Recent studies on the rate of infections in the eye after cataract surgery (endophthalmitis) once again prove that “high volume” cataract surgeons have lower rates of surgical complications. For further detail go here.
Dr Troski is proud to be the first surgeon in Australia (actually the first surgeon in the southern hemisphere!) to use the SMI Surgical Guidance System.
Studies have shown that patient satisfaction correlates with getting the best possible visual result and the SMI system is a new way of improving the results of cataract operations by allowing more accurate intraocular lens placement. This will lead to more accurate results than have been previously possible.
Oliver Kersting, head of SMI’s ophthalmic systems division explains “This is a measurement device that’s usually used preoperatively. With it, we can take a high-resolution image of the eye and a keratometry reading. Then, in the OR, there’s the Surgery Pilot system, a computing device that takes the image from the surgical microscope and, on a computer monitor, automatically registers it with the preop image. The Surgery Pilot image allows you to plan the different steps of cataract surgery based on data from different sources and the original measurements from the reference unit. You can set the incision axis, the angles of limbal relaxing incisions, and the capsulorhexis position and diameter relative to the diagnostic measurements. the system also has a toric overlay that shows the surgeon the implant axis on a live surgical image.”
Dr Troski will be using the SMI system routinely so that patients can benefit from this new cataract surgery technique.
B.I.S.C.S
(Bilateral Immediately Sequential Cataract Surgery)
Study finds less endophthalmitis after sequential bilateral cataract surgery than unilateral surgery
A survey of members of the International Society of Bilateral Cataract Surgeons shows no cases of bilateral endophthalmitis occurring among 95,606 eyes (a sample size more than six times larger than the ESCRS endophthalmitis study) that had immediately sequential bilateral cataract surgery. The overall rate of postop infection was calculated as 1 in 5,759. The authors also conducted a literature review to determine the recent incidence of postop endophthalmitis in unilateral cataract surgery with and without the use of intracameral antibiotics. Infection rates were significantly reduced with intracameral antibiotics to 1 in 14,352 cases. Journal of Cataract & Refractive Surgery, December 2011
This study suggests that BISCS is at least as safe as having surgery on one eye at a time. (generally the rate of endophthalmitis quoted is around 1 in 1000 cases)
Dr mark Troski is able to offer the option of having both cataracts removed at the same visit to theatre for suitable patients.
He follows international guidelines to ensure this as safe as possible and allows patients (especially those who live in rural and remote areas) to minimise their travel to Melbourne
Please contact Dr Troski or his staff if you would like to consider this option.
At the recent European society of cataract and refractive surgery dr Robert Cionni (one of the best known surgeons in America) reported a small series of uncorrected postoperative visual acuity results on patients having femtosecond laser assisted cataract surgery (lacs) compared to a similar group having “manual” surgery. There is also a small series reported by Dr Eric Donnenfeld (also from the USA)
We decided to compare our own results with these:
We used Dr Troski results over the last 50 consecutive patients to compare with Dr Cionni and Dr Donnenfeld.
In Dr Cionni “manual” series 64% were within 0.25d of the expected outcome compared with 83% using the laser.
In Dr Donnenfeld group of lacs patients 71% were within 0.25d
In Dr Troski group of “manual” patients had 84% within 0.25d
we also had 100% within 0.50d.
Dr Cionni also reported that in the “manual” group 27% could see 6/6 (20/20) compared with 58% in the femto lacs group.
Dr Troski group had 94% of patients seeing 6/6 (20/20) or better.
Early reports from the first centre in Australia to offer femtosecond laser assisted cataract surgery (“lacs”) have shown an exceptionally high rate of minor and major cataract surgery complications, contrary to claims that this technology is safer than traditional cataract surgery. The reported rate of complications is much higher than traditional cataract surgery; in particular there have been at least four cases of “dropped nuclei” from the group of surgeons using the first installed femtosecond laser cataract machine in Australia. Currently there are only two femtosecond cataract lasers in Australia, both located in Sydney. This is a major complication of cataract surgery requiring further surgery by a vitreo-retinal specialist to remove the cataract from the back of the eye. This complication has the potential to adversely affect the patient’s vision. So far there is no published data to support the visual acuity outcomes being better than non-laser assisted cases. There should soon be some early results data from reports from the European society of cataract and refractive surgeons annual meeting in Vienna.
There continues to be a huge amount of controversy over the place of the new femtosecond laser in cataract surgery in the correspondence of the American society of cataract and refractive surgeons.
American surgeons who have used the laser (many of whom have financial interests in the laser companies) are very enthusiastic about it. Many other surgeons in the USA are very concerned that the laser is more about marketing than real surgery benefits.
There is still no clear evidence that the enormous cost of these machines (half a million dollars) is reflected in the improved results that the laser is supposed to produce. One of the main advantages is said to be a reduction in cataract surgery complications, but with so little data it really is not clear whether the laser does represent a meaningful reduction in the complications of cataract surgery. It is also possible that the laser may cause some new complications itself that have not been seen with current “state of the art” phacoemulsification cataract surgery.
This is certainly the hottest topic in cataract surgery at the moment.
Since returning from the recent APAO conference, the American Society of Cataract and Refractive Surgeons have held their annual meeting. The big news is that laser cataract surgery is on the way. Many prominent American surgeons gave papers on the use of the femptosecond laser to form the corneal incision and anterior capsulorhexis.
Although there is currently only one actual laser in use in America and one in Europe, it seems clear that this is the future of cataract surgery.
I just returned from the Asia pacific academy of ophthalmology meeting and was an invited speaker on the topic of “multifocal intra-ocular lenses” Please find the report below from the “ocular surgery news” about my presentation:
Mark Troski, M.D., a surgeon devoted exclusively to cataract surgery, described a trend that many surgeons have been waiting for over the better part of the last decade: Alcon’s ReSTOR toric multifocal IOL.
Welcome to my Blog. I am new to the world of Blogging and I will keep you informed on the latest developments in the exciting world of cataract surgery.
I will be attending the upcoming APAO conference in Sydney on the 20-24th of March 2011.
As an invited speaker I will be discussing my experience with multi focal implants. Please contact me if you have any cataract related questions.