Refractive Lens Surgery

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25 CORE MESSAGES AMO Sovereign with WhiteStar Technology Richard S. Hoffman, I. Howard Fine, Mark Packer 2 The addition of WhiteStar technology to the Sovereign machine reduces thermal escalation at the wound while maintaining the cutting efficiency seen with continuous-mode ultrasound and improving nuclear fragment followability. 2 Markedly reduced thermal energy at the incision site allows for safe bimanual microincision phacoemulsification without the need for a cooling irrigation sleeve. 2 The Sovereign Compact maintains many of the desirable features of the Sovereign. The reduced cost of the Sovereign Compact and its easy portability should make it a competitive phacoemulsification unit in today’s market. One of the more advanced and versatile phacoemulsification machines on the market today is the AMO Sovereign (Advanced Medical Optics, Santa Ana, CA). The Sovereign offers all of the traditional features of phacoemulsification machines and has been recently upgraded with the addition of WhiteStar technology. WhiteStar is a new technology in that an ultrapulse mode is able to modulate the delivery of energy by changing both the duration and the frequency of ultrasonic vibrations. Energy is delivered in extremely brief, microsecond bursts, interrupted by rest intervals. The burst length and rest period can be varied independently of each other, yielding numerous modes of varying duty cycles to choose from (Fig. 25.1). The addition of WhiteStar technology to the Sovereign machine reduces thermal escalation at the wound while maintaining the cutting efficiency seen with continuousmode ultrasound and improving nuclear fragment followability [1]. Reduced thermal energy results from the ultrashort delivery of energy and the interval rest period.Despite the short bursts of energy, each pulse of WhiteStar ultrasound has been demonstrated to deliver similar cutting ability as that delivered with continuous-mode ultrasound. This has been demonstrated by Dr Mark E. Schafer, wherein the acoustical energy of WhiteStar pulses was transposed into electrical signals using a transducer. Similarly, the acoustical signal of continuous-mode phacoemulsification was
228 R.S. Hoffman · I.H. Fine · M. Packer also recorded and compared to WhiteStar pulses. Each pulse of WhiteStar was found to have a larger electrical signal and overall greater amounts of energy delivered despite the rest period following the pulse (Fig. 25.2). It is postulated that the greater amounts of energy delivered with WhiteStar stem from the type of cavitational energy created. In traditional ultrasound, the vacuum created in front of the phacoemulsification tip by rapid compression and expansion of the tip causes gases in the aqueous to come out of solution. Subsequent rarefaction and compression waves from the phacoemulsification tip will cause these gas bubbles to expand and contract until they eventually implode, releasing intense energy (Fig. 25.3). Fig. 25.1. Ten energydelivery modes available on the Sovereign exhibiting both lower and higher duty cycles (duty cycle = burst time/s). (Photo courtesy of Advanced Medical Optics) Fig. 25.2. Acoustical energy of WhiteStar pulses (red) and continuous ultrasound (blue) transposed into electrical signals. Note each WhiteStar pulse delivers more energy than continuous ultrasound. (Photo courtesy of Advanced Medical Optics) Two types of cavitational energy have been proposed to develop – transient and stable cavitation. With transient cavitation there is violent bubble collapse, releasing high pressures and temperatures in a very small region. In order to create transient cavitation, the tip must reach a threshold driving waveform pressure to create gas bubbles of the correct size. This threshold driving waveform pressure is generated with WhiteStar technology. With stable cavitation, there is a continuous process of small gas bubbles oscillating and collapsing without achieving the full violent collapse that is achieved with transient cavitation. With continuous ultrasound, the very initial delivery of energy is transient cav-
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Refractive Lens Surgery I. H. Fine
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Editors I. Howard Fine, MD Mark Pac
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Preface The first recorded time a h
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X Contents Chapter 14 AcrySof ReSTO
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Contributors Jorge L. Alio, MD, PhD
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1 The Crystalline Lens as a Target
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2 CORE MESSAGES Refractive Lens Exc
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na that have been observed with som
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piration through two separate incis
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6 R.S. Hoffman · I.H. Fine · M. P
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8 R.S. Hoffman · I.H. Fine · M. P
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10 R.S. Hoffman · I.H. Fine · M.
