New FLACS complication
among cases at 'World Cup
of Challenging Cases'
by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer
had orthoptic treatment for hypero-
pia who underwent femtosecond la-
ser-assisted cataract surgery (FLACS).
At Dr. Nosé's clinic, Dr.
Francesconi said that an assistant
performed the femtosecond laser
treatments before patients had the
phaco procedure with Dr. Nosé.
These treatments are recorded, but
Dr. Francesconi said that Dr. Nosé
trusted the assistant and did not
review all unremarkable femtosec-
ond treatment procedures prior to
performing phaco, and did not in
this case.
During the phaco procedure,
Dr. Nosé realized that, at least in this
case but perhaps also in all cases, he
should have: a significant section
of the Descemet's membrane was
missing.
Reviewing the femto treatment
video, Dr. Nosé found that a defect
in the Descemet's membrane had
formed when the laser created the
clear corneal incision.
About a week after the FLACS
procedure, Dr. Nosé performed
Descemet's membrane endothelial
keratoplasty (DMEK) to replace the
missing tissue.
Reviewing past videos, Dr. Nosé
found another case in which the
defect was made during the side port
incision; that phaco case had gone
unremarkably and so the complica-
tion was missed.
The machine was found to have
a misalignment in the laser focus,
and adjustments have been made.
This being a new complication
associated with a new procedure, Dr.
Francesconi encouraged surgeons to
watch out for the complication and
report their cases. EW
Editors' note: The doctors have no
financial interests related to their talks.
T
he "World Cup of Challeng-
ing Cases: Selected by the
National Societies of Cata-
ract and Refractive Surgery
Around the Globe" clinical
course offered attendees a taste
of the challenges surgeons might
typically—and not so typically—en-
counter in their respective practices
in different parts of the world.
The cases were selected by the
Brazilian Society of Cataract & Re-
fractive Surgery (BRASCRS), India's
Intraocular Implant and Refractive
Society (IIRSI), the Indonesian Soci-
ety of Cataract & Refractive Surgery
(INASCRS), the Korean Society
of Cataract & Refractive Surgery
(KSCRS), and the Russian Society
of Cataract & Refractive Surgery
(RSCRS).
Among the cases were a trau-
matic cataract in which an incom-
plete history (the patient denied
history of trauma) resulted in
"a surprise that shouldn't have
been," presented by Brian Little,
FRCOphth, London; three cataract
cases performed by Myoung Joon
Kim, MD, PhD, through hazy/opac-
ified corneas with the help of retroil-
lumination; and a cataract surgery
that had to be delayed after a clear
corneal incision and anterior capsu-
lorhexis were already performed due
to a persistent spike in IOP creating
a rock-hard eye that was subsequent-
ly referred to Boris Malyugin, MD,
PhD, Moscow.
Perhaps most interestingly,
Claudia Francesconi, MD, São
Paulo, Brazil, presented a case in
which Walton Nosé, MD, PhD, São
Paulo, Brazil, encountered a new
complication associated with a new
procedure.
The complication occurred in a
65-year-old patient who as a child
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