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    Innovations change face of modern cataract surgery

    Evolution continues in 2017 with techniques, technologies


    The year 2017 marked the 50th anniversary of phacoemulsification (phaco) and another year of innovations that continue to change the face of modern cataract surgery.

    “Cataract surgery is the best operation in all of medicine, and it keeps improving,” said Robert H. Osher, MD, professor of ophthalmology, University of Cincinnati School of Medicine, and medical director emeritus, Cincinnati Eye Institute, Cincinnati, OH. “The changes may be incremental, but they add up to better safety, efficacy, and patient satisfaction.

    “This last half century has been a tremendous time to be an ophthalmologist, and thinking back to 1983 when I decided to limit my practice to cataract surgery, makes me feel like I hit the lotto,” Dr. Osher added.

    In reflecting on the year’s advancements, Dr. Osher, Eric Donnenfeld, MD, and Mark Packer, MD, spoke about recent and forthcoming developments in cataract surgery.

    Manufacturers are persisting in their efforts to implement modifications to enhance the safety and performance of their phacoemulsification units, said Dr. Packer, president, Mark Packer MD Consulting Inc., Boulder, CO.

    “We continue to see refinements in fluidics and power modulation,” he said, citing a new method of surge protection introduced for the Stellaris Elite (Bausch + Lomb). Known as Adaptive Fluidics, the system is designed to reduce IOP fluctuation and post-occlusion surge by varying infusion pressure in response to changes in vacuum levels.

    “Rather than focusing on monitoring IOP and trying to respond to changes when they occur, the engineers at Bausch + Lomb have assumed surge will occur and developed a method for pumping in fluid in advance to lessen a fall in IOP that will lead to surge,” Dr. Packer said.

    Dr. Osher noted that Alcon Laboratories introduced its new Intrepid Transformer I/A handpiece this year. The instrument is designed to enable easy transitioning from coaxial to bimanual cortical removal without changing handpieces.

    He said he was excited about a new propeller turbo tip for torsional phacoemulsification and aspiration that was presented by Tadahiko Kozawa, MD, Japan, at this year’s meeting of the European Society of Cataract and Refractive Surgeons (ESCRS) in Lisbon. Dr. Kozawa won the grand prize at the meeting’s video competition for his film about the tip. It features a straight design with a propeller crossbar and takes cavitation from outside to inside the lumen, thereby eliminating repulsion of nuclear material and allowing for ultrasmooth emulsifying action.

    Dr. Donnenfeld highlighted the FDA approval in October 2017 of the YAG nanolaser (Cetus, A.R.C. Laser) for cataract surgery.

    “The laser emulsifies the lens with much less energy than conventional phacoemulsification, and the procedure it has been shown to be associated with less endothelial cell loss than phaco,” said Dr. Donnenfeld, clinical professor of ophthalmology, New York University, and founding partner, Ophthalmic Consultants of Long Island and Connecticut, Garden City, NY.

    “Contact of the laser beam with the iris or capsule does not cause significant damage, and the laser can be used to strip the laminin layer from the capsule to prevent capsular opacification,” Dr. Donnenfeld added.

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