EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78712
April 2012 INFINITI® Vision System Indication: The INFINITI® Vision System is indicated for emulsification, separation, and removal of cataracts, the removal of residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intra-ocular lens injection. The AutoSert™ IOL Injector Handpiece is intended to deliver qualified AcrySof® intraocular lenses into the eye following cataract removal. The following system modalities additionally support the described indications: - Ultrasound with UltraChopper Tip achieves the functionality of cataract separation. - AquaLase achieves the functionality for removal of residual cortical material and lens epithelial cells. - The AutoSert™ IOL Injector Handpiece achieves the functionality of injection of intraocular lenses. The AutoSert™ is indicated for use with ACRYSOF lenses SN60WF and SN6AD1, as well as approved AcrySof lenses that are specifically indicated for use with this inserter, as indicated in the approved labeling of those lenses. Caution: Federal (USA) law restricts this device to sale by, or on the order of, a physician. As part of a properly maintained surgical environment, it is recommended that a backup IOL Injector be made available in the event the AutoSert™ IOL Injector Handpiece does not perform as expected. Warnings: Appropriate use of INFINITI® Vision System parameters and accessories is important for successful procedures. Use of low vacuum limits, low flow rates, low bottle heights, high power settings, extended power usage, power usage during occlusion conditions (beeping tones), failure to sufficiently aspirate viscoelastic prior to using power, excessively tight incisions, and combinations of the above actions may result in significant temperature increases at incision site and inside the eye, and lead to severe thermal eye tissue damage. Adjusting aspiration rates or vacuum limits above the preset values, or lowering the IV pole below the preset values, may cause chamber shallowing or collapse which may result in patient injury. When filling handpiece test chamber, if stream of fluid is weak or absent, good fluidics response will be jeopardized. Good clinical practice dictates the testing for adequate irrigation and aspiration flow prior to entering the eye. Ensure that tubings are not occluded or pinched during any phase of operation. The consumables used in conjunction with ALCON® instrument products constitute a complete surgical system. Use of consumables and handpieces other than those manufactured by Alcon may affect system performance and create potential hazards. AEs/Complications: Use of the NeoSoniX® OZil® torsional, U/S, or AquaLase® , handpieces in the absence of irrigation flow and/or in the presence of reduced or lost aspiration flow can cause excessive heating and potential thermal injury to adjacent eye tissues. ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. had difficulty seeing with a gonio lens," Dr. Safran said. He decided to observe her on medication, as her IOP did drop with the help of meds. "My view through the cornea was so poor and the pupil so dilated, I felt a laser iridotomy would be difficult. This would give the pupil time to come down for an iridotomy," he said. © 2012 Novartis 3/12 INF12826JAD-PI Change of plans However, during an exam 2 days later, things didn't happen as Dr. Safran thought they might. "The iris was plastered to the back of the cornea. On the left side where there is a diagonal green line—that circle is the air bubble," he explained, referring to Figure 4. The patient's IOP at this point was 32 mm Hg. Dr. Safran contacted the Figure 7. The patient's atonic pupil with the cataract prior to surgery Source (all): Steven G. Safran, M.D. Figure 4. The iris plastered to the cornea 2 days later Facing continued from page 12 referring retinal specialist to stick a needle in the pars plana and draw out air to soften the eye, as she had a complete air fill with some air in the anterior chamber as well. This enabled him to drop the pressure and perform a laser iridotomy to punch a hole in the iris. He then used the YAG laser to push the iris away from the corneal endothelium a bit to create some space for a paracentesis to be made with a can- nula with viscoelastic to be placed to further separate the iris from the cornea. Since this patient was adamant that she did not want to go to the OR unless absolutely neces- sary, Dr. Safran elected to perform the procedure at the slit lamp. "At the slit lamp, I used a dia- Figure 5. The iris after deepening of the chamber at the slit lamp Figure 6. This image shows how thin the cornea became right after deepening of the chamber mond blade to create the paracente- sis. I went in with a needle to inject Viscoat [3% sodium hyaluronate, 4% chondroitin sulfate, Alcon, Fort Worth, Texas] to reopen the angle 360 degrees. I injected viscoelastic to do a viscodissection of the iris away from the cornea and to reopen the angle. You can see [Figure 5] that the iris is now away from the cornea im- mediately post-op and that the angle is wide open," he said. The patient's corneal thickness went from around 600 microns to in the 300s (Figure 6). However, the IOP remained high at 31 mm Hg. Post-op view A few days later, most of the pa- tient's fluid was gone, her corneal thickness was 535 microns, she was not on any more medication, and her angle was open as seen on go- nioscopy. Dr. Safran later performed cataract surgery and iris repair on the patient (Figure 7). In addition to difficult case management and discovering the value of OCT, Dr. Safran said this case also reinforced for him the benefit of PRK over LASIK. "I think this shows us how unstable some post-LASIK eyes are. When we do LASIK, we need to think about where the patient's eyes will be 5, 10, or 20 years later, as he/she might be affected by glau- coma, cataract, and other surgeries. The corneas are less stable. I think it's one more reason to consider PRK a safer alternative as there's no flap," he said. EW Editors' note: Dr. Safran has no finan- cial interests related to this article. Contact information Safran: safran12@comcast.net