Saturday, February 7, 2009

Rock 'n' roll phaco hits the right note

An alternative phacoemulsification procedure, dubbed "rock 'n' roll phaco" by its originator, offers surgeons faster emulsification of the nucleus of the lens without compromising safety, according to a German study.

Detlef Uthoff MD told delegates attending the 13th ESCRS Winter Meeting in Rome that the "rock 'n' roll" technique is the culmination of over 30 years of experimenting with different approaches to phacoemulsification.

“This is my favourite technique for both mono and bimanual phacoemulsification. It is characterized by primarily fragmenting or sculpting the nucleus, which is then nudged 180 degrees and rotated along its sagittal axis with the help of the phacoemulsification tip. Later the nucleus is stabilised by a spatula and then emulsified from its posterior side. During emulsification the nucleus is held under the iris with the help of spatula,” he said.

Dr Uthoff said that the technique, which demands a slightly longer learning curve to master than traditional methods, permits a faster and safer emulsification of the lens nucleus and can be used with all grades of cataract. He estimated that his modified technique reduces the ultrasound time by up to 30 per cent.

Cornea Day was officially opened by Dr Jose Guell (pictured above), chairperson of the ESCRS Congress Committee.

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Femtosecond laser enhances keratoplasty

The femtosecond laser offers several clear advantages for lamellar and penetrating keratoplasty procedures, according to an Italian surgeon speaking at the 13th ESCRS Winter Meeting in Rome, Italy.

Opening the first session at the annual Cornea Day, Emilio Balestrazzi MD gave an overview of how the femtosecond laser is changing the face of lamellar and penetrating keratoplasty surgery.

“The IntraLase femtosecond laser (AMO) is a dynamic surgical tool which enables surgeons to perform valid, safe and repeatable lamellar and penetrating keratoplasty techniques. However, we must be cautious in the application of this exciting technology and remember that it is still a work in progress,” he said.

For femtosecond laser assisted deep anterior lamellar keratoplasty (femto-DALK) procedures, Dr Balestrazzi said that the goal is to utilise a surgical option that could be compared in results to manual DALK, preserving the health and integrity of the corneal endothelium.

Using this approach, a clear graft was achieved in all patients one week after surgery and confocal microscopy evaluation showed no significant differences in pre- and postoperative endothelial pattern and density. Two patients experienced a perforation during the IntraLase cut which required a subsequent penetrating keratoplasty.

Turning to femtosecond laser assisted penetrating keratoplasty, Dr Balestrazzi said that this technique is designed to create a simpler and repeatable surgical technique to generate less astigmatism, greater scar strength and faster visual recovery times.

In addition, any cut configuration and angulation can be chosen, the cut quality is excellent and the prepared donor transplant nestles perfectly in the recipient eye.