New techniques, technology in cataract surgery highlighted at symposium

New techniques and technology in cataract surgery was the theme of a symposium Wednesday night at the World Ophthalmology Congress. The symposium touched on new phacoemulsification technology, the use of a new ophthalmic viscophthalmic device (OVD), anti-infectives, and the latest intraocular lens technology.

Richard Packard, MD, FACS of the United Kingdom moderated the symposium, which was sponsored by Alcon Laboratories.

Alan Crandall, MD, of the Moran Eye Institute at the University of Utah in the United States kicked off the talks by outlining why DisCoVisc has become his OVD of choice. After explaining the advantages of the newest OVD in the market, Dr. Crandall reinforced his points by presenting a video of difficult cases and how DisCoVisc assisted in performing the tough procedures.

Dr. Crandall pointed out that DisCoVisc performs well in these very difficult cases. One vial has plenty of OVD to complete a surgery. It also offers great endothelium protection, and has excellent visualization, allowing for a controlled capsulorrhexis. The OVD is easy to remove at the end of the case, which is critical.

David Allen, FRCOphth, of the United Kingdom continued the program with a thorough address on Alcon's latest phaco technology, the torsional handpiece. Dr. Allen presented the features of the handpiece, called the OZil, and explained the theoretical considerations on how it dissects a cataract.

In the wet lab, Dr. Allen pointed out that with "no flow" going through or around the needle, it was impossible to burn the cornea. He added that torsional phaco could be combined with longitudinal phaco, in a 1:4 ratio, to address the densest of cataracts.

Dr. Allen believes that torsional technology is the future of phacoemulsification. He added that the clinical impressions of smooth efficient cataract removal using the OZil is supported by the clinical studies, but additional studies are needed to make the technology conclusive.

Takayuki Akahoshi, MD, of Japan reinforced many of the points presented by Dr. Allen. He discussed micro-coaxial phaco using the OZil handpiece. Dr. Akahoshi emphasized many of the features of the handpiece, including the small sleeve within the small handpiece, the sufficient irrigation, wound protection, separate settings for both longitudinal and torsional phaco.

"Micro-coaxial phaco and implantation of 6 mm AcrySof lens should be the standard of cataract surgery, and the torsional handpiece should be very good technology to perform this surgery," said Dr. Akahoshi.

Edward Holland, MD, of the University of Cincinnati in the United States moved the discussion to anti-infective prophylaxis in cataract surgery. He presented data from the literature that supported the rates of infection during cataract surgery, most particularly endophthalmitis.

Dr. Holland also presented data on the effectiveness of the fourth-generation fluoroquinolones, and added that moxifloxacin (Vigamox) had the best effectiveness for penetration.

Dr. Holland concluded by offering a prevention list for endophthalmitis. Pre-operatively, surgeons should look for and treat blepharitis and dry eye. Intra-operatively, surgeons should administer with povidone-iodine, have careful lid draping, and protect the epithelium. If a wound leaks, put in a suture. Peri-operatively, administer the patient with a fourth-generation fluoroquinolone.

Stephen Lane, MD, of the University of Minnesota in the United States discussed the expanding role of toric and aspheric lenses. After outlining the history of monofocal technology from 1949 with the Ridley lens to today's aspheric and toric lenses, Dr. Lane explained the science behind aspheric lenses and explained the spherical aberration compensation strategy behind AcrySof IQ lens. He also looked at the studies supporting the advantages of the IQ lens.

Dr. Lane then moved onto AcrySof Toric IOL, pointing out its features, including design, stability, and cylinder power outline. He also presented the clinical data of the FDA trial involving 500 patients.

Leonardo Akaishi, MD, of Brazil concluded the presentation with his talk on the technology behind the AcrySof ReSTOR lens. Dr. Akaishi explained the features of the lens, most particularly the apodized diffractive optic. He also shared his own clinical experience with ReSTOR involving 444 patients.