An Innovative New Instrument for Femtosecond Laser-Assisted Cataract Surgery

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Hello, I’m Dr. Jason Brody of Atlanta, Georgia. I am a board-certified ophthalmologist specializing in cataract and refractive surgery, and have been in private practice for 10 years.

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I began doing femtosecond laser-assisted cataract surgery in the fall of 2014, and like many surgeons I was initially both cautiously optimistic about it and keenly aware of the potential drawbacks associated with it.

Specifically, I understood that femtosecond cataract cases may require new and additional instrumentation and take significantly more time than a traditional cataract case, and that I may have to alter several aspects of my surgical technique.

I asked around amongst my colleagues and our local laser representatives for advice on “the state of the art” as far as instruments and techniques, and for pearls to help me achieve early success with the laser. I quickly realized that both my excitement and my concerns were justified.

While my outcomes were generally excellent, the procedure felt somewhat clumsy and inefficient, partly due to the inevitable learning curve and partly due to the lack of Femto instruments available.

For example, there were only 2 instruments available designed to open laser incisions, and neither worked as well as I hoped. I felt that the Slade spatula was too small and required extra effort to open the wounds, and the Eippert spatula was too big and bulky.

Both instruments required multiple hand-offs between my assistant and I, which reduced efficiency. The epithelium around the wound seemed to be more disputed than I preferred as well, which made the incisions harder to seal at the end of the case.

The initial steps of my early femtosecond cataract surgery cases were as follows:

  1. Use a Slade or Eippert spatula to open the secondary incision.

  2. Hand off the spatula, pick up a lidocaine-filled TB syringe with a 27g cannula, inject into the anterior chamber (assuming the wound is open adequately, otherwise repeat #1).

  3. Hand off the lidocaine, pick up the viscoelastic, inject viscoelastic into the anterior chamber.

  4. Hand off the viscoelastic, pick up the spatula again, open the primary incision.

When I do a traditional cataract surgery, I am always thinking about efficiency of movement, fewer instrument hand-offs, fewer passes into and out of the eye, and overall safety.

With those goals in mind, I set out to create a new instrument for femtosecond cataract cases that combined several of the above steps to improve efficiency, reduce surgery time, and simplify the surgery.

Working closely with Accutome, I designed the Brody Dissecting Cannula for femtosecond cataract surgery, a disposable 25g stainless steel cannula that both easily opens laser incisions and allows for fast, efficient injection of intraocular lidocaine and/or viscoelastic.

This elegant device is placed either on a TB syringe filled with lidocaine or directly on the viscoelastic syringe (for those not using intraocular anesthetic). The shovel-like tip allows the surgeon to smoothly and effortlessly open the secondary incision, while instantaneously injecting lidocaine into the anterior chamber.

After withdrawing the cannula, either the surgeon or the assistant can transfer the cannula to the viscoelastic syringe, which is then injected through the sideport into the anterior chamber. After withdrawing the cannula, the surgeon simply moves to the primary incision and opens it with the cannula, again with minimal effort.

The surgical steps using the Brody Dissecting Cannula are summarized as follows:

  1. The cannula (placed on a lidocaine-filled TB syringe) is used to open the secondary incision and lidocaine is then injected into the anterior chamber.

  2. The cannula is transferred to the viscoelastic syringe, and viscoelastic is injected into the anterior chamber through the secondary incision.

  3. The cannula is withdrawn and then used to open the primary incision.

The entire process of opening both incisions, and injecting both lidocaine and viscoelastic takes under 30 seconds. To be able to open both laser incisions, anesthetize the eye, and stabilize the anterior chamber with viscoelastic in under 30 seconds is comparable, if not in some cases better than, traditional cataract surgery.

The incisions are opened cleanly and completely, without distorting, stretching, or struggling. Further, the incisions close easily and tightly at the end of the case, owing to the maintenance of the surrounding epithelium and lack of excessive manipulation during the procedure.

Since I began using this new cannula, I have significantly reduced my operating time for femtosecond cases, reduced clutter on my Mayo stand, improved the appearance of the wounds at the end of my cases, and generally felt more confident that my laser incisions will both open and close easily and completely. It allows me to get through the initial steps of the surgery with minimal alteration of my surgical technique – it feels “natural” – very similar to a traditional cataract case.

In summary, I believe that the Brody Dissecting Cannula will benefit surgeons and patients alike by reducing surgery times, improving efficiency, and simplifying the procedure. It maintains excellent laser incision architecture and facilitates smooth, easy opening and closure of laser incisions.

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