Laser-Mediated Cataract Emulsification a Major Advance

Brian Hoyle

October 24, 2011

October 24, 2011 (Orlando, Florida) — A new study has provided strong evidence of the increased safety and effectiveness of laser-mediated emulsification of cataracts, compared with the current method choice, phacoemulsification. The study was presented here at the American Academy of Ophthalmology 2011 Annual Meeting

"In clinical practice, surgeons expect safer, faster cataract surgery when laser pretreatment is performed before cataract removal. The combination of precision and simplification that is possible with the femtosecond laser represents a major advance for this surgery," said William Culbertson, MD, from the Bascom Palmer Eye Institute, University of Miami, Florida.

The approach uses femtosecond laser technology, which delivers near-infrared light to create precise subsurface cuts at depths that are greater than are possible using conventional approaches. Although it is approved by the US Food and Drug Administration, the procedure is not widely used in the United States.

Dr. Culbertson and colleagues investigated how the use of the femtosecond laser influenced the subsequent use of ultrasound to soften cataracts, enabling their suction removal. The study was driven by the need to lessen the use of ultrasound, given that ultrasound-associated complications can hinder recovery and/or cause cornea problems.

The prospective randomized controlled trial examined 29 patients who received femtosecond laser cataract surgery in one eye, which involved laser capsulotomy, laser lens fragmentation (in which the lens was split into sections and softened by etching a horizontal–vertical cross-hatch pattern on the surface), ultrasound emulsification, and aspiration of the emulsate. The other eye of each patient was treated using the standard phacoemulsification procedure, which involved manual incision, ultrasound emulsification, and aspiration.

The laser-treated eyes required 45% less ultrasound energy to achieve cataract removal than the conventionally treated eyes. Also, surgical manipulation, assessed by determining the number of "active phaco steps," was reduced in the laser-treated eyes, compared with the eyes receiving conventional phacoemulsification. This reduction led to the use of less ultrasound energy.

The laser was used to make horizontal and vertical cuts. Although this prolongs the procedure, it can be advantageous because it fractures the cataract into segments, which are more readily removed, making the surgery safer, Dr. Culbertson observed.

One limitation of the study, he cautioned, is that it only involved cataracts graded 1 to 4. The results are therefore not applicable to less commonly encountered cataracts.

"We can be confronted by a posterior plate of varying density. Patients can think that the plate is homogenous in density. This is a great solution to the treatment," said Stephen Slade, MD, from Slade & Baker Vision Center in Houston, Texas.

Dr. Slade is a believer in the technique, and describes it as "the single-most significant advancement in cataract surgery in the last 40 years."

Dr. Culbertson reports relationships with Abbott Medical Optics, Alcon Laboratories, Carl Zeiss Meditec, Hoya Surgical Optics, and Optimedica. Dr. Slade reports relationships with Akon Laboratories, AMO, Foresight Labs, and RVO.

American Academy of Ophthalmology (AAO) 2011 Annual Meeting: Abstract PA003. Presented October 23, 2011.

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