Staar aq2010

Thanks for visiting CRSToday. Our advertisers are important supporters of this site, and content cannot be accessed if ad-blocking software is activated. Need help?

staar aq2010

Click here for instructions. All Rights Reserved Privacy Policy. Cataract Surgery: Complex Case Management.

Refractive Surgery: Complex Case Management. After making standard incisions, I would create a capsulorhexis measuring slightly less than 5 mm. I typically make a larger capsulorhexis, but with a violated posterior capsule, I prefer to use a three-piece acrylic IOL with its haptics in the sulcus and the optic prolapsed through the intact capsulorhexis.

If the capsulorhexis is too large, the IOL can tilt and induce astigmatism. I would extract the lens without hydrodissection or hydrodelineation.

staar aq2010

Using the slow-motion phaco settings popularized by Robert Osher, MD, I would debulk and remove as much of the nucleus as possible. I would then perform viscodissection in each quadrant and fold the epinucleus toward the center before removing it with the phaco handpiece. As the viscoelastic dissects around the quadrant with the preexisting defect, it will act as a tamponade between the posterior and anterior segments—similar in theory to the management of a posterior polar cataract.

By allowing the capsular bag to remain compartmentalized, the slow-motion settings will keep the viscoelastic in place and prevent the posterior loss of lenticular material. I would perform cortical cleanup with similar settings reduced bottle height, vacuum, and aspiration. I would implant the IOL in the manner already described.

It would be wise to have a retina specialist available in case of difficulties. ANNA S. KITZMANN, MD Because the cataract has developed quickly after the repair of the macula-off retinal detachment, I would explain to the patient that his postoperative vision could be limited by the retinal detachment.

The hole in the posterior capsule could complicate cataract surgery, so I would spend additional time discussing the potential problems with the patient. Because the cataract procedure could be difficult, I would perform surgery with a retrobulbar block rather than topical anesthesia. My approach to this case would be similar to that for a posterior polar cataract.

I would try not to make an extremely large capsulorhexis so that a sulcus-fixated lens would have adequate support if implantation of an IOL in the bag were not possible. I would avoid hydrodissection and would instead perform gentle hydrodelineation. I would not try to spin the lens. Instead, I would sculpt a large central groove and attempt to crack the nucleus in half. Then, I would try to remove the halves using slow-motion phacoemulsification with low vacuum and flow rates.

Next, I would attempt to viscodissect the epinucleus away from the capsule with Viscoat Alcon Laboratories, Inc. I would repeatedly inject Viscoat over the hole in the posterior capsule while removing the cortex. If surgery proceeded smoothly and there were only a small hole in the posterior capsule, then I would place a single-piece acrylic IOL in the bag.

If the case became complicated with an extension of the hole in the posterior capsule, I would temporarily close the temporal wound with a 10—0 nylon suture and enlarge the superotemporal paracentesis.There is presently no method that can be used to accurately carry out IOL power calculations prior to corneal transplantation combined with cataract removal and intraocular lens implantation.

This is because it is impossible to know the central power of the donor graft prior to surgery. Simply basing pre-operative calculations on a "best guess" of post-operative corneal power such as It is a much better idea to instead carry out corneal transplantation with cataract removal, but without intraocular lens implantation. The lens implantation would then be carried out at a later time, as a secondary procedure. Below is what we consider to be the optimum method for achieving the intended post-operative refractive result, when it is desirable to do both corneal transplantation and cataract removal in the same operative session:.

The host tissue is removed in the usual fashion with a 0. An "open sky" continuous tear anterior capsulotomy is carried out by capsulorhexis and extracapsular cataract extraction is completed. Residual cortex is removed. The posterior capsule is polished and the eye is left aphakic. Corneal transplantation is then completed in the usual manner. We prefer a combination of interrupted and running nylon sutures for the greatest flexibility in post-operative astigmatism control.

After four to eight months, when the corneal curvature has stabilized, and corneal astigmatism has been minimized, a careful aphakic refraction is performed and simulated keratometry by topography is used to estimate central corneal power.

