Eyeworld

Reporting from the 2016 ESCRS Congress, September 10–14, Copenhagen, Denmark EW MEETING REPORTER 152 October 2016 Dr. Eskina said statistically sig- nificant differences between the PRK and ReLEx SMILE groups were found in absolute deviation of optical zone postop from the planned optical zone. The deviation in these was significantly less in the ReLEx SMILE group, she said. Dr. Eskina said the results of the analysis offer a possibility to make real planning of the optical zone postop and improve the quality of optics for operated patients. It is es- pecially important for patients with large scotopic pupils, she said. The study found several sig- nificant differences among the procedures, she said. The optical zone postop was significantly larger (3.1%) in LASIK than in the PRK group. Additionally, the optical zone decreased more significantly (5.1%) in the PRK group than in the transPRK group. The optical zone postop was found to have more deviation (5%) from the optical zone planned in the PRK group than in the ReLEx Smile group. The optical zone postop also had more devia- tion (8.3%) from the optical zone planned in the transPRK group than in the ReLEx SMILE group. Dr. Eskina added that there are unknown factors influencing the optical zone postop that should be investigated further. Dr. Eskina concluded that ReLEx SMILE is a predictable surgery pro- viding better preconditions in terms of FOZ for higher quality of vision for patients. Nanolaser cataract surgery Nanolaser cataract surgery was fea- tured in three presentations during a free paper session about femtosec- ond lasers and other types of lasers for cataract surgery. "Femtosecond laser allows us to perform laser-assisted cataract surgery, but the lens material still needs to be removed by ultrasound and aspiration," Jerome Vryghem, MD, Brussels, Belgium, said before going on to explain how nanolasers can be used to emulsify the lens for aspiration. The advantages of nanolaser over ultrasound phacoemulsifica- tion, according to Dr. Vryghem, The use of femtosecond laser in the context of lamellar procedures, small incision lenticule extraction (SMILE), to correct astigmatism, and in capsulotomy creation were dis- cussed in depth by the symposium's presenters. Holger Lubatschowski, PhD, Hanover, Germany, spoke about some of femto's other, less common applications. These included intratissue refractive index shaping, in situ IOL modification, presbyopia reversal, and non-invasive bleaching of the human lens. As for application in the poste- rior segment, Dr. Lubatschowski said it is possible to go deeper in the eye, however, there is a loss of precision because of the vitreous. He said adaptive optics could someday be used to compensate for this aberra- tion. "In conclusion we see femtosec- ond where we can do 3-D cutting, imaging, and chemistry, and I'm convinced … the femto era of ophthalmology has just begun," Dr. Lubatschowski said. LASIK free papers The effectiveness of any type of refractive surgery is very high now- adays, said Erika Eskina, MD, Mos- cow. "Nevertheless, there are still questions regarding the quality of vision of the patients." She present- ed her study on functional optical zone after corneal refractive surgery in a free paper session. Dr. Eskina's study set out to evaluate the functional optical zone (FOZ) and influencing parameters among eyes that underwent corne- al refractive treatments, including photorefractive keratectomy (PRK), transPRK, conventional LASIK, and ReLEx (refractive lenticule extraction) SMILE (small incision lenticule extraction). The study was performed in Russia, with 173 eyes of 87 patients with moderate myo- pia with or without astigmatism. Of this patient population, 16 patients (32 eyes) were treated with PRK; 16 patients (32 eyes) were treated with transPRK; 16 patients (32 eyes) were treated with LASIK; and 39 patients (77 eyes) were treated with ReLEx SMILE. The data was then analyzed at 6 months postop. Bret Fisher, MD, Panama City, Florida, presented a separate prospective, randomized study comparing Less Drops (Imprimis Pharmaceuticals), and a transzonular injection of Dropless in 25 patients having binocular cataract surgery. No significant difference was ob- served between the two groups in IOP, cells and flare, pain and floaters, central corneal thickness, central macular thickness, and best correct- ed visual acuity. "The big difference that we found in this study … was patient satisfaction. Twenty-two of 24 pa- tients were satisfied or very satisfied with the surgery itself," Dr. Fisher said, adding that 92% of patients preferred the injection route. Past, present, and future of femtosecond lasers in ophthalmology The background, current uses, and possible future applications of the femtosecond laser in ophthalmology were presented during an ESCRS/ EuCornea symposium. Mats Lundström, MD, Lund, Sweden, led the discussion with a case control study using data from the European Registry of Quality Outcomes for Cataract and Refrac- tive Surgery to evaluate outcomes of femtosecond laser-assisted cataract surgery (FLACS) in terms of visual acuity, refractive outcomes, and complications. The study involved 18 clinics from 10 countries provid- ing data on 3,379 FLACS cases from December 2013 through May 2015. Visual and refractive outcomes in these FLACS cases, overall, were good. Out of the whole group, 2.9% of cases had surgical complications, which were either classical com- plications associated with cataract surgery or laser-related, though Dr. Lundström said the latter were not visually threatening. Postop com- plications occurred in 3.3% of cases, measured at the 3-month follow-up. "We conclude that this is a reg- istry study of what's happening in the real world. If we want to go into details and get more information, we need randomized, clinical studies in order to find out the relationship and postop complications with this technique," Dr. Lundström said.

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