Eyeworld

EW FEATURE 54 Highlights from ESCRS 2016 • December 2016 AT A GLANCE • The technology is seen by some as providing true laser cataract surgery, emulsifying the lens with laser energy instead of ultrasound. • The nanosecond laser attaches to a phaco system at the vitrectomy port and is well-integrated with current surgical flow. • Some studies have found nanosec- ond laser cataract surgery can result in better endothelial cell preservation. by Liz Hillman EyeWorld Staff Writer Proponents find the technology to be safe, affordable, and well- suited for the normal surgical workflow W hile headlines about laser cataract surgery are usually focused on the femtosecond laser, another type of technology—the nanosecond laser— was discussed at the 2016 European Society of Cataract and Refractive Surgeons (ESCRS) meeting in Copenhagen, Denmark. "We are in an environment where more and more colleagues in- vest in femtosecond laser for surgery. I find it a very expensive marketing tool because I'm still not convinced it's a real advantage for the patient. It's not really laser cataract surgery; it's laser-assisted cataract surgery," said Jérôme Vryghem, MD, Brus- sels Eye Doctors, Brussels, Belgium, explaining that the femtosecond laser might be able to make the cap- sulorhexis, incisions, and fragment the lens, but the nanosecond laser actually emulsifies the lens. Dr. Vryghem, who presented his research on nanosecond laser cataract surgery during an ESCRS free paper session, found the Cetus nanosecond laser (A.R.C. Laser, Nuremberg, Germany) to be a more affordable technology that is able to emulsify the lens for aspiration with less energy dispersion in the eye, compared to ultrasound. It can add to the surgical time, he acknowl- edged, but less than femtosecond laser surgery. "I thought it was a good idea to invest in this tool; at least you're really doing laser cataract surgery," he said. The Cetus nanosecond laser, according to A.R.C. Laser's website, is 100% photofragmentation with- out any ultrasound. The system has single-use handpieces and attaches to a surgeon's current phaco machine through the vitrectomy port. The Cetus handpiece incorporates aspi- ration, irrigation, and laser, allowing the surgeon to use it just like a phaco Nanosecond laser cataract surgery update Monthly Pulse Highlights from ESCRS 2016 T his Monthly Pulse survey covered a variety of issues from this month's feature, "Highlights from ESCRS 2016." We asked, "Do you use any of the following devices to create an auto- mated capsulotomy?" The majority of respondents to this survey said they do not; a femto- second laser was the second most popular answer. When asked about rehabilitating a patient with endothelial disease, the majority of respondents would use DSAEK, but DMEK was a close second. Most respondents to this survey said the greatest advantage of nanosecond laser cataract surgery is, "There is less energy employed than with phacoemulsification." Finally, we asked, "How do you center the IOL during cataract surgery?" The majority of respondents said, "I center the IOL on the Purkinje reflex." Dr. Tanev performs nanosecond laser cataract surgery. Source: Ivan Tanev, MD

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