Surgery: Femtosecond Laser Assisted Cataract Surgery with Trifocal Toric IOL

Dr. Barber: This is Dr. Kevin Barber presenting a case of femtosecond laser assisted cataract surgery with the use of an Alcon PanOptix toric lens. So you can see the femtosecond laser treatment has already been applied. This is hydrodissection being performed with a Chang cannula. I prefer the Chang cannula because the 90 degree angle allows for subincisional, a near subincisional hydrodissection.

Here we are at phacoemulsification using the Alcon Centurion unit. Clearing some working space by removing the viscoelastic and now creating a central groove. Using the second instrument and a phaco needle to crack the nucleus. And then, going posterior to the lens material with the second instrument, and bringing the nucleus into the central safety zone, being mindful to keep the phaco needle in the central safety zone. I prefer to phaco at the iris plane, not deep in the capsular bag. So I found this to be very safe. Again, rotating the nucleus so that the fragmented eye I am aiming to remove is directly across from my phaco needle, and bringing it to the central safety zone at the iris plane.

I’ll then use a second instrument to rotate the nucleus, and again chopping from behind, or posterior to the lens. At this point, we have removed the majority of the lens, so we’ll begin to use the second instrument beneath the lens material to provide a protection for the posterior capsule. Attempting to keep the Connor wand, or the second instrument, posterior to the phaco needle, again, offering additional protection.

This is a 45 degree irrigation/aspiration tip, stripping the cortex towards the center. You can see the vacuum building to just under 600. We left the subincisional cortex for last, this is rotating a 45 degree tip posteriorly and then bringing it laterally as I strip it towards the center.

Now we’ll remove any remaining dispersive viscoelastic, as we will perform ORA intraoperative abberopathy on this case. We’ll now attempt a full and complete fill of a viscocohesive viscoelastic. We’ll check the pressure at the applanation, which is important when doing ORA intraoperative aberrometry. You can see the ORA measurements here that have verified the access and magnitude of astigmatism. So this patient has elected for a PanOptix lens, we will be using a T4 version or toric version of this lens. Use the Connor wand or the second instrument to properly position the lens implant, striving for good centration.

And then using the ORA device to verify proper toric alignment of the lens. This is Tri-Moxi made by Imprimis Pharmaceuticals. It is a combination of triamcinolone and moxifloxacin that I just injected transzonularly into the anterior vitreous. As I perform a dropless cataract surgery, my patients do not take drops post operatively.

Irrigation/aspiration has then been used to remove the viscoelastic material. We’ll use an irrigating cannula to define adjustment to the toric lens and that concludes this case. Thank you for watching.