Cataract

There was clinically significant less CME in patients who received trans-zonular triamcinolone acetonide, moxifloxacin hydrochloride, and vancomycin-known as the Dropless approach-in addition to an NSAID after cataract surgery.

Looking back over the past year and into the near future, Eric D. Donnenfeld, MD, Robert H. Osher, MD, and Mark Packer, MD, spoke to Ophthalmology Times about developments in diagnostic products and other tools used in cataract surgery. In addition, they discussed combination microinvasive glaucoma surgery (MIGS) and office-based surgery as new trends.

Cataract surgeons in the United States have long been envious of the IOL options available to their international colleagues. Finally, in 2016, American ophthalmologists gained access to some novel IOLs such as the Tecnis Symfony Extended Range of Vision IOL and the Tecnis Symfony Toric IOL (Abbott) that were approved by the FDA. According to leading cataract surgeons who spoke to Ophthalmology Times, these simultaneous approvals rank as the biggest cataract surgery news story of the year.

A review of some of the most significant advances in medications for cataract surgery during the past year revealed a mix of the expected with a few surprises.

A case of cataract surgery with planned presbyopia-correcting IOL implantation– complicated by posterior capsule rupture and a postoperative refractive surprise– reinforced important lessons and provided a new revelation to one experienced surgeon.

Findings from an updated analysis of outcomes at a single center reaffirm the safety of femtosecond laser capsulotomy by showing it is associated with a low rate of anterior capsule tears.

Thomas A. Oetting, MD, MS, shared five pearls for operating in eyes with small pupils. In the follow-up discussion, panel members commented on their experiences with newer options for small pupil management.

Accommodating-disaccommodating IOLs are being developed that mimic the movement of the young crystalline lens through the use of “Zonular Capture Haptics” technology.

In order to avoid a public health crisis and keep up with increasing vision loss among the aging baby-boomer generation, correctable vision impairments must be eliminated by 2030, according to a report issued by the National Academies of Sciences, Engineering, and Medicine (NASEM).

When a three-piece IOL intended for sulcus placement dislocates posteriorly during an IOL exchange procedure, cataract surgeons can consider several possible strategies.

When it comes to their eyes, patients want the safest treatments, and they know the best technology available is a laser. The cataract patient demographic is changing, and patients today have active lifestyles that demand functional vision.

A surgeon with clinical experience with three femtosecond lasers discusses the practicalities of creating ideal femtosecond laser inlay pockets.

A 110° reverse side cut primary incision created with a femtosecond laser provides an effective seal for potential wound leakage in a recent study.

Multifocal IOLs offer the potential to reduce spectacle dependence, but outcomes vary depending on optical design. Optimizing success and satisfaction depends on careful patient selection, thorough counseling, and good surgical technique.

New forceps designed by Lawrence Goldberg, MD, improve the technique for iris hook placement due to two-point fixation.

A tool found in every ophthalmologist’s office, the slit beam, can also be used to enhance visualization during cataract surgery in patients who have corneal opacities.

Optimal planning for correction of pre-existing corneal astigmatism at the time of cataract surgery should take into account an age-related, against-the-rule (ATR) shift.

The best candidates for multifocal intraocular lenses (IOLs) are highly motivated, have nearly perfect optics, and have healthy tear film. Otherwise, patients could have issues with contrast sensitivity, glare, and haloes.

A new trabecular meshwork excision blade takes a new approach in IOP reduction.

Cataract surgery with or without intravenous sedation can be a factor in the clinical experience. Moving to sublingual sedation may be the next step in safety and comfort for a demanding patient demographic.

Surgical draping for ophthalmic surgery has never been quick or easy-until now. A new drape design allows the surgeon or scrub nurse to fully drape the patient in seconds.

Intracameral administration of the fixed combination of phenylephrine and ketorolac injection 1%/0.3% (Omidria, Omeros) during cataract surgery is safe and effective for maintaining pupil dilation, and minimizes the need for a pupil expansion device, according to the findings of a retrospective study conducted by Frank A. Bucci, Jr., MD.

Glaucoma is more likely to develop in children who undergo cataract surgery when they are 6 weeks or younger.

In a multicenter trial including 162 eyes undergoing cataract surgery with implantation of a variety of IOL types, use of intraoperative aberrometry to guide IOL spherical power selection minimized residual refractive error.

Results of two phase III trials with dexamethasone intracanalicular depot are highlighted. Both trials met the endpoints for postsurgical pain, but only one trial met the endpoints for postoperative inflammation

An approach is described for completing cortex removal and IOL implantation after intraoperative 180° zonular dialysis.

An advanced, self-validating method is providing a new approach to IOL power selection, explains Warren E. Hill, MD, FACS.

Cataract surgery technology continues to advance with improvements that enhance surgical performance every step of the way.

In this first of a two-part series, Arun C. Gulani, MD, MS, explains how approaching keratoconus as a refractive surgery will change the way both ophthalmologists and patients will approach this condition to bring in a new era of not only relieving but also enhancing the lifestyle of this patient population. In Part 2, Dr. Gulani will share strategies and cases of patients with keratoconus with different case scenarios in action.

Lens extraction may have a role in reducing IOP in patients with primary angle-closure or primary angle-closure glaucoma.