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Purpose: To analyze the impact of learning curve on operating room (OR) times, femtosecond laser times, procedure time (time for laser and non-laser steps combined), and surgical time (procedure time minus transfer and preoperative times) during transition to femtosecond laser-assisted cataract surgery (FLACS) and comparison with conventional phacoemulsification., Methods: In this retrospective, comparative case series, patients undergoing FLACS by an experienced surgeon between November 2012 and June 2014 were reviewed using the Catalys Precision Laser system (Abbott Medical Optics, Santa Ana, CA). The cohort was divided into five sequential groups of roughly equally sized cohorts (n = 33 for groups 1 to 4, n = 34 for group 5) and temporal change in surgical times was compared. For controls, 50 consecutive patients who underwent phacoemulsification concurrently were reviewed., Results: There were 166 eyes evaluated that underwent FLACS. Femtosecond laser time shortened through the first three groups (group 1: 4.37 minutes vs group 3: 3.37 minutes, P < .05) but plateaued thereafter (group 4: 3:43 minutes, group 5: 3:35 minutes, P > .05). Total FLACS OR time reduced through sequential groups (group 1: 44 minutes vs group 5: 34 minutes, P < .001). Procedure time reduced from 33 (group 1) to 23 (group 5) minutes (P < .001). However, surgical and total OR time for group 5 (0:17 ± 0.02 and 0:34 ± 0:04 minutes, respectively) remained longer than phacoemulsification (0.14 ± 0:04 and 0:29 ± 0:05 minutes, respectively, both P < .05)., Conclusions: Despite significant reduction in OR times with increasing surgeon experience, FLACS required longer overall procedure times and surgical times compared to phacoemulsification, even when approaching 200 cases. Surgeons and institutions should budget for increased surgical times and associated costs when transitioning to FLACS. [J Refract Surg. 2016;32(5):311-317.]., (Copyright 2016, SLACK Incorporated.)

Purpose: To describe a surgical technique and intraoperative modifications to create a secondary capsulotomy using the femtosecond cataract laser in an eye with traumatic aphakia and aniridia., Methods: The expanded use of the femtosecond cataract laser (Catalys Precision Laser System; Optimedica, Sunnyvale, CA) for creation of a well-centered and circular secondary capsulotomy in the capsular remnants of an eye with traumatic aphakia and aniridia., Results: Using software modifications based on intraoperative anterior segment spectral-domain optical coherence tomography imaging, and customizing the capsulotomy settings, the femtosecond cataract laser was able to penetrate through most of the fused anterior and posterior capsular leaflets and a circular capsulotomy was achieved. The latter permitted optic capture and excellent centration of a three-piece intraocular lens placed in the sulcus with good postoperative visual rehabilitation., Conclusion: The femtosecond cataract laser can be customized to create a well-centered and circular secondary capsulotomy in aniridic and aphakic eyes where optic capture is critical for long-term intraocular lens stability., (Copyright 2014, SLACK Incorporated.)

Purpose: To describe the clinical stages and management of Achromobacter xylosoxidans keratitis with post-LASIK epithelial ingrowth in two patients., Methods: Retrospective chart review., Results: Both patients had been treated with topical antibiotics and corticosteroids for several weeks prior to presentation. Examination at presentation revealed significant areas of epithelial ingrowth without signs of acute inflammation, prompting an erroneous initial diagnosis of recurrent corneal erosion. A corneal infiltrate was eventually observed and A. xylosoxidans was cultured from both patients. Clinical resolution occurred with treatment consisting of topical fortified antibiotics. In one patient, the flap was lifted to obtain cultures and irrigate the stromal bed with fortified antibiotics., Conclusions: Post-LASIK epithelial ingrowth may have served as a risk factor for A. xylosoxidans infection. Classic signs of infectious keratitis were absent, delaying the diagnosis. Three clinical stages described herein may assist the clinician with diagnosis and customized management obviating the need for penetrating keratoplasty., (Copyright 2013, SLACK Incorporated.)