Eyeworld

EW CATARACT 80 April 2016 using femtosecond lasers should be aware of the potential for this. Jonathan Talamo, MD, Massachusetts Eye and Ear, Waltham, Massachusetts, does not think the docking attempts were to blame in this case. "I do not think that the degree of IOP elevation or fluctuations with the femtosecond laser docking systems I am most familiar with (the LenSx and Catalys [Abbott Medical Optics, Abbott Park, Illinois]) would put a patient at increased risk for a suprachoroidal hemorrhage. I don't think the IOP changes incurred by docking are any more dramatic than the brief elevations that occur in some instances during draping, speculum placement, instrument insertion, or simply pushing on the globe with a gloved finger, and likely less than those incurred by Honan balloon placement or OVD injec- tion. Where I do think one needs to be careful is during air/fluid release from the anterior chamber if the IOP is elevated significantly when the eye is entered, since rapid decom- pression of the globe can be very dramatic under such circumstances," he said. This can occur if a patient is treated with the femtosecond laser and then left waiting for a long pe- riod of time before entering the eye. "I think that significant elevations have been reported after 2 hours. It would be interesting to know in this case what the time interval was between laser treatment and the rest of surgery, and it will certainly be important to report events such as occurred during Dr. Miller's case as experience continues to grow with image-guided femtosecond laser systems." Samuel Masket, MD, clinical professor, University of California, Los Angeles, and Advanced Vision Care, Los Angeles, said he is unaware of any prior reports of suspected su- prachoroidal hemorrhages associated with the procedure. "Nevertheless, it's interesting to speculate wheth- er the multiple docking attempts could be responsible because when the docking is done, the intraocular pressure is elevated, varying with the laser … and that does have an effect on the choroidal vasculature," Dr. Masket said. Dr. Masket later added that proving what caused this complica- tion one way or the other is impos- sible, but "it's good to make other surgeons aware of this case, and we'll see if others have noted it." Fortunately, an experienced surgeon in this case recognized the condition and made the correct management decisions. As for prevention, if the docking attempts were the cause of a pres- sure rise and fall and this issue, Dr. Miller said one just has to roll with the punches. Of course a physician would prefer to dock a patient just once to a femtosecond laser, but Dr. Miller said going forward with the surgery in the presence of air bubbles would result in a worse outcome. "You have to deal with the air bubbles, you can't ignore them," he said. "The only way to avoid this particular issue, if in fact the femtosecond laser caused the problem, would be not to do the femto laser, and I'm not sure that's the solution." EW Reference 1. Stein JD, et al. Severe adverse events following cataract surgery among Medi- care beneficiaries. Ophthalmology. 2011; 118(9):1716–1723. Contact information Masket: sammasket@aol.com Miller: miller@jsei.ucla.edu Talamo: jht@jhtmdpc.com What continued from page 79 Parasol® Visit us at ASCRS Booth 519 TO ORDER: 866-906-8080 customersupport@beaver-visitec.com odysseymed.com or beaver-visitec.com Patients shouldn't fear their tears will disappear because their plugs up and left. Help them face life with eyes wide open and comfortably moist. Trust the Parasol Punctal Occluder; it's the perfect fi t for your patients — and guaranteed to stay put. Trust us. We're not like the others. Youʻre le aving me… arenʻt you? BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of a Beaver-Visitec International ("BVI") company © 2016 BVI Beaver-Visitec International, Inc., 411 Waverley Oaks Road, Waltham, MA 02452

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