OCT 2016

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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61 October 2016 EW REFRACTIVE The same patient at her 3-month follow-up appointment Source: Jack Abrams, MD wound construction. Before creat- ing the full wound, I recommend using a smaller incision for cataract removal, keeping in mind we need to have an intact capsulorhexis and normal zonular integrity for the de- vice to work properly. After cataract removal, cortical removal is a crucial step. I highly recommend polishing the capsule and then extending the incision, but extreme care is nec- essary to avoid capsular damage. I think it is essential to do capsular polish after the cataract is out—es- pecially for these patients—because we want to minimize any possibility of posterior capsule opacification. Capsular polish both on the poste- rior capsule and anterior capsule is important, in my opinion. Next, I prefer to go to at least 11 mm on the limbus; I create the scleral incision and then use a crescent blade to enter the cornea. Another pearl I have found is to stain the capsule. I use VisionBlue (trypan blue, Dutch Ophthalmic USA, Exeter, New Hampshire) to make visualization of the IMT hap- tics positioning within the capsular bag easier. This is a longer surgery than most of us are used to—anywhere from 45 minutes to an hour. There are some out-of-pocket costs for the surgeon, but it's worth it when the patient regains some visual func- tionality and independence. I've begun using the femtosec- ond laser for these surgeries and will continue to do so with all of my qualifying patients. Postop follow-up I think the most important part postoperatively is to ensure the inci- sion is well healed with no leakage before we move these patients to the low vision specialists for rehabilita- tion and training. I plan to see these patients on postop day 1, but also 7 to 10 days later before I transfer care. These patients are going to have extensive postop training with the low vision specialist. As cataract surgeons, we need to remember they are not your typical patients—there is no immediate "wow" factor. There will be some necessary training, and there may be some frustration. My patient, however, did very well, going from 20/200 preoperatively to 20/100 postop, with 3 months of follow-up. Two of my colleagues have also implanted the IMT, and all of our patients are seeing sub- stantially better and have regained a significant amount of functional vision. My patient has said she can now see faces and eyes instead of a black mass where heads should be; she can also clearly see colors of clothes. She had to train herself to use " I thought combining [the IMT and the femtosecond laser] would be great as the patient gets the benefits of both technologies. " –Jack Abrams, MD both eyes, with the implant eye for central vision and the contralateral eye for peripheral vision. As she told us, "I am reading fantasy novels on my Nook again. I can also watch my favorite PBS programs." I'm hopeful the Food and Drug Administration will approve the device for pseudophakes as that will considerably broaden our potential patient base. EW References 1. Colby KA, et al. Surgical placement of an optical prosthetic device for end-stage macular degeneration: the implantable miniature telescope. Arch Ophthalmol. 2007;125:1118–21. 2. Boyer D, et al. Long-term (60-month) re- sults for the implantable miniature telescope: efficacy and safety outcomes stratified by age in patients with end-stage age-related macular degeneration. Clin Ophthalmol. 2015;9:1099–107. 3. Hudson HL, et al. Implantable miniature telescope for the treatment of visual acuity loss resulting from end-stage age-related macular degeneration: 1-year results. Oph- thalmology. 2006;113:1987–2001. Editors' note: Dr. Abrams is in private practice in Las Vegas. He has no finan- cial interests related to this article. Contact information Abrams: jabrams@abramseye.com

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