ARS question #1 • What is the width (external) of your routine cataract surgery incision? – 1) Less than 2.2 mm. – 2) 2.2-2.4 mm. – 3) 2.5-2.75 mm. – 4) More than 2.75 mm.
ARS question #1a • What is the main reason you have not converted to a “smaller” incision? – 1) Don’t see any advantage – 2) My phaco unit does not allow for it – 3) I use an IOL requiring “larger” incision – 4) Fear of complication- eg thermal injury – 5) Happy where I am!
Why change?? • Studies show – SIA reduced with smaller incisions- ie 2.2-2.4mm – SIA “tighter” std deviation- actual vs predicted • Minimizing astigmatism leads to improved visual quality and outcomes- eg diff. multifocal IOL’s • Lower, more predictable SIA allows surgeon to intraoperatively address residual p-op cyl more accurately in modern “Refractive Cataract Surgery”- both with Toric and PC IOL’s • Other- safety, faster healing, less discomfort, etc
ARS question #2 • When do most posterior capsular tears occur during your cataract surgery? – 1) Capsulotomy – 2) Hydrodissection – 3) Phacoemulsification – 4) Cortical clean-up/capsule polishing – 5) IOL insertion/positioning – 6) Other??
“Most significant” advance in Phaco??
rief history “major advances”Phaco - late 70’s CCC- mid to late 80’s “Foldable IOL’s”- 80’s-90’s “Near-clear, sutureless”- mid 90’s Rotational phaco - mid 2000’s Femto- early 2010’s Polymer tip (insert photo of tip)
“Most significant” advances in Phaco?? SO significant- safety!!
se of cortical removal with “truncated” rtex in femto cases se of polishing both ant & post capsules se of subincisional cortical removal nlikely to tear capsule with inadvertent occlusion!!
“Levels the playing field”
ARS question #3 • Assuming you can not find preservativefree Epi, which intra-op pharmacologic agent are you currently using for IFIS/small pupils? – 1) Preservative-free Epi- compounded – 2) Dilute (4:1) preserved Epi- ± bisulfite – 3) Phenylephrine – 4) Preservative-free Phenylephrine-compounded – 5) Mechanical only (hooks, rings, etc)- ie no meds – 6) None
“History” • Shortage- why? when will it be corrected?? • Concerns- outcomes, safety, medico-legal • Solutions Compounded PF Epi- cost, stability, safety Dilute Epi with preservative at 4:1 or 5:1 Compounded PF Phenylephrine**
ARS question #4 • How long is your “normal” cataract case? 1) 1-5 minutes 2) 6-10 minutes 3) 11-15 minutes 4) >15 minutes
“Shut-up”
Pearl #4 • All need to quit worrying about “how fast” and worry about “how efficient”! – RVU debacle – Patient outcomes- our primary concern! – “Best practices”- may require additional steps • Femto, intra-operative abberometry, precise IOL alignment, etc etc
• “French experience”!
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