ESCRS Homepage

March 2003
IN THIS ISSUE

New ESCRS trial in bid to cut endophthalmitis rate to 0.01%
Lasik corrects refractive errors after PK in selected patients
Africa-Luz mobilises to provide eye care in regions riven by poverty
Multifocal IOL
choice hinges on patterns of daily routine
Anti-histamine drug mitigates risk of developing DLK after Lasik, says study
Untreated eyelid inflammatory disorders pose risk for postoperative complications
Thermotopography shows ‘enormous promise’
for diagnosis and treatment of eye diseases
Lasik offers ‘very effective treatment’ for
refractive errors after PK, says US specialist
Good results with PRK and Lasek rival Lasik for top spot in refractive excimer laser surgery
Orbital lymphomas respond well to local, systemic therapies, says study
Laser technologies still beam but economy and consumer demand will determine future of refractive surgery
Legally blind cardiologist finds new beat in low vision rehabilitation
‘Pivotal’ anti-TGF antibody therapy reduces
filtering bleb wound formation, says report
Neuroprotective agents stem optic nerve damage
by ‘offering a solution’ to open-angle glaucoma
Echothiophate iodide shortage leaves US specialists struggling to find alternative for acute cases
Postoperative complications of PK will have serious consequences unless tackled 'aggressively’
Private refractive clinics claim young specialists as public waiting lists grow in Canadian eye surgery
German doctors’ helpers oil the cogs of the private ophthalmic practice
Study of 900 ICLs reveals good safety and long-term refractive results, says Spanish specialist
New toric IOL corrects high corneal astigmatism after cataract surgery, Austrian study reveals
IVF children run increased risk of developing
retinoblastoma, claim Dutch researchers
Suture-free DLEK preserves corneal surface topography and ensures faster wound healing
The day I said goodbye to cataracts and hello to the world without glasses
Retina specialists and trauma ophthalmologists
prepare to trade notes at joint Hungarian conference
Night blindness casts bogeyman into the shadows
Erbium laser phaco requires longer time but less energy for moderately hard cataracts
FEATURES
From The Editor
Reflections on Refractive Surgery
In Your Good Books
Bio-ophthalmology
In The Driving Seat
Prime Site
The Collector's Eye
Regulatory Matters



Erbium laser phaco requires longer time but less energy for moderately hard cataracts

Stefanie Petrou-Binder MD in Berlin

The protective endothelial effect of erbium laser phacoemulsification (ELP) has been proven to provide increased safety over the ultrasound method, as well as a high degree of efficacy, according to the latest clinical trial results reviewed at the Congress of the German Society of Ophthalmology.

In order to attain FDA certification of its erbium:YAG laser (Phacolase), Carl Zeiss Meditec (Germany) initiated a prospective, randomised multi-centre trial that included six US and one German study centre.
Helmut Höh MD presented the preliminary results of 113 out of the 150 study eyes, of which 89 were treated with ELP and 24 underwent ultrasound phaco (USP). All study participants showed visual acuity values of 0.4 or better at the three-month follow-up visit.
The researchers noted that central corneal thickness increased by 1.6% as a result of ordinary phacoemulsification. By contrast, corneal thickness was reduced by –0.1% following ELP.

Endothelial cell loss was 1.9% and 1.7% in the ELP and USP groups, respectively. One patient had posterior capsule rupturing following ELP. Another ELP patient developed posterior capsular fibrosis. Cystoid macular oedema (CMD) was not evident in any of the patients.
“The pilot study established that the erbium laser phacoemulsification method had a protective endothelial effect compared to the ultrasound method employed so far for lens phacoemulsification, affording increased levels of safety and efficacy,” Dr Höh said.
He noted that the results of the pilot study were corroborated by a study involving more than 1,000 eyes carried out in conjunction with Dr Frano, a colleague in Neubrandenburg. They compared erbium laser phacoemulsification to standard ultrasound phacoemulsification.

In that trial, one surgeon performed cataract surgery with the use of both the ELP and USP systems. The surgeon operated on 1,024 eyes (857 patients) by ELP.
He also performed standard phacoemulsification on 409 eyes of 330 patients. All patients underwent identical procedures including the same clear corneal cuts, phacoemulsification-chop technique and implantation of flexible IOLs.
The investigators recorded the phacoemulsification time and energy required in both procedures. The study revealed the times were proportionate to the hardness of the lens.
They ranged from 0.7 seconds to 7.5 seconds (USP/ELP) in soft lenses to 68.9 seconds to 232 seconds (USP/ELP) in the hardest lenses. Laser required from seconds to minutes longer than standard phacoemsulsification, depending on the lens hardness, Dr Höh reported.

The energy expenditure by contrast was higher in the ultrasound procedures. For soft lenses, the energy required ranged from 0.9 J for the laser to 7.2 J for standard phacoemulsification.
The hardest lenses required 176.6 J for laser and 688.6 J for regular phacoemulsification. The complication rates were the same for both methods.
“Although the time required for phacoemulsification was seconds to minutes longer with the use of the erbium laser method, it also required less energy to be transmitted to the eye. We therefore deem this method to be extremely safe and effective for lens hardness up to 2.5,” he said.

Helmut Höh MD
Neubrandenburg Eye Clinic, Neubrandenburg, Germany
Email: aug@dbk-nb.de

Top