Eyeworld

EW SECONDARY FEATURE 132 April 2016 by Liz Hillman EyeWorld Staff Writer "Usually the laser will prevent [the Argentinian flag sign] because it is making a circular arch-shaped pattern as it's cutting, and wherever it first breaks through, if it's under high pressure that cortex will flush out into the anterior chamber and burst out," said Dr. Weinstock, who uses the LenSx laser, the VICTUS laser (Bausch + Lomb, Bridgewater, New Jersey), and the LENSAR laser (LENSAR, Orlando, Florida). "But the capsule, instead of tearing out, will tear along the little perforation that's being made by the laser, so treatment of the femtosecond laser, and in those cases I'll donate the cost of the femtosecond laser because I think it's a safer way to do a white cataract surgery," said Dr. McCabe, who works with the LenSx laser (Alcon, Fort Worth, Texas). In situations like this, a manual capsulorhexis initiated with a cysto- tome could cause the capsule to split at the first touch of the needle due to the pressure behind it. The laser should make the entire capsulotomy at one time and at a controlled pres- sure, reducing this risk, Dr. McCabe and Dr. Weinstock explained. In addition to providing the benefit of an enhanced refractive outcome, Cathleen McCabe, MD, medical director, The Eye Associates, Bradenton, Florida, said she feels strongly enough that femtosecond laser is more advantageous from a safety standpoint in some cases that she donates the extra cost if patients can't pay for it. "It's such a benefit. In patients with white cataracts who have not had adequate access to medical care—and that's why their cataract has become so bad—they can't afford to pay for the upgraded Physicians discuss patient selection, compare femto to manual cataract surgery, and provide tips for successful outcomes W hile ophthalmologists continue to debate the use of femtosecond laser-assisted cataract surgery (FLACS) as efficacy and outcome data emerges, the fact remains, it—like any other procedure—has a unique set of com- plications. Preventing and managing those complications continues to be an important topic for those adopting the femtosecond laser into their cataract surgery practice. Before discussing what could go wrong, the first consideration for ophthalmologists is patient selection and counseling. "Counseling patients for cata- ract surgery has grown increasingly more essential and time-consuming through the years with all of the options available for patients, in- cluding femto technology and various lens options with refrac- tive cataract surgery," said Kendall Donaldson, MD, medical direc- tor, Bascom Palmer Eye Institute, Plantation, Florida. "I explain to patients that I think there are several advantages to FLACS, including the correction of astigmatism with more precise limbal relaxing incisions (LRIs) and the ability to perform less traumatic surgery by conserving phaco energy, particularly in cases of denser or more challenging cata- racts." Robert Weinstock, MD, Eye Institute of West Florida, Largo, Florida, went so far as to say he thinks it's his obligation to present patients with the option of astigma- tism correction with the femtosec- ond laser and/or toric implants, "to let them know there's the oppor- tunity to not have to wear glasses after cataract surgery, especially for distance vision." To him, the femtosecond laser is "part of a package of different re- fractive technologies that we use to deliver great outcomes and freedom from glasses in cataract surgery." Where FLACS has advantages … and complications This eye was treated with the LenSx laser. An air bubble was trapped between the patient interface and the eye, causing incomplete treatments. Notice the incomplete capsulotomy between the 6 and 8 o'clock hours, as well as the incomplete fragmentation pattern on the left side. Source: Robert Weinstock, MD

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