Scribd Logo
Upload

Welcome to Scribd!

  • 134 views

    Cataract Surgery Evolution

    Uploaded by

    Ia Bezhashvili
    This document discusses the evolution of cataract surgery techniques and the potential role of femtosecond laser technology. It summarizes a new technique described by Hwang et al. for disassembling very hard cataract nuclei using a "drill-and-crack" method. It notes that cataract surgery involves more than just the surgical procedure and that trained surgeons are needed to ensure good outcomes. It raises questions about how femtosecond laser technology could be incorporated, such as whether the laser should be inside or outside the operating room. The role of this technology in fragmenting nuclei of varying hardness is also discussed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Cataract Surgery Evolution

    Uploaded by

    Ia Bezhashvili
    134 views2 pages
    This document discusses the evolution of cataract surgery techniques and the potential role of femtosecond laser technology. It summarizes a new technique described by Hwang et al. for disassembling very hard cataract nuclei using a "drill-and-crack" method. It notes that cataract surgery involves more than just the surgical procedure and that trained surgeons are needed to ensure good outcomes. It raises questions about how femtosecond laser technology could be incorporated, such as whether the laser should be inside or outside the operating room. The role of this technology in fragmenting nuclei of varying hardness is also discussed.

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses the evolution of cataract surgery techniques and the potential role of femtosecond laser technology. It summarizes a new technique described by Hwang et al. for disassembling very hard cataract nuclei using a "drill-and-crack" method. It notes that cataract surgery involves more than just the surgical procedure and that trained surgeons are needed to ensure good outcomes. It raises questions about how femtosecond laser technology could be incorporated, such as whether the laser should be inside or outside the operating room. The role of this technology in fragmenting nuclei of varying hardness is also discussed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    134 views2 pages

    Cataract Surgery Evolution

    Uploaded by

    Ia Bezhashvili
    This document discusses the evolution of cataract surgery techniques and the potential role of femtosecond laser technology. It summarizes a new technique described by Hwang et al. for disassembling very hard cataract nuclei using a "drill-and-crack" method. It notes that cataract surgery involves more than just the surgical procedure and that trained surgeons are needed to ensure good outcomes. It raises questions about how femtosecond laser technology could be incorporated, such as whether the laser should be inside or outside the operating room. The role of this technology in fragmenting nuclei of varying hardness is also discussed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    FROM THE EDITOR

