Eyeworld Daily News

EW SHOW DAILY 14 Monday, May 9, 2016 by Lauren Lipuma EyeWorld Contributing Writer ASCRS News Today S unday morning's cataract paper session focused on outcomes with femtosec- ond laser-assisted cataract surgery (FLACS). FLACS has significant potential benefits for patients compared to manual phaco, but whether these benefits are seen in the clinic is still a matter of discussion, said I. Paul Singh, MD, Racine, Wisconsin. Dr. Singh presented the results of a recent study comparing early postop visual acuity between FLACS and manual phaco, as well as differences in cor- neal edema and effective phaco time between these 2 procedures. The prospective study of ap- proximately 100 eyes found that patients undergoing FLACS had bet- ter visual acuity in the early postop period—mean uncorrected distance acuity on postop day 1 was 20/25 for the FLACS group and 20/40 for the manual group. The superior quality of vision in these patients may be due to a reduced effective phaco time, lower corneal edema, a more predictable capsulotomy, or other factors, Dr. Singh said. Seng-Ei Ti, FRCS, Singapore, then discussed a recent study com- paring manual phaco to FLACS in patients who had prior refractive surgery. Her study looked at visual and refractive outcomes using the Haigis-L formula in patients who had prior LASIK to correct myopia. The study found 90.5% of patients achieved an uncorrected visual acuity of 20/40 or better after cataract surgery, and there was no significant difference in outcomes between manual and FLACS groups. There was a strong correlation be- tween axial length and keratometry values, she said, with keratometry values primarily affecting the refrac- tive predictability. Epinephrine use Jesus Martinez, MD, Rockville, Maryland, changed the discussion to comparing the frequency of intraop- erative epinephrine use and cumula- tive dissipated energy (CDE) during surgery with 2 different FLACS plat- forms. Dr. Martinez and his co-au- thors theorized that surgery with the Catalys laser (Abbott Medical Optics, Abbott Park, Illinois) would result in less intraoperative miosis and require less epinephrine than surgery with the LenSx laser (Alcon, Fort Worth, Texas) because the laser has pre-set iris safety margins. The study also analyzed the relationship between epinephrine use and CDE. The study found that epineph- rine use was lower for Catalys surger- ies (18.9% of eyes) than for surgery with the LenSx (33.2% of eyes), as Dr. Martinez had predicted. The au- thors found that CDE for the Catalys was lower than with the LenSx. According to Dr. Martinez, the results suggest the Catalys laser may be more efficient in lens fragmen- tation, and its pre-set iris safety margins may help distribute laser energy farther away from the iris, resulting in less reactive miosis than the LenSx laser, which lacks iris safety margins. FLACS in difficult cases Some surgeons have suggested that FLACS shines in making difficult cases routine. Shail Vasavada, DO, presented results from a study looking at just that—how well FLACS compares to manual phaco in challenging cases. Dr. Vasavada's prospective, randomized controlled trial compared manual phaco to FLACS in patients with shallow ante- rior chambers (less than 2.5 mm). The study analyzed central corneal thickness (CCT) on 1 day, 1 week, and 1 month postop as well as corneal clarity, cell and flare, and endothelial cell density. The study is still ongoing, but preliminary results show that patients undergo- ing manual phaco had significantly larger CCT values on day 1 postop than those undergoing FLACS, but the values evened out between the 2 groups at 1 week and 1 month. Re- sults also show that FLACS patients have less postop inflammation on day 1, but there was no difference in inflammation between the 2 groups at 1 week or 1 month. There was no significant difference in endothelial cell density between the 2 groups, Dr. Vasavada said. EW Editors' note: Dr. Singh has financial interests with Bausch + Lomb (Bridge- water, New Jersey). Dr. Ti has financial interests with Allergan (Dublin). Dr. Martinez has no financial interests related to this article. Dr. Vasavada has financial interests with Alcon. How do laser cataract surgery outcomes compare to manual phaco outcomes? Watch ASCRS•ASOA Today in many New Orleans hotels for the latest meeting highlights Hotel Channel Hilton New Orleans Riverside 54 New Orleans Marriott 65 Sheraton New Orleans 59 JW Marriott New Orleans 8 InterContinental New Orleans 5 Le Merdien New Orleans 54 Doubletree by Hilton New Orleans 72 Westin New Orleans Canal Place 50 Embassy Suites New Orleans, Convention Center 45 Hotel Monteleone New Orleans 57 Hyatt Regency New Orleans 54 Ritz Carlton New Orleans 42 New Orleans Marriott at the Convention Center 2 Hilton Garden Inn Convention Center 48 Loews New Orleans Hotel 67 The Roosevelt New Orleans, Waldorf Astoria Hotel 7 Hyatt Place New Orleans Convention Center 99 Windsor Court Hotel 61 Hyatt French Quarter 57 Renaissance Pere Marquette 2 Omni Riverfront New Orleans 53 Renaissance Arts Hotel 51 " With smaller incisions, lower phaco energy, better fluidics, and other factors, we've seen a natural evolution to more predictable, efficient results. " I. Paul Singh, MD

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