Eyeworld

Reporting from the XXXIII Congress of the ESCRS, September 5–9, Barcelona EW MEETING REPORTER 148 randomized clinical trial including multiple centers in France. Inclusion in this study is still ongoing, she said, and an analysis will be per- formed, with first results expected in 2016. Achieving better surgical outcomes with evolving imaging methods Even when cataract surgeons have perfect preop measurements for IOL power calculations, they still face surgical challenges in hitting the desired refractive target. During the Combined Symposium of Cataract and Refractive Societies (CSCRS), "New and Evolving Imaging of the Anterior Segment of the Eye," Robert J. Cionni, MD, Salt Lake City, shared how he uses intraopera- tive aberrometry to overcome these challenges and achieve better refrac- tive outcomes. Power calculations derived from preop measurements alone are occasionally inaccurate, and although they have been refined over time, errors still happen, Dr. Cionni said. "We've gotten better at hitting the target, but we're nowhere near where we need to be," he said. Dr. Cionni showed how he has used intraoperative aberrometry with the ORA system with VerifEye (Alcon, Fort Worth, Texas) to cal- culate IOL power for patients with monofocal, multifocal, and toric IOLs, as well as those who have had clinical situations, the laser helps to perform maneuvers to ensure a safer, simpler, and more predicable out- come. "Surgeons will decide whether it is a necessary tool to include in their respective clinical-surgical practice," he concluded. Studies of the femtosecond laser Also in the session focusing on FLACS, Peter Barry, MD, Dublin, and Beatrice Cochener, MD, Brest, France, discussed current studies on results with the laser. Dr. Barry's presentation focused on the ESCRS FLACS study, which compares femto and traditional pha- co results. Based on the results of the study, he said, "Femto currently does not outperform [traditional] pha- co." Femto patients were shown to have less postoperative astigmatism and less surgically induced astigma- tism; however, they also had worse postoperative visual acuity, more postoperative complications, and more instances where postoperative visual acuity was worse than it was preoperatively. Dr. Cochener's presentation highlighted the FEMCAT study, which aims to compare the cost and efficacy between conventional surgery and the innovation and to quantify the benefit of the innova- tion from a societal perspective. This study is a prospective, comparative, independent comparative studies indicate that there are no significant differences between FLACS and stan- dard phaco, he said. What special situations would find the femtosecond laser most relevant? Dr. Güell highlighted 6 instances that may find this tech- nology particularly beneficial for treatment. For those patients with a shallow anterior chamber with or without vitreous pressure, the femtosecond laser may prove helpful because there is a risk of capsulor- hexis failure if surgeons perform it manually, and there is also a risk for direct endothelial trauma. The laser can create a nice, controlled, well- sized rhexis despite the pressure. Patients with white cataracts or small pupils may find femtosecond laser use beneficial. There is also a risk for capsulorhexis failure in these cases, as well as secondary excessive manipulation in the anterior cham- ber. Although in some cases of small pupils, he said it may be better to do a manual procedure. Congenital and juvenile cat- aracts have high elasticity of the capsule, which makes sizing and shaping very difficult when per- forming the anterior and posterior capsulorhexis, so the laser may come in handy for the surgeon in these cases. Cases of subluxated lens and combined vitreoretinal or EK surgery also might benefit from femtosec- ond laser use in order to obtain a perfect rhexis without any zonular traction and to secure IOL stability. Patients with post-traumatic cataracts and capsular fibrosis are helped by the laser to obtain a perfect rhexis without any zonular traction where manual dissection is difficult or impossible. Using the laser in front of corneal or intraoc- ular opacities and after keratoplasty will help to create a perfect rhexis, diminishing manipulations in the AC and endothelial trauma, Dr. Güell said. "We cannot predict if FLACS will become the standard for cat- aract surgery in the near future," Dr. Güell said. Although there are both advantages and disadvantages to using the technology, in certain October 2015 View videos from Tuesday at ESCRS 2015: EWrePlay.org Soosan Jacob, MD, discusses her new technique of air pump-assisted PDEK.

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