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Inside Eyetube.net | May 2012

Surgical Demonstrations and a
Comprehensive Course

Cataract surgery remains an evolving art.

Eyetube.net continues to be a repository for videos that Implantation of IOLs. In a video from the live surgery showcase the latest surgical techniques in cataract, refractive, glaucoma, and retinal surgery. Recently on Eyetube.net, several surgeons shared their experiences performing cataract surgery with the LenSx Laser (Alcon Laboratories, Inc.). This installment of Inside Eyetube.net offers surgical demonstrations of astigmatic treatment and the implantation of IOLs with the LenSx Laser. Equally worthy of attention is a comprehensive course by Lisa Brothers Arbisser, MD, on how to manage complications that arise during the various steps of the cataract procedure.

SURGICAL PROTOCOLS

Astigmatism. In their video, Eric D. Donnenfeld, MD, and Allon Barsam, MD, perform cataract surgery using the LenSx Laser to create arcuate incisions to correct astigmatism (eyetube.net/?v=nehes; Figure 1). They demonstrate how to carefully select the necessary parameters for the laser to create limbal relaxing incisions (LRIs) at a precise depth and how to open the LRIs with surgical calipers.

Implantation of IOLs. In a video from the live surgery session at the 2011 annual meeting of the American Academy of Ophthlmology (AAO), Richard Mackool, MD, and Richard J. Mackool Jr, MD, performed cataract surgery with the LenSx Laser on a 58-year-old woman with grade 2+ anterior capsular, grade 2+ nuclear sclerot- ic, and grade 1+ posterior subcapsular cataract in her left eye (eyetube.net/?v=hapuf). The patient’s cornea was nor- mal, with a central corneal thickness of 558 μm. The lens was 4.49 mm thick. The axial length was 24.69 mm, and the keratometry reading was 42.38 D @ 23° X 43.04 D @ 113°. Drs. Mackool and Mackool broke the cataract into four quadrants, and they created a 4.50-mm capsulotomy with the laser (Figure 2). After the laser portion of the surgery, the surgeons implanted an AcrySof IQ Restor IOL +3.0 D (Alcon Laboratories, Inc.).

In another video from the live surgery session, Kerry Solomon, MD, performed cataract surgery with the LenSx Laser and implanted an AcrySof IQ Toric IOL (Alcon Laboratories, Inc.) in a 65-year-old woman with grade 2+ nuclear sclerotic and grade 2+ posterior subcapsular cataract in her left eye (eyetube.net/?v=zedil). The cornea was normal, with a central thickness of 551 μm. The lens was 4.29 mm thick. The axial length was 23.41 mm, and the keratometry reading was 42.03 D @ 174° X 43.55 D @ 84°. Dr. Solomon created a 5.00-mm capsulotomy with the LenSx Laser. He broke the nucleus with a 4.90-mm cruciate and 2.50-mm cylindrical pattern (Figure 3).

CLINICAL COURSE ON MANAGING COMPLICATIONS

Dr. Arbisser provides a comprehensive course on the steps surgeons can take when they encounter com- plications during cataract surgery. In this series of 18 video vignettes, Dr. Arbisser discusses her own clinical experience and laboratory work, and she offers solu- tions including how to close a wound, how to perform a vitrectomy, and how to manage fragments from a dropped nucleus. Her videos demonstrate techniques for limiting further complications when extra steps are needed. Dr. Arbisser’s complete series may be viewed at eyetube.net/?v=rista, and a supplemental digital mono- graph is also available.

CONCLUSION

Cataract surgery remains an evolving art. These videos provide an opportunity for cataract surgeons to watch, learn, and adopt new protocols to improve outcomes with femtosecond lasers. As alluring as new technology can be, it is important to be mindful that unfamiliar complications may arise. When this happens, ophthal- mologists must return to those first, basic surgical steps that they learned as residents and recognize when it is time to put down the phaco probe and perform a vit- rectomy instead. As amazing as femotsecond lasers may become, cataract surgery will remain a highly challenging, 15-minute,electiveprocedure.

Section Editor Elena Albé, MD, is a consul- tant in the Department of Ophthalmology, Cornea Service, Istituto Clinico Humanitas Ophthalmology Clinic, Milan, Italy. Dr. Albé states that she has no financial interest in the products or companies mentioned. She may be reached at e-mail: elena.albe@gmail.com.

Section Editor Damien F. Goldberg, MD, is in private practice at Wolstan & Goldberg Eye Associates in Torrance, California. Dr. Goldberg states that he is a consultant to Alcon Laboratories, Inc., but has no financial interest in the products or companies mentioned. He may be reached at tel: +1 310 543 2611; e-mail: damien.goldberg@wolstaneye.com.

Section Editor Mark Kontos, MD, is the senior partner at Empire Eye Physicians in Spokane, Washington. Dr. Kontos states that he has no financial interest in the products or companies mentioned. He may be reached at tel: +1 509 928 8040; e-mail: mark.kontos@empireeye.com.

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