April 2016




Presentation spotlight

10 pearls for transitioning to femtosecond laser-assisted cataract surgery

by Ellen Stodola EyeWorld Senior Staff Writer


Neda Shamie, MD, Los Angeles, presented her top 10 pearls for transitioning to femtosecond laser-assisted cataract surgery during a session at the 2016 Hawaiian Eye meeting.

Pearl 1 is you need to know your tools. You need to know the strengths and weaknesses of your tools, she said. There are 4 femtosecond platforms available, and Dr. Shamie has operated on 3 of them. All of the platforms have wonderful strengths, she said. Its helpful to have access to multiple laser platforms because this allows for customization of the procedure to different patients needs.

Her second pearl was to expand preoperative considerations. When surgeons are performing cataract surgery in the traditional way, they may become confident that theyll be able to deal with certain issues when they get to the operating room. But with the laser, because were still in the learning phase, we need to think about this and anticipate problems a bit more, she said. Scars can impede laser applications and can cause capsular problems. The grading of the density of the lens is important to do at the slit lamp. Thats where you can get a better sense of what the lens density is and decide on the type of cut youre hoping to perform, she said.

Pearl 3 was that operative planning is critical. Set the right expectations, Dr. Shamie said. The patient needs to know that you may have to convert to traditional phaco and that you may not be able to use the laser. The fourth pearl related to docking the laser. The patient needs to be flat on the table, she said. There needs to be minimal tolerance for moving. She said its important to ensure centration and that there is no lens tilt. Using images on the screen can help make sure the treatment zone has enough space to the capsule.

Pearl 5 was that youre not married to those incisions, Dr. Shamie said. One of the benefits is that if you dont open the incision, it seals back down. Also, if the incision is placed too centrally, dont operate through that incision, she said.

Dr. Shamies sixth pearl was to assume there are capsular tags. The question is how fragile those tags are and how easily you can disrupt them. Ensure a complete capsulotomy before removing the cap. The next pearl was to first burp and then wave. Soften the chamber, Dr. Shamie said. Air bubbles can get trapped behind the lens, so you dont want to be too aggressive in hydrodissection, she said. You want to get some of those air bubbles out.

Pearl 8 was for easy cleavage but difficult capture. The laser cuts minimize the need for grooves and ease the splitting of the segments. Cleavage is very easy, but its important to know that these are tight spaces, Dr. Shamie added.

Next, Dr. Shamie said that you may need 2 hands to tackle the cortex. Her final pearl was to consider delaying LRI management. EW

Editors note: Dr. Shamie has financial interests with Abbott Medical Optics (Abbott Park, Illinois), Allergan (Dublin), Bausch + Lomb (Bridgewater, New Jersey), Shire (Lexington, Massachusetts), and Nicox (Sophia Antipolis, France).

Contact information
Shamie: nshamie@yahoo.com

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Can the femto for cataract live up to its hype? by Michelle Dalton EyeWorld Contributing Writer

Femtosecond mini-bubble technique by Roger F. Steinert, MD

10 pearls for transitioning to femtosecond laser cataract surgery 10 pearls for transitioning to femtosecond laser cataract surgery
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