The power of a foldable secondary intraocular lens such as the Staar AQV is calculated by means of the Refractive Vergence Formula. The intraocular lens is then placed into the ciliary sulcus, and over the intact posterior capsule, via a small scleral tunnel. It is axial length independent another potential source of errors and generally gives very good results. Arizona's Top Eye Doctors - East Valley Ophthalmology provides this online information for educational and communication purposes only and it should not be construed as personal medical advice.

East Valley Ophthalmology's disclaims any and all liability for injury or other damages that could result from use of the information obtained from this site. Please read our full Terms, Privacy, Infringement. Copyright East Valley Ophthalmology. All rights reserved. IOL Power Calculations. A-scan Biometry. Effective Lens Position. Post Keratorefractive Surgery. Optical Biometry. SIA Calculator. Physician Downloads. A few of our featured topics:.Toggle navigation. If you suspect an occlusion has occured during phaco, stop and clear the blockage immediately to prevent a wound burn.

If a burn does occur, it will induce signicant astigmatism and the wound will require extra steps to ensure closure, possibly including multiple sutures.

Image courtesy Robert Weinstock, MD. Cataract surgery is the most frequently performed surgery in the world.

Stability and safety of MA50 intraocular lens placed in the sulcus

Outcomes are overwhelmingly positive, but the sheer number of surgeries increases the odds that every surgeon will encounter an unpleasant surprise from time to time.

With that in mind, three experienced surgeons offer their advice on dealing with some of the complications a cataract surgeon may encounter—and when possible, how to prevent them in the first place. Along those lines, Audrey R. If you have a femtosecond laser available to do the capsulorhexis, that might be a good situation in which to use it. For example, if a patient has a very advanced, dense, white or brunescent cataract, then I want to have Malyugin rings, iris hooks, Trypan blue, intraoperative epinephrine and a vitrectomy setup available in the room to help in the event of a complication.

Hopefully by now every surgeon knows never to place a one-piece acrylic IOL in the sulcus. In that situation, I sculpt as much as I can and make an enormous bowl that will then collapse upon itself. I can then use viscoelastic to viscodissect it from the posterior capsule. This significantly reduces the likelihood of a complication. The solution is to make sure your assistant just irrigates very briefly, and only when you ask for it. Often the tissue can be repositioned, but if this occurs at the wound, avoid overhydrating to close the wound; a suture may be preferable.

With clear corneal incisions now a common choice in modern cataract surgery, several corneal complications can occur.

Corneal Transplantation ~ Calculating IOL Power

Another option is to debride the central epithelium, but this is usually done as a last resort, and only if there is a severely limited view into the eye because of a hazy or damaged epithelium. If this happens, it can be pretty devastating. There are usually some tip-offs that a problem is occurring; for example, you may see plumes of white smoke in the anterior chamber, and nothing seems to be evacuating out of the eye through the phaco needle.Toggle navigation.

If you suspect an occlusion has occured during phaco, stop and clear the blockage immediately to prevent a wound burn. If a burn does occur, it will induce signicant astigmatism and the wound will require extra steps to ensure closure, possibly including multiple sutures. Image courtesy Robert Weinstock, MD. Cataract surgery is the most frequently performed surgery in the world. Outcomes are overwhelmingly positive, but the sheer number of surgeries increases the odds that every surgeon will encounter an unpleasant surprise from time to time.

Managing Surgical Complications

With that in mind, three experienced surgeons offer their advice on dealing with some of the complications a cataract surgeon may encounter—and when possible, how to prevent them in the first place.

Along those lines, Audrey R. If you have a femtosecond laser available to do the capsulorhexis, that might be a good situation in which to use it.

For example, if a patient has a very advanced, dense, white or brunescent cataract, then I want to have Malyugin rings, iris hooks, Trypan blue, intraoperative epinephrine and a vitrectomy setup available in the room to help in the event of a complication. Hopefully by now every surgeon knows never to place a one-piece acrylic IOL in the sulcus. In that situation, I sculpt as much as I can and make an enormous bowl that will then collapse upon itself.

