Eyeworld Supplements

A. James Khodabakhsh, M.D. " I am confident that we can look forward to additional innovations in the future that will make it increasingly possible to combine micro- implantation technology with the latest premium IOL technologies " EW Chicago 2012 Advances in cataract and refractive surgery: A clinical update 11 by A. James Khodabakhsh, M.D. Successful micro-implantation of premium IOLs M icro-incisional cataract surgery (MICS) has many benefits. Intraoperatively, a small 2.2- or 2.4-mm incision promotes anterior chamber stability and reduces the chance of complications. Post-op, smaller wounds seal tightly and are less likely to leak. They also induce less astigmatism and limit corneal edema—essential factors in achiev- ing rapid visual recovery and crisp day 1 vision. Making less traumatic, astigmatically neutral incisions is very important in getting closer to target and consistently achieving the best possible visual outcomes. In our practice, nearly 70% of eligible patients choose a premium presbyopia-correcting or toric IOL. Expectations among these patients are very high, so we want to maximize their chance of success. Initially, however, trying to perform small-incision surgery in these cases meant giving up some of the advances in phaco technology in order to go through a smaller wound and then often still needing to enlarge the wound to insert the lens. Surgeons sometimes forced a larger inserter through a small wound, stretching it and increasing the chance of wound leak. Cataract surgery accessories are finally catching up with the advancements in phacoemulsifica- tion and IOLs. I have used many different types of lenses and inserters in my quest to maximize the potential of premium IOLs for my patients. My preference today is to use a compre- hensive system that is customized to maximize the benefits of small- incision surgery with premium IOLs. I find that using a system in which all the components—handpiece, phaco system, viscoelastics, insert- ers, and IOLs—are designed to work together provides the highest degree of flexibility and control throughout the cataract procedure. Precision-controlled insertion One of the premium IOLs that that I regularly implant is the Tecnis Multifocal (Abbott Medical Optics, AMO, Santa Ana, Calif.). Recently, I have been injecting this one-piece multifocal IOL through a 2.2-mm incision using proven, advanced phaco technology and a new insertion device, the Platinum 1 Series Unfolder (Micro-Implantation Cataract Suite, AMO). The modified angle of the bevel and the screw-style inserter design allows for a very controlled delivery of the lens from start to finish. I use a twisting motion to put the lens in with a fluid movement that doesn't stretch the wound at all. In a fast- paced practice, what I particularly like is that the Unfolder works well with the entire range of one-piece lenses, so I don't have to switch inserters. There is a lubricant coating inside that facilitates the smooth delivery of the thin, lower- diopter Tecnis lens as well as the thicker IOLs at the upper end of the dioptric range. I am confident that we can look forward to additional innovations in the future that will make it increas- ingly possible to combine micro- implantation technology with the latest premium IOL technologies. When all the parts of the system work well together, we can more efficiently and effectively perform cataract micro-implantation and help our patients achieve their visual goals. Dr. Khodabakhsh is surgical director of the Beverly Hills Vision Institute, Southern California. He can be reached at lasereyedoc@aol.com or 310-550-7888. definitely or most likely choose the same lens again. Additionally, 87% of patients said it was somewhat easy to very easy to read menus or newspapers without vision correc- tion; 91% said it was somewhat easy to very easy to see items at arms' length; 94% said it was somewhat easy to very easy to see items that were far away; and 78% said that it was somewhat easy to very easy to drive at night. continued from page 10 Surgeon satisfaction After implanting six or fewer Tecnis multifocal IOLs, 78.5% of surgeons felt comfortable implanting them, and 78.5% felt that the Tecnis multifocal performed better than other multifocal IOLs that they had used. Additionally, 71.4% said that they will continue to use the Tecnis multifocal IOL as their primary multifocal IOL. Most (92.9%) surgeons said they would recommend the Tecnis one-piece multifocal IOL to family, friends, and colleagues. Dr. Davis is an adjunct clinical assistant professor of ophthalmology, University of Minnesota, and a partner and medical director of the Surgery Center, Minnesota Eye Consult- ants, Minneapolis. She can be contacted at 952-888-5800 or eadavis@mneye.com. Unfolder inserting lens AMO Saturday supplement_Chicago 2012-USE THIS ONE_Layout 1 4/20/12 4:25 PM Page 11

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