Femtosecond Cataract Surgery Research Articles

Accuracy of the LaserArcs Femtosecond Cataract Surgery Arcuate Incision Nomogram in Patients Undergoing Cataract Surgery and Astigmatism Reduction.

The purpose of this study is to evaluate the efficacy and safety of the laserarcs.com nomogram in reducing astigmatism among cataract patients that underwent astigmatism reduction with laser arcuate incisions. In this retrospective study, 50 patients who underwent uncomplicated cataract surgery with laser arc incisions for the reduction of astigmatism with a single surgeon between the dates of January 23, 2021 and February 10, 2022 were evaluated in a single eye. Preoperative astigmatism was determined on the basis of keratometry from biometry (IOLmaster, Carl Zeiss Meditec or LenStar LS900, Haag-Streit, Bern, Switzerland) and was compared to the postoperative manifest astigmatism. The percent change in the absolute magnitude of astigmatism was calculated along with the percent of patients with various levels of postoperative astigmatism. Mean cylinder was 0.97 ± 0.49 D pre-op and 0.21 ± 0.28 D postop. Mean reduction in cylinder was 81.4 ± 47.7% (P < 0.00001, one-sample t-test compared to a hypothetical 60% reduction in cylinder). Residual cylinder was ≤0.5 D in 90%, 0.25 D in 72%, and 0 D in 58%. Postoperative uncorrected visual acuity was 20/30 or better in 92% and 20/20 or better in 40%. Subgroup analysis showed that residual astigmatism was not affected by patient age, magnitude of preoperative astigmatism, preoperative spherical equivalent, or corneal curvature. No adverse events related to the laser arcuate incisions were noted. Use of the LaserArcs nomogram yielded a significant reduction in preoperative astigmatism. Postoperative uncorrected visual acuity was substantially similar to best-corrected visual acuity, suggesting that many patients undergoing treatment will function without correction for distance tasks.

Which intraocular lens would ophthalmologists choose for themselves?

Contemporary cataract surgery is increasingly customizable with the advent of presbyopia-correcting intraocular lenses (IOLs) and the femtosecond laser. The purpose of this study was to determine the types of IOLs ophthalmologists choose for themselves and whether demographic characteristics, surgical experience, and attitudes of ophthalmologists might influence their decision-making. Additional goals included evaluating the use of femtosecond laser use in cataract surgery and investigating surgeon IOL preferences for their patients. We distributed a 29-question Survey Monkey survey to senior ophthalmology residents and practicing ophthalmologists and received 347 responses during a 1-month period. We analyzed 328 surveys using chi-square tests and Fisher's exact tests. Main outcome measures included surgeons' personal preferences for choice of IOL, femtosecond laser-assisted cataract surgery, and IOL preference for patients. In the setting of no astigmatism, 61.3% of respondents would choose a monofocal IOL set for either distance or monovision for their own surgery. For corneal astigmatism >1.25 D, 60.3% of respondents would choose a toric monofocal lens and only 6.9% would want a femtosecond laser or manual LRI for their own surgery. Of the respondents, 34.6% perform femtosecond laser-assisted cataract surgery, but only 15.3% would want femtosecond cataract surgery performed on themselves. Also, 67.7% implant presbyopia-correcting IOLs (diffractive echelette, multifocal, or accommodative). When correcting for patients' corneal astigmatism >1.25 D, 65.7% of respondents preferred a toric monofocal IOL. Ophthalmologists value quality of vision and are risk averse. Overall, a surgeons' personal preference for their own surgery is correlated with past surgical experience with patients.

New developments in femtosecond cataract surgery

ABSTRACTIntroduction: About ten years ago, the femtosecond laser was introduced into cataract surgery. Since then, laser cataract surgery (LCS) has been embraced by a large number of ophthalmic surgeons. First believed to be a procedure benefitting only a number of patients looking for perfect postoperative vision – usually after the implantation of a premium IOL – it has become a clinical tool for many individuals undergoing cataract surgery after demonstrating its efficacy and safety in many and often complicated cases.Areas covered: This review will present some recent developments like the search for optimal laser settings, surgical measures to prevent posterior capsule opacification (PCO) by employing a widely unknown anatomical structure – or rather: void – in the eye, and new technologies to alter the refractive power of the IOL long after it had been implanted.Expert opinion/commentary: LCS is still developing. It has proven to be safe and effective, particularly the precision and circularity of the capsulotomy have repeatedly been demonstrated. Any comparison with manual cataract surgery as it has developed over the last two decades is a contest between highly successful procedures, probably the most successful in the history of ophthalmology.

