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AAO Media Briefing Laser Assisted Cataract Surgery October 25, 2009 San Francisco, CA

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AAO Media Briefing Laser Assisted Cataract Surgery October 25, 2009 San Francisco, CA William W. Culbertson, MD Professor of Ophthalmology Bascom Palmer Eye Institute – Miami, Florida Interests: Cataract and Refractive Surgery (LASIK) Financial Relationships:

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AAO Media Briefing Laser Assisted Cataract Surgery October 25, 2009 San Francisco, CA

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  1. AAO Media BriefingLaser Assisted Cataract SurgeryOctober 25, 2009San Francisco, CA

  2. William W. Culbertson, MD • Professor of Ophthalmology • Bascom Palmer Eye Institute – Miami, Florida • Interests: Cataract and Refractive Surgery (LASIK) • Financial Relationships: - Optimedica (Santa Clara, CA): Consultant - Abbott Medical Optics (Santa Ana, CA): Consultant - Carl ZeissMeditec (Dublin, CA): Consultant - Alcon (Fort Worth, TX): Speaker

  3. Contemporary Cataract Surgery Steps: • Incision • Capsulorhexis • Phacoemulsification • IOL Insertion • Relaxing Incisions (Astigmatism) Eyemaginations Cartoon of Cataract surgery 1 Minute (runs with video below) Video of Cataract Surgery 1.0 minute

  4. Potential Problems in Contemporary Cataract Surgery: Steps: Incision Capsulorhexis Phacoemulsification IOL Centration Relaxing Incisions (Astigmatism) Leaking wound and endophthalmitis

  5. Potential Problems in Contemporary Cataract Surgery: Steps: Incision Capsulorhexis Phacoemulsification IOL Centration Relaxing Incisions (Astigmatism)

  6. Potential Problems in Contemporary Cataract Surgery: Steps: Incision Capsulorhexis Phacoemulsification IOL Centration Relaxing Incisions (Astigmatism) Corneal Phaco Burn Phaco burn picture

  7. Potential Problems in Contemporary Cataract Surgery: Steps: Incision Capsulorhexis Phacoemulsification IOL Centration Relaxing Incisions (Astigmatism) Decentered Multifocal IOL Decentered IOL

  8. Potential Problems in Contemporary Cataract Surgery: Steps: Incision Capsulorhexis Phacoemulsification IOL Centration Relaxing Incisions (Astigmatism) Decentered Multifocal IOL Decentered IOL

  9. Potential Problems in Contemporary Cataract Surgery: Pre-op LRIs Steps: Incision Capsulorhexis Phacoemulsification IOL Centration Relaxing Incisions (Astigmatism) Post-op LRIs

  10. Relaxing Incision for Astigmatism:

  11. History of “Laser Cataract Surgery” • YAG laser lens softening • Dodick laser • Phoenix Laser

  12. Femtosecond Laser in Ophthalmology • Corneal Surgery Lasik flaps Corneal transplants (Corneal relaxing incisions) (Cataract surgery incisions) • Companies doing corneal surgery with fs laser: AMO (Intralase) Technolas (FEMTEC Perfect Vision) Zeimer (LDV) Zeiss (Visumax)

  13. Femtosecond Laser Photodisruption • Plasma expansion • Shock wave pressure • Cavitation bubble creation • Decreased pulse duration reduces photodisruption threshold and secondary effects allowing closer placement of pulses Initial Beam Cavitation Bubble

  14. Femtosecond Laser-Assisted Cataract Surgery (FLACS) Three American Companies: LensAR (Winter Park, FL) LenSx (Aliso Viejo, CA) Optimedica (Santa Clara, CA)

  15. Femtosecond Laser-Assisted Cataract Surgery (FLACS) Objectives: • Increase safety • Improve precision • Automate undependable components

  16. Femtosecond Laser-Assisted Cataract Surgery (FLACS) Laser Assisted Steps: • Imaging of the front of the eye • Cataract incision • Capsulorhexis (anterior capsulotomy) • Cataract (lens nucleus) segmentation and softening • Limbal relaxing incisions

  17. FS Laser-assisted Cataract SurgeryImaging and Registration: OCT Technique (Optimedica) Scheimpflug Technique (LensAR)

  18. Cataract Incision: (Optimedica)

  19. FS Laser-assisted Cataract Surgery:Cataract Incision: (Optimedica)

  20. FS Laser-Assisted Cataract Surgery:Cataract Incision: Cartoon of incision Video of incision

  21. Capsulorhexis: (Optimedica)

  22. Capsulorhexis: (LensAR)

  23. Capsulorhexis Edge: SEM 500X 50X

  24. Nuclear Softening/Segmentation: (LensAR) (LenSx)

  25. Nuclear Softening/Segmentation: (Optimedica)

  26. Limbal Relaxing Incisions:

  27. FS Laser-assisted Cataract Surgery:Advantagesand Disadvantages: • Advantages: • Improved safety • Increased precision • Enhanced reproducibility • Disadvantages: • Increased Cost • Added time

  28. Conclusion: Femtosecond laser assisted cataract surgery is a promising improvement on standard contemporary phacoemulsification cataract surgery.

  29. FS Laser-Assisted Cataract Surgery:The Future: • Sub Bowman’s Relaxing Incisions • Complex Cataract Incisions • Customized Capsulorhexis • Capsulorhexis Integrating with IOLs - “Capsule in the Lens” - Toric IOL Orientation • Lens Refilling Surgery

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