Eyeworld

153 October 2016 EW MEETING REPORTER Surgical video session In a surgical video session, surgeons shared some of their complicated cases. Allon Barsam, MD, Lon- don, highlighted handling zonular weakness. It's important to identify warning signs that this problem may occur, he said. One tip he offered for these cases is to make the cap- sulorhexis bigger than you would normally because when you need to manipulate the pieces, you can exert include less energy applied in the eye, more endothelial protection, and less intraocular trauma due to no mechanical or thermal side effects. Dr. Vryghem conducted a trial with 141 patients who had nanola- ser cataract surgery and received a trifocal IOL. He used the Cetus laser (A.R.C. Laser, Nuremberg, Germany), which connects to any phacoemul- sification system at the vitrectomy port and is triggered by the air im- pulse, controlled by the foot pedal. His first impression postop day 1 was that the eyes appeared calm with less wound leakage and seemed to have a faster visual recovery. Fur- ther analysis showed a small mean spherical equivalence and average cell loss of 6.9%. Three percent of patients lost two lines or more of best corrected visual acuity, and there were eight posterior capsule ruptures, five of which were within his first 2 months. In the end, Dr. Vryghem said it's not a device we really need, but if we want cataract surgery with less energy distribution, then nanolaser could be an affordable option over phacoemulsification. Anja Liekfeld, MD, Berlin, Germany, presented results from a similar study of 100 consecutive patients, also having a few instances of posterior capsule rupture (two within her first 20 patients), but no lines of vision loss were observed. Based on it being an easily transfer- rable procedure with no significant endothelial cell damage and lower energy delivered to the eye, it is "at least as good and safe as the gold standard," she said. Finally, Gangolf Sauder, MD, Mannheim, Germany, presented the results of a randomized prospective study comparing nanolaser cataract surgery vs. phacoemulsification in 76 patients. Though no statistically significant endothelial cell loss was observed between the two groups at 3 months postop, the nanolaser group had 2.7% endothelial cell loss 1 year postop compared to 7% in the phaco group. Dr. Sauder also reported significantly less energy delivered to the eye in the nanolaser group. the force of traction more periph- erally. This exerts less force on the zonules. Boris Malyugin, MD, Mos- cow, shared a case of a hard cataract capsular rupture, discussing the way he handled a brown cataract. With brown cataracts, you need extra manipulations and a lot of energy and extra effort to crack it, he said. Dr. Malyugin said he likes to use a longer chopper in these cases. Dry eye in refractive and cataract surgery Beatrice Cochener, MD, Brest, France, chairperson of an ESCRS/ EuCornea symposium, called ocular surface disease a "hot topic" in oph- thalmology. The effect of pre-existing dry eye on outcomes was discussed, as well as postop dry eye, diagnosis, treatment, and new technologies. Free Floor Plan and Patient Flow Reviews at AAO Booth 3163 Bring your plan by for Solutions to your flow / space problems. AAOE Course #630 Tuesday @ 10:15 a.m. A Guide to the Effective Ophthalmic Facility "We have made at least $5 for every dollar we spent on Practice Flow Solutions. Working with Practice Flow Solutions saved me from a really bad plan from the general architect. Your pre-design Assessment was very detailed and pointed out all the flow issues with the plan I had. Invaluable." Dr. Edward Meier Apex Eye Cincinnati, OH www.PracticeFlowSolutions.com F L O W A S S E S S M E N T S S P A C E A S S E S S M E N T S O F F I C E D E S I G N + ONSITE EFFICIENCY STUDIES + IDENTIF Y THE PROPER AMOUNT OF SPACE + MA XIMIZE YOUR WORKFLOW TIME WITHOUT A PATIENT TO SEE? PLANNING NEW PRACTICE SPACE? continued on page 154

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