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    Perfecting art of cataract surgery with guidance technologies


    Some advancements

    The LENSAR laser provides streamline iris registration for placing limbal-relaxing incisions and intrastromal marks. Dr. Weinstock explained how the laser uses an image of the undilated pupil and an image of the unwound iris for iris registration. The two images are lined up during the laser treatment and a shift is done to move the arcuate incisions to account for cyclotorsion and head tilt.

    The laser can image the nucleus and do automatic nuclear grading and density, based on Scheimpflug imaging, to guide various treatments and the sizes of the laser treatments. After the nuclear imaging, the iris registration occurs and the laser treatment is applied accordingly.

    The technologic advances are invaluable. In one such case, Dr. Weinstock described, there was 17º error in cyclorotation.  “In patients with larger degrees of astigmatism, if the cyclorotation error and head tilt are not considered, the limbal-relaxing incisions will be placed incorrectly,” he said. “This software is desperately needed to improve our outcomes with limbal-relaxing incision.”

    Programmable pattern selection software, also in the LENSAR laser, describes the grade and density of the cataract. “The surgeon can program the laser to perform a simple fragmentation pattern for a soft lens or a more robust matrix or cube pattern for a denser cataract. This can be automated by the laser rather than being decided manually,” he said.

    The Verion Image Guided System with the LenSx laser (Alcon Laboratories) has features that are similar to those of the LENSAR laser. The features of the system include a preoperative diagnostic device that obtains an infrared image, a planning software station, the laser, and intraoperative guidance. The images obtained show the position of the capsulotomy, the optimal position for a multifocal optic, and a toric IOL.

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