Eyeworld Supplements

2 EW Boston 2014 Monday, April 28, 2014 2 T oday, more and more sur- geons who use the LenSx Laser (Alcon, Fort Worth, Texas) are exploring the potential benefits of this technology in challenging cases. This article details my successful use of the LenSx Laser in very dense cataracts cases. Cataract surgery in patients with very dense cataracts represents a particular challenge. It is associated with a greater risk of complications. In my experience with these dense cataracts, the LenSx Laser has re- duced phaco energy and balanced salt solution use, and the procedures have been done quickly. Beginning with the patient docking, the lack of a fixed bed allows us to get patients ready for the procedure quickly. This is especially helpful in elderly pa- tients who may have difficulty moving from lasers with a fixed bed. Even in dense cases, the average time from suction on to suction off has been less than 2 minutes, and this includes imaging, all settings, lens fragmentation, capsulotomy, and all corneal incisions. Phacoemulsification is more efficient when the lens is treated with the LenSx Laser. I am confident that these cases benefit from re- duced corneal endothelial damage during laser cataract surgery. The LenSx Laser helped me in these specific cases by reducing the phaco manipulation required during sur- gery, which protected the incision architecture during emulsification and I/A. Another concern with dense cataracts is there can be high pres- sure in the bag. Because the LenSx Laser completes the treatment rap- idly, I am able to get a complete rhexis. I think the LenSx Laser helps the surgeon to perform the capsulotomy confidently. The SoftFit Patient Interface, which has a hydrogel contact lens, has none of the disadvantages associated with other contact or liquid inter- faces. I am very confident that I will get a free-floating rhexis in nearly all of my cataract cases. Phacoemulsification of the very dense cataract presents the surgeon with a series of specific and difficult challenges. Many of my LenSx Laser patients have very dense/4-grade nuclear cataracts. The LenSx Laser successfully divides these nuclei into pie-shaped fragments, permitting either pre-chop or other chopping techniques. The total power required for emulsification was decreased by about a third in my hard cataract cases. While I am able to get "zero phaco" now in routine phaco cases, I do not believe this should be the objective. I try to focus on the out- come and use the right amount of energy required for each case, espe- cially in very dense cataract cases. The LenSx Laser allows for customizable lens fragmentation based on patients' pathology and surgeon preference. In these dense cases, I typically use a hybrid pattern that combines cylinder and chop patterns and permits more rapid removal with reduced ultrasound. Using the LenSx Laser in mature cataract cases by Michael Diesenhouse, MD Michael Diesenhouse, MD " The SoftFit Patient Interface, which has a hydrogel contact lens, has none of the disadvantages associated with other contact or liquid interfaces. " The LenSx Laser offers several customizable fragmentation patterns that surgeons can select based on pathology or their preference. Please refer to pages 6, 7, and 8 for important product information about the Alcon products described in this supplement. The number of cuts/cylinder is customizable. Radial incisions aid in removing epi-nuclear plates. This pattern allows me to make the deep cracks through the entire thickness of the nucleus. Once the segments of the dense nucleus are fragmented by the laser, I am able to phaco be- cause the phaco energy is delivered more posteriorly, and the endothe- lium is usually well-protected. The recently released "Frag" pattern is designed to be effective in all cataract cases. This pattern will permit both horizontal and vertical segments, and because it is customizable, it will allow surgeons to adjust the size of cubes. The LenSx Laser's user interface is simple to understand and easy to adjust. I make the primary incision 0.1 to 0.2 mm larger than my manual incision to ensure there is no thermal injury from the phaco handpiece. Additionally, with the LenSx Laser, the lens cortex is cut cleanly, with no strands of cortex floating in the bag. During I/A, I go further into the fornix of the capsular bag to grab the cortex. I recommend that surgeons approach the subincisional cortex first to aid in cortical removal. I've had good success with the LenSx Laser, even in challenging cases. Dr. Diesenhouse is medical director of Eye Associates of Tucson and Catalina Surgery Center in Tucson, Ariz. He can be contacted at mcd4@mindspring.com.

• Cover