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Simple surgical steps give femtosecond laser accuracy to conventional cataract surgery
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WAIKOLOA, Hawaii — To improve accuracy of conventional cataract surgery, mark the limbal relaxing incision with the patient upright, mark the capsulotomy, and be compulsive about cleaning up epithelial cells, a speaker said here.
In a presentation at Hawaiian Eye 2013, John A. Hovanesian, MD, FACS, presented data on optimizing cataract surgery outcomes to achieve similar accuracy as obtained by femtosecond lasers.
“When placing a toric IOL or performing limbal relaxing incisions, marking the astigmatic axis with a marking pen before surgery eliminates the inaccuracy of cyclorotation when the patient lies down, where a 15° inadvertent rotation can decrease astigmatic effectivity by as much as 50%,” Hovanesian said.
He also emphasized the placement of a mark on the cornea to guide the capsulotomy.
“Marking the cornea prevents us from following false or moving landmarks, like the iris,” he said.
Lastly, he recommended meticulous removal of lens epithelial cells using a device such as the Whitman Shepherd Capsule Polisher (Storz), which breaks adhesions of remaining lens epithelial cells after cortex removal. Removing these cells, he said, makes capsular contraction less aggressive and helps achieve effective lens position closer to formula predictions.
Combining these techniques, Hovanesian showed that, among 37 patients who recently underwent surgery, 92% of eyes were within 0.5 D of target spherical refraction. These results are similar to the accuracy reported for femtosecond cataract lasers.
Disclosure: Hovanesian receives fees from Abbott Medical Optics, IOP and Tear Science; does research for Bausch + Lomb, ReVision Optics and SARcode; and has ownership interest in 1-800-DOCTORS and Ista Pharmaceuticals.