Small incisions special

September 12, 2012

OTEurope covers presentations on laser-blended vision improving visual field depth…

Small incisions are stress-relieving in cataract surgery


A combination of using small incisions and high-power IOLs is more successful and minimizes complications in extreme hyperopic eyes, revealed Dr Isabel Prieto yesterday.
"Nanophthalmic eyes cases are always challenging because they are very uncommon and prone to intraoperative complications," explained Dr Prieto.
"The main goal during surgery was to try working in a very closed environment to avoid anterior chamber collapse. And performing the surgery by microincision and using bimanual I/A allows a very good stability of the anterior chamber.&quot
Surgery was performed on a 68 year-old woman with bilateral nuclear cataracts. She presented a very small eye without ocular malformations. Diagnostic features of nanophthamos include a small eye, short axial length, high hyperopia, small cornea, shallow anterior chamber, narrow angle, high lens-to-eye volume ratio and high incidence of angle-closure glaucoma, thickened sclera and uveal effusion.
Preoperative refraction in the right eye (OD) was +13.00 and in the left eye (OS) was +14.00. The best-corrected visual acuity (BCVA) was 20/60 in OD and 20/200 in OS with rigid gas permeable lenses. The axial length was 16.03 mm and 16.02 mm in the OD and OS, respectively. Intraocular pressure (IOP) was 14 mmHg and 16 mmHg in OD and OS, respectively.
Both eyes underwent sequentially surgery under general anaesthesia with prior scleral massage to reduce IOP. The team conducted torsional microcoaxial phacoemulsification on the patient then implanted a foldable high power (+53 D OD and +51 D. OS) hydrophillic acrylic IOL with hydrophobic surface.
Dr Prieto explained, "Our option for this personalized type of IOL provided a suitable result. However, as in other extreme cases, there is still controversy over the IOL,s power calculation method, proper positioning and type of IOL,s, to avoid postoperative refractive complications."
The patient was very satisfied with the results, despite the refractive error, with BCVA at 20/40 in both OD and OS and a final refraction of -3.00-2.00 in OD and +3.00+0.50 in OS. This type of surgery can be very stressful, but, to be aware of the features of these eyes and be prepared to their behaviour, with careful consideration of the surgical procedure and IOL selection, will allow a greater chance of success and reduce the complication rates.

Simultaneous cataract and DMEK effective


Combined cataract and DMEK surgery is safe and effective for patients with cataract and endothelial dysfunction, announced Dr Pavel Stodula, speaking at the Cataract and Corneal issues lecture.
The study, called "Simultaneous cataract: DMEK surgery" involved 14 eyes of 14 patients with Fuchs, endothelial dystrophy with cataract. No intraocular OVD was used throughout the surgery and recipient endothelium was stripped off after IOL implantation.
An endothelium-descemet membrane (EDM) was implanted through a 3.2 mm corneal incision via a glass pipette into the anterior chamber. It was then unfolded and attached to the cornea, supported by an intracameral air bubble.
The mean postoperative UCVA improved significantly and mean endothelial cell density was reduced from 2761 cells mm

2

to 1853 cells mm

2

three months postoperatively. The most common postoperative complications included repeated early rebubbling in six eyes for non-adherent or wrinkled EDM.

SUPRACOR improves UCVA


SUPRACOR significantly improves far and near uncorrected visual acuity (UCVA), according to findings presented by Dr J. Soler at the Presbylasik lecture yesterday.
The paper, titled "SUPRACOR for presbyopia: short-term results", included 30 eyes of 15 patients who were followed up for six months after the SUPRACOR procedure. The prospective, longitudinal, comparative case series was based on an inclusion criteria of +1.0 D to +2.5 D mean refractive spherical equivalent MRSE, up to 1.0 D astigmatism, Km 42.0 – 44.0 D, near addition (Add) of +2.0 D in both eyes.
The outcome measures included monocular and binocular, uncorrected/best corrected far and near visual acuities (UCVA, BCVA), spherical equivalent (SE), subjective refraction, addition (Add), mean topographic K (Km) and astigmatism, and Q.
The findings for different variables were monocular far UCVA 0.77, 0.7, 0.79, 0.81, respectively monocular near UCVA 0.9, 0.9, 0.9, 0.8 on day seven, one month, three months and six months, respectively.
Bilateral far UCVA 0.93, 0.90, 0.91, 1.0, bilateral near UCVA 0.98, 0.98, 0.91, 0.97, SE -0.4, -0.45, -0.34, -0.35, astigmatism -0.4, -0.35, -0.30, -0.54, Km 44.9 D, 44.8 D, 46.3 D, respectively. The mean Add at one month was 0.50, 0.84 after 3 months and 0.76D at 6 months and the final mean Q value was -0.48.

Laser blended vision increases visual depth of field


Laser blended vision increases visual depth of field in both eyes with non-linear aspheric ablation, revealed Dr K. Ditzen in the Presbylasik lecture.
Dr Ditzen presented findings from the paper "Laser blended vision: a new procedure to correct presbyopia". The procedure was completed with the binocular approach of MEL 80 (Carl Zeiss Meditec) and the Schwind Pendula microkeratome in 18 myopic and 23 hyperopic eyes. The dominated eye was corrected to plano standard and the non-dominant eye to an undercorrection of -1.5D.
The results revealed a good subjective acceptance and satisfaction and binocular vision was only decreased in the early postoperative follow-up. Laser blended vision combines micro-monovision and increased depth of field with non-linear aspheric ablation.

IOL fits through small phaco incisions


Dr Portaliou introduced a new IOL for use in small-incision MICS during the New IOLs free paper session on Tuesday.
The study, titled "A new intraocular lens for micro incision cataract surgery", included the use of the InfiniteVision Optics multi-component IOL (MC IOL) that could fit through an incision of less than 1.8 mm.
The MC IOL can be adjusted, combining all degrees of sphere, cylinder and multifocality. The lens is made up of two 10 D lens components, meaning a 20 D correction can be injected through smaller incisions.
Dr Portaliou commented, "The MC – IOL advances the concept of micro incision cataract surgery since it is the first lens that can have the minimum size necessaryfor the phaco tip to pass through. It includes components that can cover for the whole range of spherical, cylindrical and multifocal corrections, meeting the needsof 100% of the population."
The use of an MC IOL could reduce incision size to an average of 1.3 mm with bimanual cataract surgery or to minimize astigmatism induction. Additionally, because of the two-component lens design, one component in the bag and one outside the bag, using the same micro incision, refractive adjustments of the lens is feasible at any postoperative time."
Currently, explained Dr Portaliou, there are no IOLs that can fit through small incisions, meaning this could be the first IOL of its kind to reduce phaco wound size. Dr Portaliou said, "Through the small incision created there can be performed a postoperative IOL exchange easily, safely and without inducing any amount of astigmatism. The cataract surgeon can do all of these procedures, primary and enhancement, without referring or relying on other technology (i.e., LASIK)."