November 2019


Best of ASCRS 2019: International Cataract

by Liz Hillman EyeWorld Editorial Co-Director

Roger Zaldivar, MD, MSc, MBA

The Best of ASCRS 2019 is a general session at the ASCRS ASOA Annual Meeting where members of the EyeWorld Editorial Board select what they think were the best papers in different categories from the meeting. They choose from the papers that were awarded Best Paper of Session in each individual paper session throughout the meeting and explain why they made their selections. Here we recap what those papers were in the International Cataract category and why Roger Zaldivar, MD, MSc, MBA, a member of the EyeWorld Editorial Board, thought they were noteworthy.

Comparison of elasticity and fracture strength of manual, femtosecond laser, and selective laser capsulotomies

Sheraz Daya, MD, Soon-Phaik Chee, MD, Seng Ei Ti, MD, Richard Packard, MD

This study compared the strength and elasticity of manual, femtosecond laser-created, and selective laser-created (CAPSULaser, Excel-Lens) capsulotomies. It included three groups of 10 paired human cadaver eyes: Group 1: selective laser capsulotomy (SLC) to manual CCC, Group 2: manual CCC to FLACS, and Group 3: FLACS to SLC. Scanning electron microscopy was used to examine the capsule edge and the standardized Instron device was used to measure load and extension to tear of each eye. Exclusion criteria consisted of determining circularity (minor axis has to be less than 90% of the major axis) and size (outside diameter of 5.0 mm of ± 0.2 mm).
SLC (28 ± 2 mm) was statistically significantly stronger compared to manual CCC (24 ± 2), while manual CCC was statistically significantly stronger than FLACS (23 ± 2). SLC was stronger when compared to FL ACS capsulotomies. Dr. Zaldivar noted the bigger perimeter of SLCs and more elasticity of the capsulotomy edge.
Scanning electron microscopy reflects that SLC/CAPSULaser creates a double edge, a rolling, to the capsulotomy. That, along with a thermal change of the anterior capsule created by the procedure, Dr. Zaldivar said, could make it more resistant to tearing.

Iris registration-guided femtosecond laser-assisted capsular markings to guide toric IOL alignment during cataract surgery

Denise Visco, MD

“What I found interesting in this presentation is that it might truly optimize time and flow while improving clinical results,” Dr. Zaldivar said. LENSAR has developed a novel technique for precise toric IOL alignment. This novel technique consists of creating a pair of small pointers or marks on the capsular rim (IntelliAxis-Refractive Capsulorhexis) as part of the standard laser capsulotomy procedure.
The study included 60 eyes that underwent FLACS with iris registration-guided capsular markings on the capsular rim (IntelliAxis Refractive Capsulorhexis, LENSAR). Results were pretty impressive: Mean Residual Refractive Astigmatism was 0.15 D (mean preop corneal astigmatism was 2.11 D). Astigmatism decreased significantly postoperatively (p < 0.001). Fifty-six percent of eyes had no residual astigmatism and 98% had less than 0.5 D, Dr. Zaldivar noted.

Pinhole implantation after posterior capsule opening

Bruno Cancado Trindade, MD, Fernando Cancado Trindade, MD,
and Claudio Cancado Trindade, MD

Dr. Zaldivar said he wanted to share this paper because he was impressed by the versatility of the technology. The patient’s vision was 20/800 J7. After removing the nucleus, the surgeon realized there was a hole in the posterior capsule. The pinhole IOL (IC-8, AcuFocus) is sulcus placed, so it was used in this case. At 1 week postop, the patient was 20/25 J3.
Dr. Zaldivar posed the question of whether the IC-8 is the new kid on the block because “we have so many aberrated corneas. There are so many post-LASIK.”

Editors’ note: The session is available on demand at for those who attended the 2019 ASCRS ASOA Annual Meeting.

About the doctor

Roger Zaldivar, MD, MSc, MBA

CEO, Instituto Zaldivar
Mendoza, Argentina

Relevant financial interests

Zaldivar: None

Contact information


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