Eyeworld

EW CATARACT 33 August 2016 Dr. Tipperman: I like to choose a technique or surgical maneuver paper as one of the "Best of ASCRS" papers because I think it gives surgeons an opportunity to learn about an approach they might otherwise not have heard of. For instance, the 2015 selections included a novel approach to suturing posterior chamber IOLs. This year I've chosen a paper that describes a number of clinical cases where the femtosecond laser was used to cut an IOL to aid in explantation. I don't think that prior to this presentation many femtosecond laser users would have even realized that their lasers had this capability. There were a few cases presented at the 2016 ASCRS•ASOA Symposium & Congress demonstrating enlargement of a constricted phimotic anterior capsule with the femtosecond laser; however, this paper demonstrates an even wider range of use and versatility. Although I think this clinical approach is not that likely to be widely adopted for multiple reasons, it does demonstrate that the femtosecond laser can mechanically alter an IOL in situ. Theoretically this could lead to reshaping of IOLs once implanted or using the laser to alter the haptic/optic junction geometry to change the ultimate effective lens position. EW Editors' note: Dr. Tipperman is at- tending surgeon at Wills Eye Hospital, Philadelphia. He has financial interests with Alcon (Fort Worth, Texas). Contact information Tipperman: rtipperman@mindspring.com not any significant difference in toric calculator performance for manual toric cases. However, surprisingly, the Barrett toric calculator performed significantly better in femtosecond laser cataract surgery cases than in manual cases. As such, this paper raises some interesting questions as to whether advances in IOL power calculation formulas such as Dr. Barrett's Universal II formula or the Hill-RBF formula will allow improved results with femtosecond laser cataract surgery compared to manual cataract surgery. Intraocular lens transection and explantation assisted by a femtosecond laser Jonathan Lake, MD, Celso Boianovsky, MD, Francisco Soares, MD, Mário Carvalho, MD Purpose: To evaluate femtosecond laser-assisted intraocular lens tran- section followed by explantation. Methods: Consecutive case series. Femtosecond laser was used for tran- section of an opaque hydrophilic IOL, a PMMA iris fixation IOL, and a hydrophobic IOL. Results: IOL transection using femtosecond laser was successfully performed in all cases. After transec- tion, the fragments were manually separated and removed through mi- croincisions with minimal manipu- lation. After 6 months no significant changes in endothelial cell count, astigmatism, and macular OCT were observed. Conclusion: Femtosecond laser- assisted IOL removal in this series allowed for safe IOL explantation with minimal manipulation. toric IOL powers (59%), followed by the Holladay (49%) and the Barrett (46%). These differences were not statistically significant. Outcomes of the femtosecond eyes will be com- pared and added to final abstract. Conclusion: Excellent refractive outcomes can be obtained with toric IOL implantation. There was sig- nificant variability among available toric calculators, and no calculator proved significantly better than any other for manual surgery. Outcomes will be evaluated for femtosecond cases. Dr. Tipperman: I chose this paper because the results are quite surprising and striking, and not what I think most surgeons would have anticipated. It is interesting that in the past 2 years at the ASCRS•ASOA Symposium & Con- gress, the Innovator's Lecture has been given for work in IOL power calcula- tions (Graham Barrett, MD, in 2015 and Warren Hill, MD, in 2016). This paper looked at toric IOL outcomes using different calculators and formulas. In and of itself, this type of study is not novel and in fact, at the 2015 ASCRS•ASOA Sympo- sium & Congress, Dr. Barrett's paper was chosen as one of the "Hot Off the Press" (the previous name for "Best of ASCRS") papers for a superb analysis demonstrating that of all the current- ly available calculators, the Barrett toric calculator proved to be the most accurate. This paper took this type of work one step further and examined the accuracy of the different calculators when they were used with manual or femtosecond laser cataract surgery. In general, results were good for all patients, but femtosecond laser cataract surgery/toric cases were statistically bet- ter than manual/toric cases. There was Comparison of toric IOL outcomes and calculator recommendations in patients with toric IOL implantation after manual or femtosecond- assisted cataract surgery Claudia Perez-Straziota, MD, J. Bradley Randleman, MD, James Lockwood, MD Purpose: To compare outcomes of toric IOL implantation between manual and femtosecond laser-as- sisted cataract surgery and compare recommended toric IOL powers among 3 different calculators. Methods: Analysis of 71 eyes (44 patients) with manual surgery and 27 eyes (14 patients) with femtosec- ond laser-assisted surgery. Toric IOL calculations were performed with the Alcon, Barrett, and Holladay IOL Consultant programs. Outcomes included postoperative uncorrected distance visual acuity (UDVA), cor- rected distance visual acuity (CDVA), manifest refraction sphere, cylinder, axis, and manifest refraction spheri- cal equivalent (MRSE). Results: Average postoperative UDVA for the manual group was logMAR 0.13±0.13 (Snellen 20/27), with 34% 20/20 or better and 92% 20/40 or better. Average postoper- ative CDVA was logMAR 0.03±0.05 (Snellen 20/21), with 77% 20/20 or better and 100% 20/40 or better. Average MRSE was –0.22±0.43 D, with 79% ±0.5 D and 98% ±1.0 D, and cylinder was 0.56±0.46 D (range 0.0 to 1.50 D), with 59% ≤0.5 D, 79% ≤0.75 D, and 88% ≤1.0 D. The implanted IOL was the same as the calculated ideal IOL in 63% of eyes, stronger than ideal in 27%, and weaker than ideal in 10%. The Alcon calculator generated the most ideal Cataract

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