EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78710
58 EW MEETING REPORTER May 2012 Reporting live from APAO/SOE Busan 2012, Busan, Korea Femto laser cataract surgery "the way of the future" Femtosecond laser cataract surgery was the focus of the first session of Cataract Subspeciality Day held on Friday, April 13 as part of the Joint Congress of APAO/SOE in conjunc- tion with the 107th Annual Meeting of KOS. Tim Roberts, M.D., Sydney, Australia, said that "laser phaco" is different from "manual phaco," and the new technology as applied in cataract surgery represents a para- digm shift that some experts already equate to the introduction of pha- coemulsification during the time of extracapsular cataract extraction. One indication of this paradigm shift is the emergence of capsular block syndrome as a complication of femto cataract surgery. Dr. Roberts said that the gas generated by femto laser cataract surgery leading to an intraoperative increase in bag vol- ume combined with a perfectly sealed laser capsulotomy among other factors related to the new pro- cedure creates a "perfect storm" situ- ation for this complication not seen in standard phaco. Experts at the session agreed that femtosecond laser cataract sur- gery is, as Benjamin Cabrera, M.D., Manila, Philippines, put it, "the way of the future." However, there re- main barriers to acceptance, includ- ing a significant learning curve. Cesar Espiritu, M.D., Manila, Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from APAO/SOE Busan 2012, Busan, Korea offered some tips for "beating the learning curve." He said that the keys to overcoming the learning curve are knowing the machine, in- cluding all the details usually left for technicians; adopting modifications to surgical technique that include taking into consideration the laser incision, the placement of cuts, and the use of intracameral dilators and prophylactic anti-inflammatory medication since the laser could induce inflammation, resulting in miosis; employing a properly trained staff to serve as a patient manage- ment team; and marketing, which includes the creation of new patient packages, the initiation of clinical studies, and publication of results. Editors' note: Dr. Espiritu has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), and Bausch + Lomb (Rochester, N.Y.). Dr. Roberts has no financial interests related to his comments. Optimizing outcomes While cataract surgery is often con- sidered near perfect with the skillful application of today's techniques and technology, there is always room for improvement, particularly when cataract co-exists with other conditions. Tien Yin Wong, M.D., Singa- pore, said that it is increasingly the case that patients with cataracts have co-existing conditions like diabetes that predispose them to retinal pathology in addition to cataract. Therefore, cataract surgeons should be on the lookout for macular pathology—including diabetic macu- lar edema (DME), age-related macular degeneration, subtle epiretinal mem- branes, and macular scars—and, pe- ripherally, retinal tears or breaks. In cases of patients with cataract who are found to have diabetic retinopathy (DR) or DME, Dr. Wong recommended that adequate laser therapy be instituted prior to cataract surgery. He said that cataract surgery should be delayed until the DR or DME is stabilized with therapy. Surgeons may also consider ad- junctive therapy in the form of steroids or anti-VEGF agents. Cataract surgeons should distin- guish DME from cystoid macular edema (CME); the latter, said Dr. Wong, will present with few or no microaneurysms, no or mild DR, and angiograms would indicate a petaloid pattern with disc staining. Editors' note: Drs. Kim and Wong have no financial interests related to their comments. Glaucoma progression is hot topic at session In a morning glaucoma session, seven specialists discussed ways to assess progression of the disease. Aiko Iwase, M.D., Tajimi, Japan, said it's important to differentiate variability from real progression in glaucoma. To test the progression of nor- mal tension glaucoma (NTG), she said that trend-type analysis using hemifield mean total deviation (TD) or pattern standard deviation (PSD) may be more useful in following NTG patients than using mean devi- ation, visual field index, or TD (PD) change at each point. Using examples from four major U.S. trials, David C. Musch, M.D., Ann Arbor, Mich., stressed the im- portance of clinical study design and conduct and pointed out the often- unspecific nature of study results, especially in selection criteria, refusals, and randomization of patients in those trials. Retinal nerve fiber layer photog- raphy is a simple way to detect progression of a localized defect in glaucomatous eyes, said Ki Ho Park, M.D., Seoul, South Korea. Dr. Park showed the advantages of using red-free photography by displaying three photographs of the same eye that were taken with different cam- eras. "The retinal nerve fiber layer photography is quite straightforward with little variation," he said. "Re- gardless of the camera, you will get very clear RNFL photos and defects." The theory that disk hemor- rhages are part of an ongoing neurodegenerative process in glauco-