Eyeworld

EW INTERNATIONAL 126 February 2018 by Ellen Stodola EyeWorld Senior Staff Writer, and Liz Hillman EyeWorld Staff Writer International meeting paper session recap A snapshot of some of the paper presentations at the XXXV Congress of the ESCRS T he XXXV Congress of the European Society of Cata- ract & Refractive Surgeons (ESCRS) in Lisbon, Portugal, Oct. 7–11, 2017, featured many papers sessions, covering topics including femtosecond laser-assisted cataract surgery, small incision lenticule extraction, dry eye, infection, intraocular lenses, and more. While EyeWorld published its coverage of the meeting in the November 2017 issue, there were ad- ditional presentations that were not included due to space constraints. The following is a summary of some of the paper sessions. Femto laser-assisted cataract surgery (FLACS) I paper session A few presentations during this pa- per session compared FLACS to con- ventional phacoemulsification cat- aract surgery. One study, described by Anna Sophie Mursch-Edlmayr, MD, Linz, Austria, involved 100 eyes of 50 patients where one eye received FLACS while the other un- derwent traditional cataract surgery. Overall, effective phaco time was comparable between the two groups; pre-fragmentation with femto didn't significantly reduce phaco time. While centration of the capsulotomy was better in the femto group, IOL centration was compa- rable between the two groups. Dr. Mursch-Edlmayr said all surgeries were successfully completed. Suction loss occurred in two femto proce- dures, but redocking was successful. An incomplete capsulotomy was made in five eyes. Harry Roberts, MD, London, U.K., discussed a study where 400 eyes of 400 patients were random- ized to receive either conventional phaco or FLACS. There was no dif- ference seen between the two groups in terms of vision, IOP, endothelial cell loss, corneal thickness, patient reported questionnaires, or refractive results. There was a trend toward reduced phaco energy in the FLACS group, but it was not significant, Dr. Roberts said. There was a reduction in the number of posterior capsule tears, however, with none occurring in the femto group and three in the phaco group. Overall, Dr. Roberts said, "we found the laser is a safe operation in terms of posterior capsule damage," but, he added "we didn't realize a lot of the benefits [of FLACS]." He also noted the increased cost associated with FLACS. David O'Brart, MD, London, U.K., presented research on using a "hub-and-spoke" model in a high volume cataract surgery setting, evaluating its effect on time and cost efficiency. In this model, Dr. O'Brart said one technician performed the femto portion of the procedure in a laser room, and the rest of the surgery was performed in operating theaters. The hub-and-spoke model decreased operating time by 3 minutes per case, which translated to a 12.5% increase in productivity. Dr. O'Brart said the femto procedure itself cost about £150 more per case. To break even, one would need to have one laser to four operating rooms running 6,000 cases per year with a discounted average cost at the patient interface at 78%. The cost and relatively limited increase in productivity associated with the femtosecond laser, as seen in this research, is "simply not enough," Dr. O'Brart said. The cost makes it "not viable in our hospital to persuade managers to buy one." Small incision lenticule extraction paper session In this session, small incision lenticule extraction (SMILE) was compared to LASIK on several outcome metrics, new techniques were discussed, and SMILE to correct astigmatism and presbyopia was presented. It's known that visual recovery with SMILE is longer than that of LASIK, which Sheetal Brar, MD, Bangalore, India, said is due to inter- face healing. With the conventional SMILE technique, a dissector is used to separate the upper and lower planes of the lenticule, and if done excessively, it can lead to stromal damage, she said. A no dissection technique could reduce this damage and speed healing. Lenticuloschisis involves peeling the edge of the lenticule 3 to 4 clock hours with microforceps in one di- rection and repeating the maneuver on the other half. Once separated, the lenticule can be extracted from the pocket. Prerequisites for this technique include an energy pattern with a smooth uniform bubble layer (no black spots), myopia with spherical equivalent of more than 3 D, minimum lenticule thickness of 25–30 µm, and an experienced SMILE surgeon. Dr. Brar described research that compared these two techniques in the eyes of 50 patients (one eye was dissected normally while the other eye had lenticuloschisis). Lenticuloschisis resulted in better immediate postop day 1 results in terms of UCVA and corneal modu- lation transfer functions. Outcomes between the two techniques were similar at later follow-up. Sabong Srivannaboon, MD, Bangkok, Thailand, discussed out- comes with cap thicknesses of 140 µm vs. 80 µm. More eyes achieved 20/20 UCVA in the 80 µm group compared to the 140 µm group. Similarly, more in the 80 µm group achieved 20/16. More eyes in the superficial lenticule group gained at least one line and fewer lost one line compared to the deeper lenticule group. A possible explanation, Dr. Srivannaboon said, is that the deep stroma of the cornea appears less smooth, and the deeper lenticules take more time to remodel. Dan Reinstein, MD, London, U.K., discussed management and in- cidence of suction loss in analysis of 4,000 consecutive SMILE procedures. Eye movement on the patient's part is the main cause of suction loss, he said. Based on his analysis, suction loss is patient generated more than three-quarters of the time, with the surgeon initiating the suction The XXXV Congress of the ESCRS took place in Lisbon, Portugal, Oct. 7–11, 2017. Presentation spotlight

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