Chris Hodge

Capsular block syndrome associated with femtosecond laser-assisted cataract surgery.

UNLABELLED We report intraoperative capsular block syndrome occuring during the first 50 femtosecond laser-assisted cataract surgeries performed in our facility. Two patients had uneventful combined laser fragmentation, capsulotomy, and corneal incision procedures. In both cases, following transfer to the operating room and manual removal of the laser-cut capsulotomy, posterior capsule rupture was noted during hydrodissection, resulting in posterior dislocation of the lens. Pars plana vitrectomy, removal of the crystalline lens, and sulcus implantation of an intraocular lens were performed in both patients with good visual outcomes. Femtosecond laser-assisted cataract surgery changes the intraoperative environment with the generation of intracapsular gas and laser-induced changes in the cortex. With awareness of the changed intraocular environment following laser lens fragmentation and capsulotomy and a modification of the surgical technique, no additional cases of intraoperative CBS have been seen in more than 600 laser-assisted cataract surgery procedures performed to date at our facility. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.

Femtosecond laser cataract surgery: technology and clinical practice

The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high‐resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side‐port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer‐guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience.The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience.

Outcomes of Femtosecond Laser Cataract Surgery With a Diffractive Multifocal Intraocular Lens

PURPOSE To report the visual and refractive outcomes in an initial series of eyes undergoing femtosecond laser cataract surgery with implantation of a diffractive multi-focal intraocular lens (IOL). METHODS The first 61 consecutive eyes undergoing femtosecond laser cataract surgery and ReSTOR (Alcon Laboratories Inc) +3.00-diopter (D) add IOL implantation between May and July 2011 were enrolled in the study (LCS group). The control group consisted of a retrospective consecutive cohort of 29 eyes that underwent manual phacoemulsification cataract surgery and ReSTOR +3.00-D add IOL implantation (MCS group) between December 2010 and April 2011. Visual and refractive parameters were collected pre- and postoperatively at 1 and 3 months. RESULTS Mean postoperative spherical equivalent refraction was -0.01±0.35 D and -0.06±0.30 D in the LCS and MCS groups, respectively (P=.492). Mean absolute refractive prediction error (PE) was 0.26±0.25 D for the LCS group and 0.23±0.16 D for the MCS group (P=.489). Mean arithmetic refractive PE was 0.06±0.44 D and -0.02±0.30 D for the LCS and MCS groups, respectively (P=.388). No significant difference was noted in mean postoperative uncorrected distance visual acuity or uncorrected near visual acuity between groups. No eyes in either group had surgical complications or loss of corrected distance visual acuity in the follow-up period. CONCLUSIONS Mean spherical equivalent refraction and visual acuity of our initial group of patients undergoing laser cataract surgery are comparable to the manual phacoemulsification cohort for the AcrySof ReSTOR +3.00-D add IOL.

Laser in situ keratomileusis for refractive error after cataract surgery

Purpose: To evaluate the safety and efficacy of laser in situ keratomileusis (LASIK) to correct refractive error following cataract surgery. Setting: The Eye Institute, Sydney, Australia. Methods: This retrospective study reviewed 23 eyes (19 patients; 10 female, 9 male) treated with LASIK for refractive error following cataract surgery. The Summit Apex Plus and Ladarvision excimer laser and the SKBM microkeratome were used. The mean age was 63.5 years (range 50 to 88 years). The mean length of follow‐up was 8.4 months (range 1 to 12 months) and mean interval between cataract surgery and LASIK was 12 months (range 2.5 to 46 months). Results: The mean preoperative spherical equivalent refraction (SEQ) for myopic eyes was −3.08 ± 0.84 diopters (D) (range −4.75 to −2.00 D) and for hyperopic eyes was +1.82 ± 1.03 D (range +0.75 to +3.00 D). The mean improvement following LASIK surgery was greater for myopic than hyperopic eyes (myopic, 2.54 ± 1.03 D versus hyperopic, 1.73 ± 0.62 D; P = .033). The percentage of patients within ±0.5 D of intended refraction post‐LASIK surgery was 83.3% for myopic eyes and 90.9% for hyperopic eyes and all eyes were within ±1.0 D of intended (P<.001). The percentage of eyes with uncorrected visual acuity of 20/40 or better in the myopic group improved from none preoperatively to 91.7% postoperatively (P<.001) and in the hyperopic group improved from 27.3% preoperatively to 90.9% postoperatively (P = .008). No eyes lost 2 or more lines of best corrected visual acuity. Conclusion: Laser in situ keratomileusis appears to be effective in correcting refractive error following cataract surgery. Longer‐term studies are required to determine refractive stability.

External analysis of the Randleman Ectasia Risk Factor Score System: a review of 36 cases of post LASIK ectasia

Background:  To validate Randlemans model of ectasia risk factor scores using a large unbiased sample of unpublished cases.

Femtosecond cataract surgery: transitioning to laser cataract.