Resident surgeon efficiency in femtosecond laser-assisted cataract surgery.

PurposeComparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification.Patients and methodsA retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation.ResultsTotal room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each P<0.05). Mean duration for manual completion of anterior capsulotomy was shorter in the laser group (P<0.001). There were no statistically significant differences in the individual steps of nucleus removal, cortical removal, or intraocular lens placement. Surgical complication rates were not significantly different between the groups.ConclusionIn early cases, resident completion of femtosecond cataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparities of performance. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training.

Avoiding Complications with Femtosecond Cataract Surgery

Many potential complications in laser cataract surgery (LCS) can be avoided by careful patient selection. Patients with kyphosis, restlessness, and massive obesity might profit from other cataract surgery options. Miosis, a problem obviously caused at least in part by the femtosecond laser, can be prevented by preoperatively applying nonsteroidal anti-inflammatory drug (NSAID) eye drops. Intumescent white cataracts should receive a miniature capsulotomy first. To detect capsular tags, a modified dimple-down technique is recommended.

Anterior segment changes after femtosecond cataract surgery measured with optical coherence tomography and scheimpflug imaging technology

PurposeTo determine changes in anterior chamber depth (ACD), iridocorneal angle size (IAS) and central corneal thickness (CCT) using optical coherence tomography (OCT) and Scheimpflug imaging technology (SIT) in subjects implanted with multifocal intraocular lens (IOL) after femtosecond cataract surgery.MethodsProspective study of 36 healthy eyes (68.8 ± 7.9 years) undergoing femtosecond laser assisted‐cataract surgery and AcrySof REsTOR SN6AD1 IOL implantation. The anterior segment parameters were measured preoperatively and 1 month after surgery with the Visante‐OCT (Zeiss) and the Oculyzer™ II (WaveLight® AG) systems. Analysis of agreement and interchangeability of the preoperative 2 systems measurements was performed by the Bland‐Altman method.ResultsAfter femtosecond cataract surgery, the ACD and IAS measured with Oculyzer™ II showed a significant mean increase of 1.54 ± 0.28 mm and 10.2 ± 4.23 respectively. Also, using the Visante‐OCT there was a significant mean increase: 1.27 ± 0.34 mm for ACD and 9.38 ± 6.52 (Temporal) and 8.29 ± 7.13 (nasal) for IAS. CCT showed no significant changes. The range of agreement indicated that the 2 techniques cannot be used interchangeably for preoperative measurement of ACD and IAS.ConclusionsAfter cataract surgery with femtosecond laser, ACD and IAS increased significantly when measured using OCT and SIT. Visante‐OCT and Oculyzer™ II systems can be used interchangeably for CCT evaluation but not for ACD and IAS.

眼科激光手术系统在白内障超乳手术应用中的相应护理

Objective: To explore the principles of perioperative nursing in the patients with LENSXLASER femtosecond laser in phacoemulsification, and to ensure more perfect visual function and less complications after cataract surgery. Methods: To analyze the direction of laser and the accuracy of the 3 - dimensional model, the key steps in the process of the traditional cataract surgery, such as transparent corneal incision, tearing capsule and splitting, were accomplished automatically. Nurses care for patients with specification, and doctors can be assured the pupil. Results: The patients were under the best condition in the surgery through careful perioperative nursing care and skilled to master the use of instruments and equipment. In addition, postoperative observation of the complications and health education, fully guaranteed the femtosecond laser cataract surgery under the expected effect. Conclusion: The skilled use of the instrument and perioperative nursing care play an important role in the precision and safety of femtosecond cataract surgery increases the security and predictability of the surgery, and reduces the loss of endothelial cell, shorten the time of the patient's visual acuity.

The LENSAR® Laser System–fs 3D for Femtosecond Cataract Surgery

The LENSAR® Laser System’s ergonomic design permits flexible functionality in any operating environment. Its low-pressure liquid interface eliminates corneal compression and facilitates accurate and complete capsulotomy construction. The Augmented Reality™ imaging system utilises a variable super luminescent diode for scanning structured illumination to provide high-contrast, high-definition targets, which guide the laser. Real-time imaging adjustments compensate for minute degrees of tissue displacement, permitting unrivalled precision in corneal incision architecture. Precise laser spot application allows fragmentation of all grades of cataract, without the need for unnecessarily large safety margins. Iris registration compensates for cyclotorsion in the construction of arcuate incisions by aligning preoperative corneal biometry to intraoperative imaging. The ability to define the cataract grade intraoperatively facilitates efficient phacofragmentation by permitting surgeon-specified preset patterns for the full range of nuclear densities. The LENSAR Laser System represents the state of the art in femtosecond cataract surgery.

