Technolas Perfect Vision GmbH Research Articles

Surgical technique for aspiration of soft lens nucleus with preoperative femtosecond laser-assisted fragmentation

This study was conducted to develop a non-ultrasound technique for aspiration of a soft lens nucleus after its preliminary femtosecond laser-assisted fragmentation. The study included 63 patients (63 eyes) aged 23 to 40 years who underwent surgery. In 27 cases, early or immature cataract was observed, and in 36 cases, cataract removal was performed for refractive purposes in high myopia and complex myopic astigmatism. The VICTUS femtosecond laser surgical system (Technolas Perfect Vision GmbH, Germany) was used for preliminary fragmentation of the lens nucleus. Surgeries were performed using the Centurion Vision System phacoemulsifier (Alcon Laboratories, Inc., USA). The volume of the required irrigation solution was evaluated during the surgery. Intraoperative and postoperative complications were assessed. The surgery was performed without complications in all cases. Capsulorhexis edge was completely preserved along its entire circumference. The study showed the fundamental possibility of aspirating a cataract with a nucleus of grade I-II density without low-frequency ultrasound after preliminary femtosecond laser-assisted fragmentation of the nucleus with a "grid" pattern, which ensures minimal fragment size in the central zone of the nucleus. The volume of irrigation solution required for aspiration of the nucleus was 36.0 (27.0; 44.0) ml, which does not significantly differ from the volume of solution during ultrasound phacoemulsification of a nucleus of such density. Femtosecond laser-assisted fragmentation of the lens nucleus with a "grid" pattern and phacoemulsifier systems with a high vacuum level allow effective aspiration of a soft lens without using low-frequency ultrasound.

Refractive Outcomes of Cataract Surgery in Patients With Intrastromal Femtosecond Laser Treatment of Presbyopia (INTRACOR).

To evaluate the outcomes of cataract surgery with intraocular lens (IOL) implantation in patients who underwent intrastromal femtosecond laser treatment of presbyopia (INTRACOR). This was an interventional case series of 8 patients (10 eyes) who presented for cataract surgery 6.1 ± 3.2 years (mean ± standard deviation [SD]) after INTRACOR (Technolas Perfect Vision GmbH) treatment. A monofocal IOL was implanted in 9 eyes (7 patients) and a small-aperture IOL was implanted in 1 eye. The IOL power was calculated without adjustments using biometry obtained after the INTRACOR treatment. For additional calculations, keratometry obtained before the INTRACOR treatment was used. Postoperative examinations included visual acuity testing, manifest refraction, defocus curve, ocular biometry, corneal tomography, aberrometry, anterior segment optical coherence tomography, and slit-lamp examination. After the cataract surgery, the mean ± SD uncorrected distance visual acuity was 0.37 ± 0.17 logMAR, the corrected distance visual acuity was 0.10 ± 0.10 logMAR, and the manifest refraction spherical equivalent, adjusted to infinity, was +0.39 ± 0.63 diopters (D). Intermediate and near visual acuity, both uncorrected and distance-corrected, and distance-corrected defocus curves varied considerably among patients. Using biometry performed after INTRACOR, the traditional IOL power calculation formulas produced hyperopic outcomes, with the mean ± SD prediction error ranging from +0.72 ± 0.34 to +0.96 ± 0.41 D. Although the mean ± SD prediction error decreased (range: -0.34 ± 0.56 to -0.15 ± 0.53 D) when using keratometry obtained before INTRACOR, the accuracy remained low due to high variability. In patients with cataract who had previous INTRACOR treatment, IOL power calculation could be inaccurate, with a tendency toward hyperopic outcomes. These results require confirmation in more extensive studies. [J Refract Surg. 2023;39(10):676-682.].

Orbscan 3 Versus Pentacam HR: Evaluating the Possible Interchangeable Use of Various Parameters.

