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Vietnam welcomes APACRS as its first major international ophthalmic summit
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HANOI — The latest advance in cataract surgery is a new preloaded disposable IOL injector that uses no viscoelastic, according to one surgeon.
Kimiya Shimizu, MD, discussed the development of the preloaded disposable injector, which uses balanced salt solution irrigation in place of viscoelastic, in the Lim Lecture he delivered at the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS) meeting.
Dr. Shimizu said there have been a number of advances in recent years in phacoemulsification surgery that make the procedure safer and more effective than ever before. In particular, the use of a small, temporal clear corneal incision assures that there will be no induced astigmatism.
“The most important advantage of today’s surgery is that there is less induced astigmatism because today’s incision is small,” he said.
“This is why we prefer phacoemulsification surgery. In Japan, almost 1 million cataract surgeries were performed last year, and more than 90% of those were done with phaco and a foldable IOL,” he said.
Dr. Shimizu said foldable, injectable IOLs are the reason small incision sizes have been achieved. “In small-incision surgery, we can reduce induced astigmatism and achieve quick visual recovery,” he said.
In addition to less induced astigmatism, injectable IOLs also create a cleaner environment, which aids in preventing endophthalmitis, “the most feared and miserable complication after cataract surgery,” Dr. Shimizu said.
To help further create the cleanest surgical environment, Dr. Shimizu and colleagues invented a disposable IOL injector in 1993. At the time, there was a problem with IOL damage occurring during the loading process, he said.
“IOLs are damaged in 3% of the insertions. So we hoped to decrease such an undesirable complication when we invented preloaded injectors in 2002,” Dr. Shimizu said.
“With this preloaded injector, damage to the IOL decreased dramatically from 3% to 0.14%,” he said.
“We had realized an ideal system, [but] we still had the desire to improve surgical devices, instruments and surgical steps,” Dr. Shimizu said. This led him to develop a visco-free preloaded disposable injector, he noted.
“Is visco material essential in IOL implantation? The answer is no,” he said.
The injector uses saline irrigation instead of viscoelastic to inject the IOL. The main advantage of this is that the capsular bag is formed more deeply and uniformly with saline irrigation, Dr. Shimizu said.
The only additional step required to use the new injector during cataract surgery is that, before the injection, the surgeon needs to connect the irrigation tube to the injector.
“You can make a deep capsular bag with irrigated [saline] and then push the IOL into the bag in almost the same way as with visco material,” Dr. Shimizu said. “Without any additional procedure, you can finish the surgery.
“With this visco-free injector, we can prevent the pressure rise in glaucomatous patients after surgery and also we can achieve simple, safe and economical surgery,” he said.
These items appeared originally as daily coverage from the meeting on OSNSuperSite.com. Look for more in-depth coverage of these and other topics in upcoming issues of Ocular Surgery News.
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Images: Mullin D, OSN |
State dignitary welcomes APACRS to Vietnam
Vietnam’s Minister of Health, Nguyen Quoc Trieu, welcomed more than 1,000 delegates to the annual APACRS meeting in the opening ceremony.
“It is our great honor for us to hold for the first time such a big international meeting of ophthalmologists in Vietnam,” Mr. Trieu said.
“On this occasion on behalf of the Vietnamese Ministry of Health and the State of the Socialist Republic of Vietnam, I would like to give thanks for the effective and kind support our international friends have given to Vietnam through the Vietnam Health Service and particularly Vietnamese ophthalmology over the past years. I hope in the future we will continue to receive your support and that our collaboration will develop further. The Vietnamese people always welcome all of our international friends from all over the world,” Mr. Trieu said.
This year marked the 20th meeting of the APACRS and was held in conjunction with the 50th anniversary of the Vietnam National Institute of Ophthalmology, which is comprised of more than 1,000 ophthalmologists.
“The annual APACRS meeting is an opportunity for ophthalmologists from different cultures to get together and affirm our progress in cataract and refractive surgery,” APACRS president Graham Barrett, MD, said.
During the ceremony, the APACRS Lim Lecture award was given to Dr. Shimizu professor and chairman of the department of ophthalmology at Kitasato University in Japan. The APACRS Medal was awarded to Ton Thi Kim Thanh, MD, vice president and general secretary of the Vietnam Ophthalmological Society.
APACRS Certified Educator credentials were given to Cesar Espiritu, MD, vice chairman of the department of ophthalmology at Manila Doctors Hospital in the Philippines; Han-Bor Fam, MD, senior consultant at the Eye Institute of the National Healthcare Group in Singapore; and Hung-Won Tchah, MD, chairman of the department of ophthalmology at the University of Ulsan in Korea.
Toric ICL safe, effective in Asian eyes
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The Toric ICL from STAAR Surgical appears safe and effective for use in Asian eyes, according to a study.
John Chang, MD, reported good results in 34 eyes of 23 patients implanted with the Toric ICL, especially in eyes treated for high myopia.
