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Surgical Innovations: When the Enemy of Good is Better

January 19, 2010

This week is the annual  Hawaiian Eye Meeting.  This is an excellent eye meeting held at an awesome location.  According to their web site:

At Hawaiian Eye 2010, you can learn from more than 80 of the ophthalmic
community’s foremost experts. Speakers will use their clinical
experience and subspecialty expertise to provide you with new
information and fresh perspectives on the practices and procedures you
use most. You’ll be learning directly from the source – the researchers
and specialists revolutionizing today’s ophthalmic techniques to
improve patient care.

Although I am not attending this year's meeting, I do receive daily updates through Occular Surgery News. Today I received information concerning a lecture titled: Primary posterior capsulotomy a viable option for multifocal IOLs in hyperopes.  According to the article:

Primary posterior capsulotomy with IOL optic buttonholing is a
tricky surgery but can have excellent outcomes when implanting
multifocal IOLs in hyperopes, a surgeon said here.
"I use primary posterior capsulotomy in hyperopes to avoid secondary
cataract and decentration," Michael C. Knorz, MD, said in a
presentation at Hawaiian Eye 2010.

This is the perfect of taking a straightforward surgical procedure and making it a very difficult procedure with a much higher complication rate!  The doctor in this article is trying to minimize 2 relatively insignificant complications of refractive cataract surgery:

  1. After cataract surgery there is a 20% incidence of getting a clouding of a capsule we leave in the eye.  If this occurs, it is easily treated with a simple laser procedure called a YAG capsulotomy.
  2. There is a slight chance of decentration of the refractive IOL.  If it is mild, nothing needs to be done as there is no effect on vision.  If the decentration does effect vision, the implant can be repositioned easily through surgery, or the pupil can be moved with a laser treatment.

So, in trying to minimize these 2 easily treated sequalae, this doctor is advocating a procedure of placing a hole in the capsule at the time of surgery and trapping the implant in the hole.  With this new complications can be expected:

  • increased retinal detachment
  • increased inflammation of the macula (CME)
  • increased vitrectomy (removal of the jelly in the back of the eye)
  • dislocation of IOL

As a surgeon, we need to be wary of innovations that purport to improve outcomes.  Many times these solutions have inherent risks which far exceed the risks of those procedures they claim to improve upon!

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