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T he Cataract Refractive Suite (Alcon, Fort Worth, Texas) features the VERION Image Guided System,* LuxOR Microscope, LenSx Laser, and the CENTURION Vision System. Each component of the Cataract Refractive Suite is designed to help ensure accuracy at every step of the procedure, so that surgeons can con- sistently deliver excellent refractive outcomes, even in unusual or diffi- cult cases. Cases can be difficult be- cause of the anatomy of the patient or eye, and sometimes they can be difficult because of disinhibition from the relaxing medication used during surgery. I recently had a case in which the patient had an extraor- dinarily deep anterior chamber and hard cataract, and then turned out to be unable to cooperate very well in the OR. Each of the components provided by the Cataract Refractive Suite was recruited to help me achieve the outcome I had hoped to achieve under normal circum- stances. The patient was a 40-year-old woman with a hard cataract. She had 3+ nuclear sclerosis with an LOCS III grading of NO 4.2 NC 3.9. I had planned femtosecond laser- assisted cataract surgery to implant a 21.5 D AcrySof IQ ReSTOR multifo- cal IOL (Alcon). In her preop examination, we used the VERION Reference Unit to create a digital image of her conjunctival vessels and iris features, including the position of the undi- lated pupil. During surgery, this would confirm incision locations by projecting them through the micro- scope oculars and assist in making sure that the IOL was well centered at the conclusion of the case. Before moving into the OR, we used the LenSx Laser to accomplish the critical steps of incision creation and capsulotomy as well as to create a chop pattern for lens dissection. Once in the OR, the patient was prepped and draped and received some relaxing medication through the IV. Everything was fine as we placed the speculum, but as we were opening the incisions with a blunt spatula, the patient started to move excessively and tried to reach her hands to her face. This happened repeatedly throughout the case. To accomplish surgery, my OR techni- cian stabilized her forehead, and the anesthetist held her arms while I repeatedly reminded her of where Just another day at the office: How the Cataract Refractive Suite helped by James Davison, MD, FACS 4 EW Boston 2014 Monday, April 28, 2014 4 Figure 1. The LenSx femtosecond laser-created 2.5-mm incision was easily opened with a blunt dissection instrument. Figure 2. The injection of VISCOAT folded over the free-floating anterior capsule. Figure 3. Even with this moving patient, the CENTURION and Balanced Tip helped to provide precision and control in the deep grooving process of the firm cataract. James Davison, MD, FACS " In this particular case, I had more than 1,000 of my peers observing the case via live satellite feed at the 2013 American Academy of Ophthalmology meeting, so the pressure was really on. " Please refer to pages 6, 7, and 8 for important product information about the Alcon products described in this supplement. she was and what we were doing and appealed for cooperation. Fortunately, the most critical parts of the surgery had already been accomplished before she started moving. It could have been disastrous to have the patient move suddenly while using a keratome blade because the incision would then be too large and would allow too much fluid outflow, which would rapidly produce iris trauma and miosis and shallow the anterior chamber. If the patient had moved during the capsulorhexis, the capsular opening would be at least imperfect and could even extend through an anterior radial tear, which could become a posterior tear and could lead to a sunken nucleus and vitreous loss with no IOL im- planted. The relief of having those steps accomplished before things got difficult cannot be overstated. Fortunately, I was using the LuxOR Ophthalmic Microscope, another component of the Cataract Refractive Suite. One of the features

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