The LENSAR® Laser System–fs 3D for Femtosecond Cataract Surgery

The LENSAR® Laser System’s ergonomic design permits flexible functionality in any operating environment. Its low-pressure liquid interface eliminates corneal compression and facilitates accurate and complete capsulotomy construction. The Augmented Reality™ imaging system utilizes a variable super luminescent diode for scanning structured illumination to provide high-contrast, high-definition targets, which guide the laser. Real-time imaging adjustments compensate for minute degrees of tissue displacement, permitting unrivalled precision in corneal incision architecture. Precise laser spot application allows fragmentation of all grades of cataract, without the need for unnecessarily large safety margins. Iris registration compensates for cyclotorsion in the construction of arcuate incisions by aligning preoperative corneal biometry to intraoperative imaging. The ability to define the cataract grade intraoperatively facilitates efficient phacofragmentation by permitting surgeon-specified preset patterns for the full range of nuclear densities. The LENSAR Laser System represents the state of the art in femtosecond cataract surgery.

Femtosecond cataract surgery: The basic procedure and surgical details

AbstractFemtosecond lasers (FsL) have already proven to be a useful tool to improve efficacy ans safety in cataract surgery. This section of the course will review the basic steps of FsL‐assisted cataract surgery, the learning curve and transition, as well as the different variants and maneuvers of the procedure as compared to traditional phaco.

The more things change, the more they stay the same

Ophthalmologists who started their surgical career with extracapsular cataract extraction (ECCE) may remember the inevitable transition to phacoemulsification cataract surgery. For some individuals, there was the niggling fear that the introduction of the phaco machine would somehow make us less of a ‘surgeon’ and ultimately render surgical skill obsolete. In reality, ophthalmologists acquired a whole new set of surgical skills with phacoemulsification surgery that was no less expert than what we had developed with ECCE. The introduction of femtosecond laser cataract surgery has generated similar philosophical musings amongst cataract surgeons. Would we gradually lose our ability to perform a manual capsulorhexis or to crack the nucleus as we outsource these steps to the laser machine? The answer is that there is little danger of surgeons losing their skills with conventional phacoemulsification. In practical terms, the cost of the technology makes it unlikely to be as widespread or as essential as the phaco machine and will probably remain a premium option for the cataract patient. Furthermore, there will always be eyes where femtosecond cataract surgery would be unsuitable or would encounter difficulties. In their review ‘Femtosecond Cataract Surgery: Transitioning to Laser Cataract’, Dr Gerard Sutton and colleagues (pp. 3–8) find femtosecond cataract surgery to be well tolerated, effective, and a viable alternative to conventional phacoemulsification, but suggest avoiding laser cataract surgery in eyes with corneal opacity or with advanced glaucoma. These are situations that are also highly pertinent in conventional phacoemulsification surgery, and Drs Jonathan Greene and Shazad Mian (pp. 9–14) review the issues with ‘Cataract surgery in patients with corneal disease’, whilst Dr Helen Danesh-Meyer (pp. 15–20) discusses the ‘Incidence and management of cataract after glaucoma surgery’. Drs Dhivya Ashok Kumar and Amar Agarwal (pp. 21–29) also present an excellent review on glued intraocular lenses, which serves as a further reminder that there will always be patients with complex cataracts that will require our surgical expertise. Of course, phacoemulsification was a paradigm shift in how ophthalmologists managed cataracts, and made possible the innovations that surgeons now utilize to optimize the visual function of their patients during cataract surgery. Without the refractive predictability and rapid visual recovery of phaco surgery, ‘Approaches to Corneal Astigmatism in Cataract Surgery’ as reviewed by Dr Jonathan Rubenstein and Dr Michael Raciti (pp. 30–34) would have been much more limited. Similarly, it is fair to say that the advantages of phacoemulsification made presbyopia-correcting intraocular lens much more viable and widespread, so much so that we can now even consider ‘The Role of Presbyopia-Correcting Intraocular Lenses after LASIK’. And the evolution of cataract surgery continues at a rapid pace – Dr William Fishkind (pp. 41–46) analyses the latest technology in use with phaco machines, Dr Pho Nguyen and Dr Vikas Chopra (pp. 47–52) discuss ’Applications of Optical Coherence Tomography in Cataract Surgery’ (including the use of optical coherence tomography-guided femtosecond laser cataract surgery), while Drs Yu-Chi Liu, Tina Wong, and Jodhbir Mehta (pp. 53–59) consider the possibility of using the intraocular lens as a drug delivery reservoir. In the midst of these changes, Drs Jayesh Vazirani and Sayan Basu (pp. 60–65) provide surgeons with a timely update on the use of antibiotics in cataract surgery, whereas Drs Bradley Shoss and Linda Tsai (pp. 66–73) discuss ’Postoperative care in cataract surgery’. Finally, Dr Robert Copeland and Dr Neal Desai remind (pp. 74–78) us that despite all our technological advances, there still remain significant gender and socioeconomic disparities in the access to cataract surgery, both within the United States and in the wider world. It is still too early to predict whether femtosecond cataract surgery will be a great and lasting advance on cataract surgery, as phacoemulsification proved to be over ECCE. What we can say with certainty is that ophthalmologists will find their surgical skill sets expanding, not shrinking, as we learn and adapt to femtosecond laser cataract surgery. Acknowledgements None. Conflicts of interest There are no conflicts of interest.