I can then use viscoelastic to viscodissect it from the posterior capsule. This significantly reduces the likelihood of a complication. The solution is to make sure your assistant just irrigates very briefly, and only when you ask for it. Often the tissue can be repositioned, but if this occurs at the wound, avoid overhydrating to close the wound; a suture may be preferable.

With clear corneal incisions now a common choice in modern cataract surgery, several corneal complications can occur. Another option is to debride the central epithelium, but this is usually done as a last resort, and only if there is a severely limited view into the eye because of a hazy or damaged epithelium. If this happens, it can be pretty devastating. There are usually some tip-offs that a problem is occurring; for example, you may see plumes of white smoke in the anterior chamber, and nothing seems to be evacuating out of the eye through the phaco needle.

Most of time I find the culprit is a piece of dense nucleus stuck in the tubing. Left: Ballooning of the conjunctiva can occur if the wound is made too far posteriorly, allowing irrigation to flow under the conjunctiva. The surgeon can make an incision to release the fluid or close that wound and make a new incision.

Right: An iris repair done after the iris was inadvertently damaged by the phaco needle during surgery. Weinstock notes that when corneal tissue burns, it contracts, leaving a gaping fish-mouth wound.Toggle navigation. However, hyperopic ablations are often decentered; then the positive asphericity could backfire and a zero-aberration lens would be preferable bottom scans. Donnenfeld, MD. Surgery is a lot like life, in at least one respect: The greatest challenges we face are not the situations we encounter most often, but the ones that are exceptional in some way—the situations that require us to alter our strategy to achieve the best outcome.

In cataract surgery, this is often the case when the eye undergoing surgery is nonstandard. Here, three experienced surgeons share their insights about choosing an intraocular lens when a standard choice might not be ideal.

staar aq2010

Spherical Aberration As every cataract surgeon knows, determining the ideal power for an intraocular lens can be challenging in eyes that have previously undergone refractive surgery. Many surgeons try to counteract the alteration by choosing an IOL with a level of positive or negative asphericity that may offset it. In fact, this strategy is now common-ly used to try to produce the best possible vision in eyes with virgin corneas, which normally have some spherical aberration as well.

Those aberrations led to glare and halo, a loss of contrast sensitivity and an overall loss of vision quality. All of these play a role in my surgical armamentarium when managing patients undergoing cataract surgery.

For routine cases, I generally choose a negative spherical aberration lens, unless the eye is unusual; for the overwhelming number of patients, negative spherical aberration lenses yield better quality of vision.

Donnenfeld notes that hyperopic LASIK leaves the cornea steeper, inducing negative spherical aberration. See examples, right. On the other hand, when patients have had previous myopic LASIK their corneas are flattened, inducing positive spherical aberration. As a result, they generally have more positive aberration than a normal cornea. If the disease is mild-to-moderate as in the case above and the eye has some astigmatism, but not a significant amount of irregular astigmatism, a toric lens may improve vision.

Image courtesy Eric D. Jorge L. The reason is that these eyes all have some amount of optical aberration.

Stability and safety of MA50 intraocular lens placed in the sulcus.

In particular, they often have coma, and combining coma with asphericity can be problematic. A neutral lens is also less problematic if there is decentration, particularly in hyperopia.

In cases with previous corneal refractive surgery I also would avoid choosing a multifocal lens, unless corneal aberrometry shows an absence of higher-order aberration. On the other hand, if the eye has undergone myopic LASIK, with good centration and no significant amount of coma, then I prefer to use negative asphericity lenses to compensate for the positive spherical aberration these patients usually have.

Alio notes that eyes that have undergone refractive surgery within the past two or three years may not have this altered corneal spherical aberration because of improvements in the software used to perform the surgery.Thank you for visiting nature. You are using a browser version with limited support for CSS.

To obtain the best experience, we recommend you use a more up to date browser or turn off compatibility mode in Internet Explorer. In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Inclusion criteria included patients with over 4 weeks of follow-up data. Fifty eyes of 49 patients meeting the inclusion criteria were identified. There were no cases of pigment dispersion syndrome or need for lens exchange. The MA50 IOL is a reasonable, stable option for placement in the sulcus, with a low-risk profile; however, in eyes with longer AEL and presumably larger anterior segment, surgeons should consider placing an IOL with longer haptic distance than the MA50 to maintain centration.