Many topography/tomography devices are available, and their interchangeable use is frequently questioned. This study aimed to compare the analogous indices of Orbscan 3 and Pentacam HR to detect whether the interchangeable use of the 2 devices is feasible. This retrospective study was conducted at Eye World Hospital, Giza, Egypt. Displays of Orbscan 3 (Bausch & Lomb; Technolas Perfect Vision GmbH) and Pentacam HR (Oculus Optikegrate) for 660 healthy right eyes were explored for various analogous indices. Bland-Altman plots with 95% limits of agreement (LoA) were used for comparisons. The highest systematic error and lowest agreement existed in the front and back elevations from the best fit sphere (mean differences of 4.7 and 9.2 μm, respectively, and 95% LoA of -2.5 to 12.0 and -10.0 to 28.6, respectively). There was a relatively wide 95% LoA for each pachymetry at the corneal apex (-18 to 22 μm) and at the thinnest location (-22 to 22 μm), anterior chamber depth (-0.88 to 0.95 mm), flattest keratometry (-0.44 to 0.62 D), and steepest keratometry (-0.71 to 0.89 D). By contrast, the lowest systematic error and highest agreement existed for front and back best fit sphere radii of curvature (mean difference of 0.08 mm and 95% LoA of -0.08 to 0.24 and mean difference of 0.03 mm and 95% LoA of -0.17 to 0.23, respectively). This study negates the accuracy of the use of devices interchangeably regarding most parameters. Therefore, examinations with the 2 devices should not be regarded comparable.

Preoperative intraocular pressure as a strong predictive factor for intraocular pressure rise during vacuum application in femtosecond laser-assisted cataract surgery.

To evaluate the effect of preoperative intraocular pressure (IOP) and the vacuum level on IOP during femtosecond laser-assisted cataract surgery. Intraocular pressure was measured in 40 enucleated porcine eyes by intracameral manometry prior, during and after vacuum application using the VICTUS femtosecond laser platform (Bausch&Lomb, Technolas Perfect Vision GmbH, Germany). Twenty combinations of different preoperative IOP levels (12, 16, 20 and 24mmHg) and different vacuum levels (350-550mbar) were investigated. Multivariate regression analysis indicated that both the vacuum level (beta=0.138; p<0.001) but much stronger the preoperative IOP (beta=0.861; p<0.001) were predictive factors for IOP rise during vacuum application. Mean IOP was 28.23±3.86, 34.23±3.92, 40.35±4.41 and 46.82±4.11mmHg in groups with baseline IOP of 12, 16, 20 and 24mmHg, respectively. In the 350, 450 and 550mbar group, and mean IOP was 35.85±7.85, 37.33±7.90 and 39.00±8.04mmHg, respectively. Lowering the preoperative IOP by 2mmHg and reducing the vacuum from maximum to minimum resulted in a similar reduction in IOP during vacuum application (-3.10±0.79mmHg versus -3.15±0.88mmHg; p=0.015). Furthermore, decreasing the baseline IOP from 20 to 12mmHg resulted in a 30.0% reduction in intraoperative IOP. Preoperative IOP was a stronger predictive factor for intraoperative IOP rise than the applied vacuum level. Measurements and critical interpretation of preoperative IOP in a preliminary examination could help estimating the individual risk of significant IOP rise during femtosecond laser-assisted cataract surgery and could help taking early countermeasures in selected cases. Due to the porcine ex vivo model, further studies are needed to verify these findings.

Myoring Femtosecond-Assisted Intracorneal in Management of Keratoconus

Purpose: To evaluate long term follow‑up data on implantation of a full‑ring intra‑corneal implant (Myoring) for management of keratoconus with no cross linking postoperatively done. Patients and methods: A prospective non –randomized interventional clinical study was carried out at Nour- EL–Hayaha Eye Center (Cairo) between July, 2015 and July, 2017.40 eyes of 20 patients with symptomatic marked diminution of vision and keratoconus grade 2 to 4 were enrolled in this study. For all patients, a MyoRing (Dioptex, GmbH, Austria) was implanted using a femtosecond laser (Victus Femto Second Laser SW version 3.2 Technolas Perfect Vision GmbH .Munich, Germany). Inclusion criteria; age was between 18 and 35 years, maximum K reading less than 60D (based on pentacam examination), and a central corneal thickness (CCT) was at least 380 μm. Patients who had corneal scarring, any concomitant ocular disease or any history of ocular surgery were excluded from the study. Patients who failed to complete follow-up examinations one month after the surgery were also excluded. Results: 40 eyes of 20 patients 5 males (25%) and 15 females (75%) with keratoconus grade 2 to 4 enrolled in this study with a mean age of 24.6 ± 7.92 years. Preoperatively, mean central corneal thickness (CCT) was 440.25±44.49 μm in the right eye and mean CCT 441.35±43.02 in the left eye, while mean keratometry (K) readings, 52.57±5.24diopters (D) in the right eyes and 50.16±3.59 D in the left eyes. Postoperatively, there was a statistically significant improvement in the uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), K readings, manifest spherical and cylindrical refractive errors, and spherical equivalent (P<0.05). Mean K reading decreased by 6.8 D, from52.57±5.24D to 45.77±2.16D. No serious intraoperative complications were occurred. Conclusion: Myoring had the capability in halting the progression of the disease, Insert it whatever the site of lesion and it was noticed that no need for cross linking done postoperatively.