Cataract Surgery and the LenSx® Femtosecond Laser System

The use of femtosecond laser systems in cataract surgery has been stated to be arguably the single biggest change to the procedure since phacoemulsification. The combination of a controllable high-frequency laser with increasingly advanced ocular imaging technology provides for a surgical precision that is difficult or impossible to duplicate manually. As a new technology, much clinical research is underway to identify best practices, and quantify the benefits of femtosecond cataract surgery. The main measures of interest are improvements in surgical precision, reduced complication rates and lower variability in clinical outcomes compared with manual procedures. The lower variability in outcomes would translate to a higher percentage of patients achieving their desired refractive target after surgery. This article provides an overview of the LenSx® femtosecond laser system, some of the ways in which it is being utilized in cataract surgery, and related surgical/ clinical results recently reported in the peer-reviewed literature.

Femtosecond laser cataract surgery: technology and clinical practice

The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience.

Femtosecond phacoemulsification

PURPOSE FOR REVIEW: Phacoemulsification is the preferred method for cataract surgery in the developed world. The number of phacoemulsification procedures performed annually is expected to increase as the population ages. Femtosecond cataract surgery offers several surgical advantages over conventional phacoemulsification and has already attained commercial application in some countries. The purpose of this review is to outline the benefits, risks and commercial issues of femtosecond lasers as applied to cataract surgery. Cataract surgeons are adopting femtosecond technology to perform laser capsulotomy, lens fragmentation, clear cornea incisions and limbal relaxing incisions. Femtosecond lasers clearly perform these surgical steps with greater precision and reproducibility. Further benefits such as improved postoperative refractive results and reduced complication rates are being investigated. Commercial issues have invariably arisen such as cost of installation and operation, value proposition and return on investment. Femtosecond cataract surgery is an evolving procedure that can potentially lead to better and safer surgical outcomes. This review presents the currently available scientific evidence and discusses some of the relevant financial issues concerning this technology.

The Expanding Spectrum of Refractive Surgery

illustrates that concept better than this month’s issue of the Journal, with articles encompassing nearly every available anterior-segment approach now considered refractive surgery. Among the diverse topics presented herein, the safety and effi cacy of femtosecond cataract surgery, the advanced analysis of subclinical ectatic corneal disease, and the evolution of corneal collagen cross-linking (CXL) techniques provide essential information for all ophthalmologists. Perhaps the hottest topic in ophthalmology currently is femtosecond laser‐assisted cataract surgery. A prime concern about new technologies is that “hype” may speak louder than facts; therefore, surgeons need hard data from which to make educated decisions about this new technology. In this issue, Mihaltz and colleagues 2 report potential visual aberration benefi ts for femtosecond laser cataract surgery. Although standard visual acuity outcomes did not differ between femtosecond or manual capsulotomy groups, more subtle markers of visual quality, including internal aberrations, Strehl ratios, and modulation transfer functions favored the femtosecond laser group. Members of the same research group also reported favorable outcomes regarding macular thickness in the early postoperative period, suggesting that the suction ring utilized for femtosecond laser cataract surgery has minimal adverse effect on the retina. 3 With femtosecond laser cataract surgery still in its infancy, more studies are essential to evaluate the technique, benefi ts, and potential complications. Improved identifi cation of subclinical ectatic corneal disease in refractive surgery candidates remains of utmost importance. Wei and colleagues 4 com