic cat- aract, combination procedures, and cases requiring iris hooks or iris ring devices. A comparison of the group's MP vs. LCS vitreous loss rates was made by statistical analysis. Results: The group's rate of vitreous loss cases decreased from 1.16% in the MP cases to 0.72% in the LCS cases. In absolute terms, the rate decreased for every surgeon in the study. The chi-square test revealed a statistically significant association between date of surgery, and thus technique, and vitrectomy cases (X2(1)=9.77, p<0.01). Odds ratio analysis indicated that surgeries per- formed from 2010–2012 using MP were 1.6 times more likely to have vitreous loss than those surgeries performed from 2013–2014 using the femtosecond LCS technique. Conclusion: Conversion from MP to LCS resulted in a statistically signif- icant decrease in vitreous loss. Since vitreous loss increases the risk of other serious complications of cata- ract surgery, such as retinal detach- ment and endophthalmitis, this new finding has important implications for the safety of cataract surgery. Dr. Tipperman: I chose this paper for a couple of reasons: 1) femtosecond laser cataract surgery remains among many a polarizing topic; and 2) although it is a single clinic study, it includes a large case volume comparing surgical compli- cations with and without femtosecond laser assistance. The authors reviewed all complications from 3,700+ cataract cases performed by their practice in the 2 years prior to beginning femtosecond cataract surgery and 3,300+ cases (or 98% of their volume) immediately upon beginning FLACS. Of note is that they did not exclude any FLACS cases or account for any element of a learning curve. Despite the learning curve associated with FLACS this study demonstrates a statistically significant lower rate of vitreous loss in EVERY surgeon's experience. Although this is a study from a single clinic it is notable for the high number of cases pre/post FLACS and also for the high percentage of patients (98%) treated with FLACS once the technology was instituted in the clinic. Improving the prediction of astigmatism after toric IOL implantation Graham D. Barrett, FRANZCO, Adi Abulafia, MD Purpose: To compare the relative contribution of surgical induced Hot off the press: Scan to watch video! Second in a series of 5 presentations

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