Myoring Femtosecond-Assisted Intracorneal in Management of Keratoconus

Purpose: To evaluate long term follow‑up data on implantation of a full‑ring intra‑corneal implant (Myoring) for management of keratoconus with no cross linking postoperatively done. Patients and methods: A prospective non –randomized interventional clinical study was carried out at Nour- EL–Hayaha Eye Center (Cairo) between July, 2015 and July, 2017.40 eyes of 20 patients with symptomatic marked diminution of vision and keratoconus grade 2 to 4 were enrolled in this study. For all patients, a MyoRing (Dioptex, GmbH, Austria) was implanted using a femtosecond laser (Victus Femto Second Laser SW version 3.2 Technolas Perfect Vision GmbH .Munich, Germany). Inclusion criteria; age was between 18 and 35 years, maximum K reading less than 60D (based on pentacam examination), and a central corneal thickness (CCT) was at least 380 μm. Patients who had corneal scarring, any concomitant ocular disease or any history of ocular surgery were excluded from the study. Patients who failed to complete follow-up examinations one month after the surgery were also excluded. Results: 40 eyes of 20 patients 5 males (25%) and 15 females (75%) with keratoconus grade 2 to 4 enrolled in this study with a mean age of 24.6 ± 7.92 years. Preoperatively, mean central corneal thickness (CCT) was 440.25±44.49 μm in the right eye and mean CCT 441.35±43.02 in the left eye, while mean keratometry (K) readings, 52.57±5.24diopters (D) in the right eyes and 50.16±3.59 D in the left eyes. Postoperatively, there was a statistically significant improvement in the uncorrected distance visual acuity(UDVA), corrected distance visual acuity(CDVA), K readings, manifest spherical and cylindrical refractive errors, and spherical equivalent (P<0.05). Mean K reading decreased by 6.8 D, from52.57±5.24D to 45.77±2.16D. No serious intraoperative complications were occurred. Conclusion: Myoring had the capability in halting the progression of the disease, Insert it whatever the site of lesion and it was noticed that no need for cross linking done postoperatively.

A new approach of presbyopia over a myopic population: PresbyLASIK using the myopic SUPRACOR Algorithm (preliminary results about 12 eyes)

PurposeThe aim of our study was to analyze refractive outcomes and satisfaction after myopic presbyLASIK with induced micro‐monovision (−0.50 D), a new approach of correcting presbyopia among myopic patients.MethodsThis retrospective consecutive cases study included 12 eyes of 9 patients treated for myopia and presbyopia with central presbyLASIK with micro‐monovision using the Technolas 217P excimer laser (Technolas Perfect Vision GmbH, Munich, Germany) between December 2014 and May 2016. Study parameters included uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA), iniitial and final sphere and cylinder, abberrometry, central steep zone, and patient satisfaction.ResultsPatients median age was 50.7 ± 4 years (range: 46–54 years), predominantly females at 78%, with a mean preoperative spherical equivalent of −3.38 [−1.25; −5.25]. Mean postoperative spherical equivalent refraction was 0.18 ± 0.47 diopters (D) for dominant eyes and −0.45 ± 0.46 D for dominated eyes. Mean monocular UDVA was 0.09 ± 0.10 logMAR (Snellen 20/24) at 1 month postoperatively. Mean binocular UDVA was −0.06 ± 0.07 logMAR (Snellen 20/18) at last follow‐up visit. Mean binocular UNVA was 0.18 ± 0.14 logMAR (Parinaud 2). At 1 months, 83.3% of patients achieved 20/20 or better and could read Parinaud 2 binocularly, and 91.6% of patients achieved 20/20 and could read Parinaud 3 binocularly. The mean central steep zone was 1.95 ± 1.00 D. There was no need for retreatment (under/over‐correction) but one eye underwent interface washing with corticoids. Patients were satisfied in 92 and 80% were independent of spectacles at all distances.ConclusionsMyopic PresbyLASIK is safe and efficacious with postoperative improvement in binocular vision at far, intermediate, and near distances vision, being an attractive alternative to monovision.

Profitability analysis of a femtosecond laser system for cataract surgery using a fuzzy logic approach.

