Percepcao do laser de femtosegundo
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Cirurgia de Catarata a Laser em 2013
Wallace Chamon
Adjunct Professor
Department of Ophthalmology & Visual
Sciences
College of Medicine
University of Illinois at Chicago (UIC)
UICUNIVERSITY OF ILLINOIS
AT CHICAGO
Professor Adjunto
Departmento de Oftalmologia
EscolaPaulista de Medicina (EPM)
Universidade Federal de São Paulo
(UNIFESP)
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Declaração de Conflito de Interesses
O apresentadordeclara as
seguintesrelaçõescomerciais:
Nenhuma
Código de Ética Médica (17 de setembro de 2009)
Resolução da Diretoria Colegiada - RDC 96/2008 - ANVISA
Resolução 1.595/ 2000 - Conselho Federal de Medicina
Resolução 196/96 - Conselho Nacional de Saúde
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Mudanças
• Intracapsular
• Não Implante LIO
• Ceratômetro
• RK
• Extracapsular
• Microcerátomo
• Faco
Extracapsular
Implante de LIO
Topógrafo
Excimer
Faco
Femtosegundo
Femtosegundo?
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Femtosegundo em
Refrativa
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Preço Médio em Refrativa
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Média de Aumento por
Olho
Preço Prévio:
US$$ 1.900,00 ou R$ 3.420,00
Média de Aumento:
US$ 394,00 ou R$ 709,00
Preço Final Médio
US$ 2.294,00 ou R$ 4.130,00
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Lucro Bruto em Refrativa*
* Sem Considerar a Depreciação
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O Mais Importante...
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Escolha por Femtosegundo em
Refrativa
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Mercado de Catarata Refrativa
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Centralização das Incisões
CentralizaçãodaRéxiseFratura
Determinação dos LimitesdaCápsula Anterior
Determinação do Limite Anterior daFratura
Determinação do Limite Posterior daFratura
Localização dos Limites das Incisões
DeterminaçãodaArquiteturadaIncisão Principal
DeterminaçãodaProfundidade das IncisõesArqueadas
Início do Tratamento
Réxis
Fratura
Arqueadas
Incisão Principal
Paracentese
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Fatos
As incisões e a réxis são mais rápidas com o laser
A movimentação do paciente torna o procedimento mais
lento
A Facomeulsificação não é mais rápida após o laser
Idealmente, 2 cirurgiões com 1 laser e 2 salas cirúrgicas
deveriam atuar conjuntamente
O Procedimento é mais reprodutível com o laser
O procedimento pode ser mais seguro com o laser (?)
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Dificuldades
Adaptação com o software
Abertura das Incisões
Réxis incompleta
Lidando com a Cavitação Posterior
Espaço para a Quebra do Núcleo (Slicer)
Remoção do Córtex na Cápsula Anterior
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PostOp OCT image of LenSx
Courtesy of Jose de la Cruz, MD
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Capsulorréxis Perfeita
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Segurança Endotelial
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Catalys
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LenSx - Alcon
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Victus - Baush&Lomb
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Lensar
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Catalys - Optimedica
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Comparações
LensSx Victus LensAR Catalys
Alcon B&L LensAR Optimedica
OCT OCT Scheimpflug OCT
USA Alemanha USA USA
FDA / BR FDA / BR CE FDA
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Custos Aproximados
US$ 500.000 a 700.000 de custo na compra
US$ 500 custo por procedimento
US$ 1.500 Sobretaxa para o paciente
600 Cirurgias para amortizar o investimento
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