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What’s Cooking in Cataract?

As the title suggests, this session featured the latest and greatest buns from the metaphorical cataract oven. With renowned ophthalmologists from around the world, we sample topics like FLACS innovation, prolene flange sutures for complex cases, and making phaco fly (literally). Buckle up, CAKErs, it’s time to see what’s cooking in cataract…

Femto cataract surgery is improving

This was the topic covered by CAKE magazine advisory board member, Dr. Harvey Uy, from the Peregrine Eye and Laser Institute in the Philippines. He shared that femtosecond laser assisted cataract surgery (or FLACS) was introduced about 10 years ago to assist with the essential steps of cataract surgery: anterior capsulorhexis, lens fragmentation and clear corneal incision.

So, what’s new in FLACS capsulotomy? Dr. Uy shared that he’s excited because the FLACS laser can now create toric IOL alignment marks (called anterior refractive capsulorhexis marks) on the anterior capsule. “We’re also exploring the ability of free floating laser cut capsulotomy buttons to protect the corneal endothelium in eyes with endothelial dystrophy.” 

Next, he covered lens laser fragmentation, which has the goal of softening the lens to facilitate nuclear disassembly, before moving on to clear corneal incisions. 

“The clear corneal incisions made by the FLACS laser allow access to the interior of the eye for surgery. When you use a FLACS laser, it will consistently create a nice, multiplanar incision which seals shut at the end of the surgery more often than not,” explained Dr. Uy. 

Another development is the new software and equipment that helps surgeons improve refractive outcomes after cataract surgery. “We recognize that astigmatism is a major cause of unhappiness after cataract surgery and about one-third to half of the population will have significant astigmatism — which if not corrected, results in degradation of vision, especially if you put in a premium IOL,” he said.

Yippie Aye Yay: Flanged prolene solutions for complex cataract surgeries

We’ve got to give credit where it’s due, and Dr. Cathleen McCabe, a cataract specialist from Sarasota, Florida, USA, came to the CAKE & PIE Expo (C&PE) dressed to impress in western wear and with a themed presentation. (That’s a big yeehaw, partner.)

Her presentation focused on the advantages of using 5-0 and 6-0 prolene sutures in cataract surgeries. She discussed various ways prolene sutures are used, like the belt loop technique. Overall, she said that, “5-0 and 6-0 prolene with a flange for scleral fixation allows for the original IOL to be fixated securely — and this is particularly important in premium lenses where patients may want to retain that lens.

“It also can support a secondary IOL and it’s minimally disruptive to the conjunctiva, especially in cases where you’re trying to preserve it, like prior to trabeculotomy,” she continued. “Small incisions are possible, too. Plus, you may avoid anterior vitrectomy because no IOL exchange is needed in some cases. 

“It’s also useful for other problems, such as iridodialysis or severely loose zonules at the time of original cataract extraction. It’s a low tech solution, it’s accessible to everyone. And burying the flange into the superficial sclera is key to preventing erosion and more serious complications,” concluded Dr. McCabe. 

Make my phaco fly

Dr. Florian Kretz, the CEO, shareholder and founder of Precise Vision Augenärzte in Rheine, Germany, took this “flying phaco” down two routes: tips and tricks — and actually traveling with the machine. Below, we look at the clever way he (literally) flies with phaco…

“Making my phaco fly has a special meaning for me: By really flying with a highly transportable phaco machine that fits in a pilot’s suitcase. It’s fun to have a portable phaco machine because of all the options it offers you — I even carry it on board as hand luggage,” shared Dr. Kretz. For these procedures, he uses the Oertli CataRhex (Berneck, Switzerland).

Dr. Kretz, along with his surgical team, performed 100 surgeries in three locations in three days, using one little phaco machine,” added Dr. Kretz. 

Editor’s Note: A version of this article was first published in Issue 2 of CAKE & PIE POST, C&PE 2021 Edition. The CAKE & PIE Expo 2021 was LIVE on June 18-19. All sessions are available on demand until July 19 at upon login.

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