Eyeworld

6 6 What does the data say? Safety, efficacy, and clinical outcomes of laser-assisted cataract surgery by Kerry Solomon, MD Embracing evolving refractive enhancements: Safety, efficacy, and future opportunities 2. Qian DW, et al. Femtosecond laser capsulotomy versus manual capsuloto- my: a meta-analysis. Int J Ophthalmol. 2016;9:453–8. 3. Daya SM, et al. Translenticular hydrodis- section, lens fragmentation, and influence on ultrasound power in femtosecond laser-assisted cataract surgery and re- fractive lens exchange. J Cataract Refract Surg. 2014;40:37–43. cataract surgery easier, especially in cases where the pupil is on the small side or when the lens is quite dense. References 1. Quiñones A, et al. Benefits and Harms of Femtosecond Laser Assisted Cataract Surgery: A Systematic Review. VA-ESP Project #05-225; 2013. To achieve the outcomes that patients expect, surgeons need to develop customized plans and precise enhancement strategies Kerry Solomon, MD continued from page 5 Figure 1. This image shows the planned laser pattern on an eye with a small pupil. It was captured after imaging of the eye was completed on a femtosecond laser. The central part of the pattern (yellow) is the planned fragmentation pattern of the nucleus. The green curved line toward the limbus is the location for the main incision. The capsulotomy is designated by the inner green circle, which is just outside the yellow region. Figure 2. The femtosecond main incision can be custom-designed. In this case, the main incision has been designed with a reverse-angle exit from the cornea. This provides improved sealing at the end of the procedure. D espite their efforts, refractive cataract sur- geons achieve outcomes within 0.5 D of their intended refractive target only approximately 71% of the time. 1 To deliver the visual out- comes patients expect, ophthal- mologists who are expanding their services to include refractive cataract surgery need to master enhancement techniques or refer enhancements to a colleague. Precise enhancements are a vital part of this process. Evaluating residual refractive error If a patient is dissatisfied with his or her outcome, our first task is to determine the cause of the residual error. If a toric intraocular lens (IOL) rotated, we need to re- position it. If rotating it does not correct the problem, I may insert a capsular tension ring, which usually holds the toric IOL in place, or I optic-capture it to hold it in position. To correct residual spherical or cylindrical error, I usually per- form LASIK, creating a 100–110 µm flap with a femtosecond laser 4. Conrad-Hengerer I, et al. Effect of fem- tosecond laser fragmentation on effective phacoemulsification time in cataract surgery. J Refract Surg. 2012;28:879–883. 5. Conrad-Hengerer I, et al. Femtosecond laser-assisted cataract surgery in eyes with a small pupil. J Cataract Refract Surg. 2013;39:1314–1320. 6. Huseynova T, et al. Evaluating the differ- ent laser fragmentation patterns used in la- ser cataract surgeries in terms of effective phacoemulsification time and power. Clin Ophthalmol. 2015;9:2067–71. Dr. Trattler practices with the Center for Excellence in Eye Care, Miami. He can be contacted at wtrattler@gmail.com.

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