Optic capture of the MA50 IOL by the anterior capsule should be considered for longer eyes, as it is protective against decentration. In cataract surgery, a wide variety of pre-operative and intra-operative complications can necessitate the placement of a sulcus supported intraocular lens IOL. Single-piece IOLs placed in the sulcus have been shown to have multiple complications, 2 including pigment dispersion syndrome, 3 pigmentary glaucoma, 45 and uveitis-glaucoma-hyphema UGH syndrome.

Ideal characteristics of a sulcus-based IOL include a large optic, long thin angulated haptics, a smooth anterior optic surface, and a safe optic material. A large optic of at least 6. IOLs with posteriorly angulated haptics and a smooth anterior surface of the optic allow for sufficient iris clearance and minimize the risk of uveal irritation and pigment dispersion syndrome.

Acrylic material is preferred, as these patients are often at higher risk for future retinal issues and silicone lenses may compromise surgical visibility in vitreoretinal surgeries if silicone oil or expansile gas is used.

Finally, an ideal sulcus IOL would fold and allow for a smaller incision using an injector the surgeon is comfortable with. Although it only has a We hereby report our results. Consecutive patients with MA50 IOLs placed in the sulcus at University of Iowa Hospitals and Clinics were identified based on a review of surgical records from to Data collection focused on age, gender, axial eye length AEL, as measured with optical coherence or A-scan echographypre-operative best-corrected visual acuity, reasons for IOL placement in the sulcus, intra-operative complications, post-operative best-corrected visual acuity, and complications at 4 weeks and at the last available data point.

staar aq2010

The study population characteristics of the 50 eyes of 49 patients meeting the inclusion criteria are outlined in Table 1. The most common reasons for IOL placement in the sulcus were: capsular tear during phacoemulsification, zonular problems during phacoemulsification, and aphakia Table 2 ; several patients had more than one cause, that is, anterior and posterior capsular tear.

Intraoperative case data showed that only 1 case had mild marring of the IOL intraoperatively. There were 12 cases of optic capture using an intact capsulorrhexis, which may be the ideal position of an IOL in the sulcus. There were no cases of pupil capture or posterior loss of IOL intraoperatively. Immediate post-operative data showed that 4 pars plana vitrectomies were performed, 2 of which were planned and 2 of which were necessitated by retained lens material. There was one case of immediate post-operative IOL decentration, which improved by 4-week follow-up.

Four-week follow-up data is shown in Table 3. Long-term follow-up data, mean weeks, median 50 weeks is shown in Table 4. Glaucoma occurred in the operative eye in 3 patients. The third patient developed proliferative diabetic retinopathy and neovascular glaucoma and needed intervention with an Ahmed seton device, which was not thought to be secondary to the IOL.These lenses are intended to provide visual freedom for patients, lessening or eliminating the reliance on glasses or contact lenses.

All of these lenses are foldable, which permits the surgeon to insert them through a small incision. Watch the video. Cataracts are the clouding of the eye's natural lens, which inhibits light from easily passing through the lens. The clouded lens can be removed and replaced with an intraocular lens IOL.

STAAR, which has been dedicated solely to ophthalmic surgery for over 30 years, designs, develops, manufactures and markets implantable lenses for the eye with companion delivery systems. More than 1, Visian ICLs have been implanted to date. STAAR has approximately full-time equivalent employees and markets lenses in over 75 countries.

By using staar. You can view our updated Privacy Policy here. Cataract Solutions Cataracts are the clouding of the eye's natural lens, which inhibits light from easily passing through the lens. Invest in innovative technology STAAR, which has been dedicated solely to ophthalmic surgery for over 30 years, designs, develops, manufactures and markets implantable lenses for the eye with companion delivery systems. Learn more. Latest news See all news.


thoughts on “Staar aq2010

Leave a Reply

Your email address will not be published. Required fields are marked *