    Cataract surgery evolution

    Many variants of the Gimbel1 divide-and-conquer Or would it be better located inside the operating
    cataract nucleus disassembly have been described room, allowing the convenience of a single surgeon
    since 1991dall variations of the same theme aimed to complete all aspects of the procedure? Would
    to improve nucleus management in phacoemulsifica- productivity be enhanced by a 2-person team for the
    tion surgery.2–8 The emergence of technical refine- surgery, 1 for the laser aspect and 1 for the lens aspira-
    ments over the intervening years is symptomatic of tion, capsular bag cleansing, and IOL implantation?
    the need to pursue safety in this critical aspect of cata- These are fascinating questions to be answered in the
    ract surgery. light of practical experience with the current compet-
    In this issue, Hwang et al. (pages 1627–1630) describe ing femtosecond cataract laser devices.
    a new technique and its advantages for use in eyes with Cataract surgery involves more than the surgical
    a very hard nucleus cataract, which demand a different aspect of the process; ie, preoperative evaluation of
    approach than eyes with soft nuclei. They describe the indications for surgery and then documentation
    a drill-and-crack technique, making a deep hole in the of the physical status of the eye as a whole; creation
    central nucleus with the phaco tip and dividing the of the surgical plan, including biometry; the cataract
    nucleus with a prechopper inside the hole. Disassembly and IOL surgery; postoperative management, includ-
    of a cataract nucleus depends on its hardness and integ- ing complications if they occur. The whole process
    rity. The prevention of posterior segment complications should be undertaken by trained surgeons to ensure
    during cataract surgery relies on the maintenance of an maximum success and minimum deviation from the
    intact lens capsule and zonular apparatus. Phacoemul- excellent outcomes that are expected with current
    sification techniques are designed to minimize the risk surgical methods. Femtosecond technology should
    for damage to the posterior capsule by maximizing add predictability in preparation of an eye for lens
    control of nucleus disassembly and evacuation. evacuation and IOL implantation. A trained laser
    The next major step in the evolution of cataract and technician under the overall control of the ophthalmic
    intraocular lens (IOL) surgery must surely be the use surgeon could conceivably undertake this aspect of the
    of femtosecond laser technology to automate several surgical process. Such teamwork could maximize
    aspects of the process. We look forward to peer- productivity and make best use of trained personnel.
    reviewed material verifying advances suggested by Many years ago, a financial journalist proposed
    this adapted technology: repeatable clear corneal a law that stated ‘‘improvement means deterioration,’’
    incisions of varied designs, dependable astigmatism- referring to new laws or regulations intended to make
    neutralizing corneal/limbal incisions, capsulorhexis progress but often having the reverse effect. Cataract
    of any design and dimension, nucleus fragmentation surgery, as any surgical process, should evolve and
    to allow subsequent lens matter aspiration with or improve as innovative technology and methods
    without minimal phacoemulsification. offer advantages. Our profession will adapt and
    It is this latter aspect of cataract surgery that is a incorporate such opportunities if, in the end, they
    particular challenge to femtosecond laser technology. help our patients by reducing risks and yielding
    Nuclear fragmentation is possible but limited at this greater benefits of enhanced safety and efficiency.
    stage by the hardness of the cataract nucleus. Soft nuclei
    can be fragmented into various forms suitable for safer Emanuel S. Rosen, MD, FRCSEd
    aspiration than that using phacoemulsification power.
    One difficulty to be overcome is adaptation of femtosec- REFERENCES
    ond technology to deal with the hard nucleus, in which 1. Gimbel HV. Divide and conquer nucleofractis phacoemulsifica-
    tried and tested methods and innovations, as described tion: development and variations. J Cataract Refract Surg 1991;
    by Hwang et al., will have to be deployed for some time 17:281–291
    2. Hayashi K, Nakao F, Hayashi F. Corneal endothelial cell loss after
    to come. phacoemulsification using nuclear cracking procedures.
    Physical management of the process of femtosecond J Cataract Refract Surg 1994; 20:44–47
    laser–assisted cataract surgery will be determined by 3. Koch PS, Katzen LE. Stop and chop phacoemulsification.
    equipment design and learning by experience. For J Cataract Refract Surg 1994; 20:566–570
    example, is the bulky femtosecond laser best placed 4. Maloney WF, Dillman DM, Nichamin LD. Supracapsular phacoemul-
    sification: a capsule-free posterior chamber approach. J Cataract
    outside the operating room, where the semiautomated Refract Surg 1997; 23:323–328
    laser surgery by surgeon or assistant will prepare an 5. Mansour AM. Simple nucleus cracking technique [letter]. J Cataract
    eye for lens matter removal and IOL implantation? Refract Surg 2000; 26:164–165

    Q 2010 ASCRS and ESCRS 0886-3350/$dsee front matter 1625


    Published by Elsevier Inc. doi:10.1016/j.jcrs.2010.08.004
    1626 FROM THE EDITOR

    6. Koplin RS, Anderson JE, Seedor JA, Ritterband DC. In situ 7. Fine IH, Packer M, Hoffman RS. Prevention of posterior segment
    nuclear disassembly: efficient phacoemulsification without complications of phacoemulsification. Ophthalmol Clin North Am
    nuclear rotation using lateral sweep sculpting and in situ 2001; 14(4):581–593
    cracking techniques. J Cataract Refract Surg 2009; 35: 8. Woodlief NF, Woodlief JM. Endocapsular deep-wedge-removal
    1487–1491 phacofracture. J Cataract Refract Surg 2009; 35:1656–1658

    J CATARACT REFRACT SURG - VOL 36, OCTOBER 2010

    You might also like