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Intraoperative aberrometry enhances outcomes after previous refractive surgery
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KIAWAH ISLAND, S.C. — Supracapsular phacoemulsification with intraoperative aberrometry and a small-incision IOL is ideal in cases with previous refractive surgery, a speaker told colleagues here.
Richard L. Lindstrom, MD, OSN Chief Medical Editor, shared pearls on technique at Kiawah Eye 2013.
“Intraoperative aberrometry is something we could and should be using, particularly in these complex cases that have prior refractive surgery,” Lindstrom said.
Lindstrom said that in his practice, each of six different formulas generates individual recommended IOL power calculations, with the range from the highest to lowest recommended power among the formulas being 6 D. The ORA intraoperative aberrometer (WaveTec Vision) enhances the accuracy of IOL calculations, he said.
He reviewed a case study of a patient with previous LASIK and no astigmatism who underwent supracapsular phacoemulsification with the Stellaris platform (Bausch + Lomb) and received an Akreos MI60 IOL (Bausch + Lomb) inserted through a 1.8-mm incision.
“I use the AMO, B+L and Alcon phaco machines. The new Centurion (Alcon) will have forced infusion in a very advanced fashion that will enhance chamber stability. The Bausch + Lomb machine also has that,” he said.
Lindstrom recommended using a dispersive viscoelastic, which protects the ocular surface and enables clear visualization.
Eric D. Donnenfeld, MD, OSN Cornea/External Disease Board Member, also discussed the accuracy of intraoperative aberrometry.
“When we started using intraoperative aberrometry 5 or 6 years ago, it was kind of an interesting technology. Now, you almost feel naked in the operating room, especially operating on complex cases like this,” Donnenfeld said. “It makes a world of difference. My enhancement rate has gone from about 30% to 40% on post-LASIK cases down to less than 5%.”
Disclosure: Lindstrom is a consultant for Alcon, Abbott Medical Optics and WaveTec Vision.