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EW CATARACT 56 September 2016 vaulting, position, or sizing that would have led to capsule touch and cataract formation. I remove one or two ICLs per year and find that they can be more challenging to remove than an IOL because the phakic lens is cumbersome and thin, shredding easily. Its position just under the iris also demands that care be taken not to damage the iris during removal. The femto laser-treated crystal- line lens was easily aspirated. I find that a disposable silicone capsule guard I/A tip (Bausch + Lomb, Bridgewater, New Jersey) is a useful adjunct in such cases due to its soft tip and larger port that allows for aspiration of slightly thicker nuclei after femto fragmentation. I implanted a +9 D monofocal lens. The patient was 20/25 uncor- rected at 1 week postop. I sent him back to the cornea specialist for the fellow eye, which had had an ICL implanted more recently and still had some residual corneal edema. I would have liked to implant a presbyopia-correcting lens to pro- vide more functional near vision for this young patient, but our options at the time of this procedure have a limited power range. In conclusion, this was an interesting case because many of us would consider the presence of an ICL to be a relative contraindication to femtosecond laser-assisted cata- ract surgery. Surgeons should check the image resolution and surface fits carefully. Provided they are accurate, my experience has been that ICL patients can benefit from the advan- tages of the femtosecond laser. EW Reference 1. Packer M. Meta-analysis and review: ef- fectiveness, safety, and central port design of the intraocular collamer lens. Clin Ophthalmol. 2016;10:1059–77. Editors' note: Dr. Grayson practices in New York and New Jersey at Omni Eye Services. He has no financial interests related to this article. Contact information Grayson: dkgrayson@icloud.com Femto continued from page 54 Are you a fan of EyeWorld? Follow us on Twitter at twitter.com/EWNews removed under sterile conditions. Doing that first and then taking the patient out of the OR for the laser portion seemed impractical, so I decided to try performing the femtosecond laser treatment with the ICL in situ. Had the ICL caused some disturbance in the laser's abil- ity to image the lens and capsule, I would likely have gone to the OR to remove the ICL and do manual phaco. Fortunately, the laser accurately identified the ICL and the anteri- or capsule below it (Figure 1), so I proceeded with femtosecond treat- ment. The laser was able to create a complete capsulotomy without interference from the ICL and soften the lens as planned (Figure 2). Following laser treatment, removal of the ICL was no more difficult than usual. I cut the ICL nearly in half and then slowly rotated it out. Although there were some iris-corneal synechiae, there were no obvious problems with poor

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