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Speaker presents keys to avoid complications with femtosecond laser cataract surgery
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LAS VEGAS — There are a variety of ways for surgeons to avoid complications with femtosecond laser-assisted cataract surgery, according to a presentation here.
H. Burkhard Dick, MD, presented his tips, pearls and hints in preventing complications with femtosecond cataract surgery at the American Academy of Ophthalmology annual meeting.
H. Burkhard Dick
“We have to separate these [complications] in terms of the time point of occurrence. Of course, we have preoperative, intraoperative and postoperative,” he said.
Preoperatively, if there are anatomical issues, Dick recommended evaluating the feasibility of the laser system or choosing another platform independent of the bed. The role of the patient interface is also important to take into consideration to prevent multiple docking attempts or suction loss.
Most importantly, Dick recommended having a clear strategy.
“You have to review your charts and procedure settings that are put in the laser because this will be done then by footprint only, and this will be done by IOL calculation, corneal tomography for true net power, accurate incision calculations and placement, lens density grade and current status of the pupil,” he said. “And it’s real teamwork. You have to communicate, have a checklist of what we are talking about all the time.”
Intraoperatively, there are a variety of pearls to prevent capsulotomy tears: optimizing capsulotomy settings, redocking in decentered docking, looking for homogenous “champagne” bubbles, taking an incomplete cut into account, using the dimple-down technique, double checking if the capsulotomy is free and not tearing any tongue-like adhesions.
“It needs to be conducted in a sterile procedure. You have to secure a stable anterior chamber, judge dilation diameter and prevent opacities, and take out the OVD if possible,” Dick said.
Lastly, he recommended not relying on machines and performing routine cross-checks for automatic detection. – by Kristie L. Kahl
Reference:
Dick B. Avoiding complications with femtosecond cataract surgery. Presented at: American Academy of Ophthalmology meeting. Nov. 15, 2015; Las Vegas.
Disclosure: Dick reports he is a consultant for Abbott Medical Optics, AqueSys, Bausch + Lomb and Ocular Surgery News; has equity ownership in Calhoun Vision; and receives royalties from Morcher and Oculus.