COMMENTARY

Femtosecond Laser: Why We Need It for Cataract Surgery

American Academy of Ophthalmology 2013

Roger F. Steinert, MD; H. Burkhard Dick, MD, PhD

Disclosures

November 22, 2013

In This Article

Good Results With Femtocataract Surgery

Dr. Steinert: Tell us about standard results and then about special cases.

Dr. Dick: We conducted a randomized intraindividual comparator trial because I am interested in the evidence base behind all of this. It turned out that inflammation was a little less, and the best corrected visual acuity for the first week was better than with standard care. We performed one eye with standard surgery and the other with femtosecond cataract surgery in the same patient.

Endothelial cell loss was comparable. It was a little bit less in the femto group. Of course, we found a tremendous reduction in effective phacoemulsification time because of the fuller fragmentation that the laser offers. It lases outside of the capsulotomy from the inferior to the entire part. My complication rate is extremely low with this laser. On a prospective scale, we are high-definition videotaping the procedure, and another medical doctor documents everything. We found a 0.16% rate of anterior as well as posterior capsular tears.

Dr. Steinert: All capsular tears? Front and back? A rate of 0.16% is quite different from the initial report with users of a different platform in Australia, which created quite a sensation.

Dr. Dick: Yes, right.

Dr. Steinert: Do you have special maneuvers that allow you to not have, for example, gas pressure rupturing the posterior capsules?

Dr. Dick: These are different lasers, and different lasers have different approaches. They have different numerical apertures and use different energy, and the fragmentation is different. We found that we can do a hydrodissection as usual, meaning that we don't have difficulties with aspiration, for example. It's all about taking care around it, because if there is movement (for example, the patient breathes or the eye moves) you need to take care of the patient. I say to the patient, "Breathe in, stop," like when taking an x-ray, and then I do the lasing which takes about less than 2 seconds. The lasing of the capsulotomy is the most critical issue. The detection of the surfaces is automatic -- you just confirm it -- it's on 3D spectral domain optical coherence tomography (OCT), so it's extremely precise.

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