Eyeworld

Reporting from Hawaiian Eye 2016, January 16–22, Wailea, Hawaii EW MEETING REPORTER 94 Sponsored by Optics (Abbott Park, Ill.), Alcon (Fort Worth, Texas), and Allergan. Challenging cases Audrey Talley-Rostov, MD, Seat- tle, highlighted cataract surgery in patients with compromised cor- neas. She offered tips for handling a number of different scenarios. With cataract surgery after intrastromal corneal ring segments (ICRS), be sure to watch IOL calculations, she said. These patients may get post- operative hyperopia. You can use a monofocal, toric, or accommodat- ing IOL for these patients, but Dr. Talley-Rostov does not recommend multifocal IOLs. She also added that it's important to watch the place- ment of cataract surgery incisions to avoid interference with the ICRS. Meanwhile, in cataract sur- gery after radial keratotomy (RK), it's important to plan incisions to minimize the trauma to previous RK incisions. Also, watch the IOL, Dr. Talley-Rostov said, because calcula- tions and intraoperative aberrometry may be variable. Dry eye disease is another special consideration. It's key to manage this before, during, and after cataract surgery, she said. Dry eye disease can impact the refraction, so surgeons may want to consider topical cyclosporine, arti- ficial tears, fish oil supplements, or punctal plugs as treatment options. surgery between 2 different pha- co platforms. The data collected included the cataract grade, time in the operating room, the cumulative dissipated energy (CDE), and the amount of fluid used. Converting the fluidics from gravity to active offers a number of advantages, Dr. Donaldson said. It gives the surgeon active control over maintaining a certain intraocular pressure for the case, and there is also less fluid displacement, which allows for maintaining a stable AC, she said. Additionally, CDE is signifi- cantly lower with active fluidics. In her study of femto vs. pha- co, benefits of each method were shown. The study looked at more than 1,000 cases from Bascom Palm- er. Simply by improving fluidics, Dr. Donaldson said that about a 20% reduction of time in the OR was shown. Procedure time was also correlated with cataract density for both traditional and femtosecond laser cases. She concluded that more efficient use of torsional energy reduces CDE with active fluidics. Using femtosecond cataract surgery significantly reduced CDE when us- ing gravity and active fluidics. CDE reductions also seemed to be more significant with denser cataracts. Editors' note: Dr. Donaldson has financial interests with Abbott Medical non-comparative, single-arm study including patients with astigmatism greater than or equal to 0.83 D with a surgeon preferred incision and SIA. Results showed good safety with no adverse events. Interestingly, the distance, intermediate, and near vision results were the same as the pre-market FDA study. Additionally, no lenses rotated significantly, Dr. Packer said. In conclusion, Dr. Packer said that the toric posterior chamber presbyopia-correcting lens per- formed as demonstrated in the pre-market approval study. There was similar rotational stability to the FDA study, similar percent reduc- tion in cylinder (85% in the FDA study vs. 88.3% in the post-market approval study), similar accuracy to target, and equivalent uncorrected visual acuity. Editors' note: Dr. Packer has financial interests with Bausch + Lomb. Fluidics vs. femto During the new technologies ses- sion, Kendall Donaldson, MD, Miami, discussed fluidics vs. femto and a study that she worked on looking into which of these options helps improve phaco efficiency the most. There are 2 recent major ad- vances, Dr. Donaldson said. One involves the advances to the fluidics of phacoemulsification machines, converting from gravity fluidics to active fluidics. The second is the use of femtosecond lasers for cataract surgery. The goals for both are for less traumatic, safer surgery and for better visual outcomes. These goals can be measured by endothelial cell density, which often can be used to measure trauma during surgery, and by the range of cell loss during cat- aract surgery, which can range any- where from 4 to 23%. The surgery trauma and visual outcomes can also be correlated with the cataract grade, the phaco time, the total ultra- sound energy or CDE, the volume of balanced salt solution used, and the axial length. Dr. Donaldson detailed her study with the purpose of comparing intraoperative data for traditional and femto cataract February 2016 View videos from Hawaiian Eye 2016: EWrePlay.org Jeremiah Tao, MD, discusses the role of correcting eyelid and lacrimal system disorders in patients who are planning to undergo cataract surgery.

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