Laser-Assisted Cataract Surgery

Benefits and Barriers

Kathryn M. Hatch; Jonathan H. Talamo

Disclosures

Curr Opin Ophthalmol. 2014;25(1):54-61. 

In This Article

How the Femtosecond Laser Works?

The FSL cuts its target through photodisruption, a process in which light is absorbed by a nonopaque structure through which infrared light can penetrate, allowing for the generation of a plasma of free electrons and ionized molecules that rapidly expand, collapse, and create microcavitation bubbles.[2] An acoustic shock wave is produced which separates and incises the target tissue.[3,4] In contrast with historical Nd:YAG laser technology using longer pulse durations, the microcavitation bubbles produced with FSL are much smaller, allowing for reduced collateral damage.[3]

FSLs have been in use for corneal surgery for over a decade.[5,6] This was possible because of the proximity of optically clear corneal tissue to the laser delivery system along with the ability to stabilize the globe and deliver precise, localized treatment to corneal stroma using low fluence settings without sophisticated image guidance. With the emergence of image guidance systems such as high-resolution OCT[7] (Fig. 1) with sophisticated image processing and coupling devices to achieve better globe stabilization and optics within the anterior segment,[8] precise treatment of the lens and lens capsule are now not only possible, but also highly effective.

Figure 1.

High-resolution OCT. Reproduced by courtesy of OptiMedica (Sunnyvale, California, USA).

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