Purpose of review The introduction of the femtosecond laser to the field of cataract surgery offers many potential benefits. The femtosecond laser is able to perform three important steps in cataract surgery: capsulotomy, lens fragmentation and corneal incisions. Although evidence in support of its efficacy is accumulating, there is a surgical learning curve that needs to be addressed. This review outlines key issues to consider when contemplating the transition to laser cataract surgery in clinical practice. Recent findings Laser cataract surgery has been shown to be associated with an initial learning curve. Femtosecond lasers produce a more accurate and precise anterior capsulotomy, improve intraocular lens centration and reduce intraocular lens tilt. Visual and refractive outcomes, although in a limited number of studies, have been shown to be at least as good as those of conventional phacoemulsification. The impact of reduced phacoemulsification energy on the corneal endothelium is still being investigated. Summary The automation of key steps by the use of femtosecond lasers in cataract surgery has several potential advantages. Emerging literature supports the transition from conventional phacoemulsification to the laser cataract surgery.

Laser in situ keratomileusis with Alcon CustomCornea.

PURPOSE To report the 3-month results of our first cases of laser in situ keratomileusis (LASIK) with Alcons CustomCornea. METHODS Wavefront analysis was performed using the LADARWave aberrometer and ablation was performed with the LADARVision4000 system. Thirty-one eyes of 17 patients were analyzed prospectively, at 1 and 3 months after CustomCornea surgery. Psychophysical tests were performed, including high and low contrast acuity, and contrast sensitivity under scotopic and photopic conditions. In addition, psychometric testing was performed using a subjective vision questionnaire. RESULTS Mean spherical equivalent refraction improved from a baseline -3.05 +/- 1.92 D to +0.02 +/- 0.28 D at 3 months (28 eyes). At 3 months, 46.4% (13 eyes) had uncorrected visual acuity of 20/16, 92.7% (26 eyes) had 20/20, and 100% (28 eyes) had 20/25 uncorrected visual acuity. Three months after CustomCornea surgery, there was a statistically significant improvement in contrast sensitivity under both scotopic and photopic conditions, and a statistically significant increase in third and fourth order aberrations. There was a statistically significant improvement in visual quality as measured by the subjective vision index, increasing from a preoperative mean 66.62 to 87.63 at 3 months after surgery. CONCLUSIONS CustomCornea was an improvement over conventional LASIK as measured by most psychophysical and psychometric parameters. The relationship between higher order aberrations and other psychophysical and psychometric measurements needs more analysis.

Laser in situ keratomileusis in 2012: a review

Laser in situ keratomileusis (LASIK) is a safe and effective treatment for refractive error. A combination of technological advances and increasing surgeon experience has served to further refine refractive outcomes and reduce complication rates. In this article, we review LASIK as it stands in late 2012: the procedure, indications, technology, complications and refractive outcomes.

Femtosecond laser assisted cataract surgery in phacovitrectomy

IntroductionThe introduction of phacoemulsification in the 1990smade combined cataract surgery and vitrectomy a prac-tical procedure. Small and secure corneal incisions, in-creased anterior chamber stability, and implantation ofthe intraocular lens (IOL) in a stable capsular bagimproved the safety and visual outcomes of phacovitrec-tomy [1]. Refinements in vitrectomy instrumentation andtechniques, including sutureless pars plana incisions,have further improved the outcomes of this combinedprocedure [2].Femtosecond lasers have been used successfully to per-form some steps in cataract surgery. These have beenreported to produce superior corneal incisions, more preciseand stronger capsulotomies, and require reduced phacoe-mulsification power [3, 4]. We retrospectively report eightcases that underwent femtosecond laser-assisted cataract ex-traction in combination with sutureless 25-gauge vitrectomy.Materials and methodsEight cases with co-existing retinal pathologies (Table 1)andcataract underwent combined femtosecond laser-assistedcataract extraction and sutureless 25-gauge vitreoretinal sur-gery. Informed written consent was obtained for all subjects.Surgical techniqueThe patients were initially placed in the operating suiteunder the femtosecond laser (LenSx Lasers Inc., AlisoViejo, CA). Under topical anesthesia (tetracaine 1 % Min-ims), a disposable patient interface was docked to thepatient’s eye. Once adequate suction was achieved, the lasertreatment was performed after selection of capsulotomy andlens fragmentation patterns. The capsulotomy diameterwassetfor5mm;withananteriorandposterioroffsetof 150 μmand300μm, respectively. For the lens, themethod of fragmentation was“chop” (Fig. 1, laser phaco-fragmentation immediately prior to removal of the cata-ract). Anterior and posterior offsets were set at 500 and1,100 μm.Following the laser ablation, a retrobulbar block (1 %ropivacaine + hyaluronidase 75 μg/ml) was used. Patientswere then transferred to the operating room. Three trans-conjunctival angled pars plana incisions were performedusing 25-gauge trocar microcannula (Alcon, Fort Worth,TX, USA) in the inferotemporal, superotemporal, andsuper-onasal quadrants 3.5 mm from the limbus. The inferotem-poral microcannula was connected to an infusion line,whereas the other two microcannulae were closed withplugs. The infusion line was kept off to prevent posteriorvitreous pressure during phacoemulsification and IOL im-plantation. Phacoemulsification was completed through aclear corneal superotemporal incision and was followed byinsertion of an AcrySof SN60WF foldable IOL (Alcon, FortWorth, TX, USA). A near-complete vitrectomy includingvitreous base shaving was performed (Accurus, Alcon Lab-oratories, Inc., Fort Worth, TX, USA). Where indicated, the

Rapid visual recovery after penetrating keratoplasty for keratoconus

Purpose:  To ascertain the level and speed of visual recovery after penetrating keratoplasty for keratoconus.