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

Indications and Contraindications

Dr. Steinert: I am hearing at the meetings and from you and others that there are some very special indications for using the laser, which you believe really made things better.

Dr. Dick: There are a lot of contraindications currently, if you look at the menus of the laser platforms. These contraindications are the indications for femtosecond laser -- for example, small pupils. We have shown and shared the surgical technique for this. If the lens is already prefragmented and you are just aspirating. During my last 400 cases, I aspirated only; I did not use ultrasound. The small pupils come with pseudoexfoliation, intraoperative floppy iris syndrome, and many other pathologies, so they are challenging. These eyes benefit most -- small pupils -- intumescent cataracts, for example. You go into the eye first, inject some ophthalmic viscosurgical device (OVD) so there is some resistance in the anterior capsule, and then you fire the capsulotomy. It's all about the capsulotomy in these fluid milky lenses. It's easier to do these cases, and also on corneal guttata eyes. I saw the differences. When using aspiration only or minimal or no ultrasound, the cornea looks better and clearer on the day of surgery. In children, everybody knows how great the elasticity of the capsular bag is and how hard it is at times to prevent an extension of the capsule.

Dr. Steinert: Exactly.

Dr. Dick: You need a little correction factor, and we are working on that, because the capsulotomy is a little larger than you fired. It depends on age and the elasticity behind it. We have done 20 eyes now with great success, and these eyes benefit because we can do the anterior capsulotomy and align the posterior capsulotomy according to the anterior. This provides many options.

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