“The majority of patients are seeing 20/40 or better 3 hours after surgery,” Dr. Chang said. All eyes were stable at 3 months, with all eyes within 0.5 D of intended refraction, he noted.
In addition, there was a stable mean manifest refraction spherical equivalent, with no initial overcorrection and no problems with fluctuations in IOP. Also, among patients with a preoperative refractive error of -12 D, all achieved 20/30 uncorrected vision, he said.
“The stability is impressive,” Dr. Chang said. “I prefer implanting the Toric ICL over LASIK for high myopes.”
The advantages of Toric ICL implantation include that the surgery can be completed in less than 10 minutes, patients can be scheduled for surgery during a routine cataract rotation, patients can see well within 3 hours and full target vision is achieved 1 to 2 days postop, Dr. Chang said.
Other advantages include a short surgical learning curve and minimal night vision problems. In addition, the lens can be relatively easily explanted if there are any problems, he said.
Among the disadvantages, Dr. Chang noted that sizing the lens can be difficult and it is expensive.
‘Phaco axe’ method for nuclear disassembly draws praise from surgeon
A vertical chopping technique, referred to as the “phaco axe” method, is the preferred means of cataract disassembly for Dr. Barrett because of its efficiency, efficacy and safety, he said.
“In my experience, the key to mastering the vertical chop is the wedge-shaped nature of the axe-like instrument,” he said.
Dr. Barrett said the surgical steps of the technique are relatively simple. “First, impale the nucleus deeply, bring the axe down in front of the phaco tip, separate the phaco tip from the axe with an upward arcing motion and finally aspirate the remaining quadrants.
“The phaco axe technique creates a quick vertical crack of the nucleus by the vertical motion of the axe into the central nucleus, which is held in place by the phaco tip,” he said. “An immediate vertical fracture is created by the vertical chopping motion of the axe just in front of the phaco tip. The nucleus is then rotated 90·, and the maneuver is repeated, and this creates the first quadrant, which is now available for removal from the phaco tip.”
Dr. Barrett said one reason that the procedure is safer than sculpting a groove or a horizontal chop is because the entire procedure is performed in the central nucleus within the confines of the rhexis. He added that the procedure requires less time and energy – absolute phaco time – than sculpting a groove in the nucleus.
“The phaco axe vertical chop technique is effective,” he said. “It can be used for cataracts with a wide range of nuclear density. The technique is as equally effective as four-quadrant divide and conquer in managing soft cataracts, ideal for nuclei of medium density and is equal to phaco chop in dealing with a hard nucleus. The vertical chop technique is also well-suited to phacoemulsification in patients with small pupils.
“In conclusion, my comparison of surgical techniques some 40 years after Kelman introduced phaco suggests a vertical chop offers improved safety, efficacy and efficiency and is my preferred technique for nuclear disassembly in 2007,” Dr. Barrett said.
Surgeon encourages ‘tranquil transition’ to torsional phaco
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Image: Mullin D, OSN |
A quick learning curve, ease of use and improved safety make torsional phacoemulsification the best option available for cataract surgery, according to one surgeon.
Con Moshegov, MD, said that torsional phacoemulsification is an improved cataract surgery technique and that making the switch to using it is “easy.”
Dr. Moshegov listed several advantages to switching to torsional phaco performed using the Infiniti system (Alcon) and the OZil torsional handpiece (Alcon). The torsional, side-to-side motion of the phaco tip reduces cavitation, which results in less repulsion, better followability and less heat, he said.
“You only need a little amount of movement in the wound vs. the jackhammer effect of traditional phaco,” which he said results in a low amount of actual contact with the nucleus.
Because of the torsional contact, Dr. Moshegov said he does not need to change his phaco settings during surgery.
“When you use traditional phaco, you have to adjust. For me, I only need one set of parameters for all densities of cataract. It’s comparable to driving an automatic car,” he said.
Phacoemulsifier, IOL allow safe 1.8-mm incision coaxial surgery
The new Stellaris phacoemulsification system, used with the Akreos MI60 IOL, will allow surgeons to make an “easy” transition to cataract surgery performed through a 1.8-mm incision, according to one surgeon.
Paul Ursell, MD, shared his early experience using the Stellaris (Bausch & Lomb) phaco system. “The main advantage of this system is that you can now perform coaxial 1.8-mm surgery,” he said.
Dr. Ursell said he had been disappointed with bimanual microincision surgery and had been waiting to perform small-incision coaxial surgery.
“I personally have found converting from coaxial 2.5-mm surgery to bimanual 1.4-mm surgery to be extremely challenging,” he said. “I find the surgical technique makes it difficult to maintain the anterior chamber, the wounds are much more difficult to seal afterwards and there are concerns about endophthalmitis.”
Dr. Ursell described the first of 10 surgeries he performed with the Stellaris system through a 1.8-mm incision. “As you will agree, this is standard cataract surgery and most of us ... could perform this,” he said. “I found it [to be] a straightforward transition. And in many respects, it’s very similar to regular cataract surgery.”
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