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12 M. Packer · I.H. Fine · R.S. H
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22 J.T. Holladay 4.1 Introduction T
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24 J.T. Holladay but only seven pre
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26 J.T. Holladay from morning to ni
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28 J.T. Holladay 4.3.2.2.3 Corneal
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30 J.T. Holladay rienced this condi
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32 J.T. Holladay many of these pati
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34 J.T. Holladay IOL eRx V 1336 =
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36 J.T. Holladay raised. A more tho
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38 J.T. Holladay rior segment laser
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40 D.D. Koch · L.Wang corneal refr
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42 D.D. Koch · L.Wang Table 5.1. M
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44 D.D. Koch · L.Wang Fig. 5.4. Nu
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46 D.D. Koch · L.Wang Fig. 5.5. Ce
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48 D.D. Koch · L.Wang ∑ Double-K
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50 L.D. Nichamin surgeon the abilit
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52 L.D. Nichamin Table 6.1. The Nic
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54 L.D. Nichamin 3.2 mm, its neglig
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56 L.D. Nichamin Fig. 6.4. The Nich
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58 L.D. Nichamin References 1. Anon
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60 S. Bylsma aphakic state. In cont
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62 S. Bylsma length),underwent full
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64 S. Bylsma K-Astigmatism
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66 S. Bylsma STIOL in the reversed
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68 S. Bylsma about the dynamics at
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8 Correction of Keratometric Astigm
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Fig. 8.2. AcrySof toric IOL implant
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Fig. 8.3. Mean absolute residual cy
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References 1. Hoffer KJ (1980) Biom
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10 The Eyeonics Crystalens Steven J
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Fig. 10.3. Under binocular conditio
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Fig. 10.6. Anterior movement of the
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Fig. 10.7. One- and 3-year data fro
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10.6 Postoperative Considerations C
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10. Dell SJ (2004) Objective eviden
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100 N.X. Nguyen · A. Langenbucher
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12 CORE MESSAGES Synchrony IOL H. B
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Fig. 12.1. The single-piece silicon
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12.5 Clinical Results Clinical tria
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Fig. 12.6. Retroillumination photog
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References 1. Fisher RF (1973) Pres
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124 F.M. Sarfarazi 13.1 The Nature
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126 F.M. Sarfarazi Fig. 13.4. Lens
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128 F.M. Sarfarazi Fig. 13.5. Mecha
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130 F.M. Sarfarazi Fig. 13.9. Secon
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132 F.M. Sarfarazi Fig. 13.14. Sche
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134 F.M. Sarfarazi Fig. 13.18. Work
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136 F.M. Sarfarazi References 1. Ma
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138 A. Mirshahi · E.Terzi · T. Ko
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15 The Tecnis Multifocal IOL Mark P
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Fig. 15.1. The Alcon AcrySof multif
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Fig. 15.4. Multifocal vs. monofocal
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16 Blue-Light-Filtering Intraocular
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Fig. 16.2. Cultured human RPE cells
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tion to benefiting from less exposu
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16.7 Blue-Light-Filtering IOLs and
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15. Marshall J, Mellerio J, Palmer
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17 CORE MESSAGES The Light-Adjustab
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Fig. 17.2 a-c. Cross-sectional sche
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17.4 Animal Studies Dr. Nick Mamali
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Fig. 17.8. A laser interferogram (l
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enhanced visual function that remai
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13. Mather R, Karenchak LM, Romanow
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Page 190 and 191: 184 S. Norrby Koopmans et al. [28]
Page 192 and 193: 186 S. Norrby 40. De Groot JH, Zuru
Page 194 and 195: 188 L. Nordan · M. Morris regular
Page 196 and 197: 190 L. Nordan · M. Morris produce
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Page 202 and 203: 5. Tsuneoka H, Shiba T, Takahashi Y
Page 204 and 205: 200 J.L. Alio · A. Galal · J.-L.R
Page 212 and 213: 22 CORE MESSAGES The Infiniti Visio
Page 214 and 215: Fig. 22.3. The AquaLase handpiece u
Page 216 and 217: 23 CORE MESSAGES The Millennium Ros
Page 218 and 219: Fig. 23.1. Bausch & Lomb’s new cu
Page 220 and 221: Fig. 23.2. Advanced flow system car
Page 222 and 223: Fig. 23.5. Pulse or burst mode with
Page 224 and 225: 24 CORE MESSAGES The Staar Sonic Wa
Page 226 and 227: Fig. 24.2. The tip undergoes compre
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Page 232 and 233: Fig. 25.3. Schematic diagram of cav
Page 234 and 235: the Sovereign Compact (see Fig. 25.
Page 236 and 237: 234 M. Packer · R.S. Hoffman · I.
Page 238 and 239: 27 Conclusion: The Future of Refrac
Page 240 and 241: 240 Subject Index Contrast sensitiv
Page 242 and 243: 242 Subject Index P Pachymetry 53,
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