To define the financial and management conditions required to introduce a femtosecond laser system for cataract surgery in a clinic using a fuzzy logic approach. In the simulation performed in the current study, the costs associated to the acquisition and use of a commercially available femtosecond laser platform for cataract surgery (VICTUS, TECHNOLAS Perfect Vision GmbH, Bausch & Lomb, Munich, Germany) during a period of 5y were considered. A sensitivity analysis was performed considering such costs and the countable amortization of the system during this 5y period. Furthermore, a fuzzy logic analysis was used to obtain an estimation of the money income associated to each femtosecond laser-assisted cataract surgery (G). According to the sensitivity analysis, the femtosecond laser system under evaluation can be profitable if 1400 cataract surgeries are performed per year and if each surgery can be invoiced more than $500. In contrast, the fuzzy logic analysis confirmed that the patient had to pay more per surgery, between $661.8 and $667.4 per surgery, without considering the cost of the intraocular lens (IOL). A profitability of femtosecond laser systems for cataract surgery can be obtained after a detailed financial analysis, especially in those centers with large volumes of patients. The cost of the surgery for patients should be adapted to the real flow of patients with the ability of paying a reasonable range of cost.

Investigating the ocular temperature rise during femtosecond laser lens fragmentation: an in vitro study.

To investigate the trend of temperature variation during lens fragmentation simulated by a femtosecond laser on an in vitro eye model. In our experimental study, a convex cylinder of gelatinous material, usually employed in femtosecond laser calibration, was used to simulate both an anterior segment and a crystalline lens during fragmentation performed with the Victus femtosecond laser (Technolas Perfect Vision GmbH, Germany; Bausch + Lomb Incorporated, USA). Two radiated energies (7000 nJ and 9000 nJ) and three cutting patterns (crosses, circles and cross + circle) were applied. Trends of temperature variation as a function of time were obtained using a T-type thermocouple. The maximum value of temperature rise during lens fragmentation ranged from 3.53 to 5.13°C; the rise was directly proportional to the intensity of the radiated energy (7000 nJ or 9000 nJ) and the cutting pattern performed. This behavior was experimentally represented by an asymmetric function with a characteristic bell curve shape, whereas it was mathematically described by a transport diffusive model. Since the temperature rise at the fragmentation volume base resulted to be around 5°C in our in vitro study, lens fragmentation performed using the Victus femtosecond laser might be considered safe form a thermal point of view.

Central PresbyLASIK for Hyperopia and Presbyopia Using Micro-monovision With the Technolas 217P Platform and SUPRACOR Algorithm.

To analyze the refractive outcomes and satisfaction of presbyopic hyperopes treated with central presbyopicLASIK (presbyLASIK) with induced micro-monovision. This retrospective study included 74 eyes of 37 patients treated with central presbyLASIK with micro-monovision using the Technolas 217P excimer laser (Technolas Perfect Vision GmbH, Munich, Germany) between June 2011 and March 2014. Study parameters included uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA), aberrometry, the central steep zone, and patient satisfaction. Median age was 54.3±4 years (range: 46 to 63 years). Mean postoperative spherical equivalent refraction was 0.00±0.58 diopters (D) for dominant eyes and -0.51±0.54 D for non-dominant eyes. Mean binocular UDVA was 0.01±0.10 logMAR (Snellen 20/20) at 6 months and -0.01±0.05 logMAR (Snellen 20/19) at 1 year postoperatively. Mean binocular UNVA was 0.18±0.14 logMAR (Parinaud 2) (Jaeger 1) at 6 months and 0.18±0.12 logMAR (Parinaud 2) (Jaeger 1) at 1 year postoperatively. At 6 months, 79.31% of patients achieved 20/25 and could read Parinaud 2 (Jaeger 1) binocularly. At 1 year, 84.21% of patients achieved 20/25 and could read Parinaud 2 (Jaeger 1) binocularly. The mean central steep zone was 2.35±1.00 D. There were significantly more negative spherical aberration and vertical coma in the central 5 mm postoperatively (P<.05). The re-treatment rate was 6.75%. Eighty-three percent of these patients did not need any glasses for distance and near vision. This procedure may improve functional near, intermediate, and distance vision in presbyopic patients with low and moderate hyperopia.

Supracor Hyperopia and Presbyopia Correction: 6-Month Results

To investigate refractive and visual outcomes and complications of the Supracor procedure to treat presbyopia. A total of 123 eyes from 68 presbyopic patients with hyperopia were enrolled in this prospective, nonrandomized, clinical trial. The Supracor procedure was performed using the Technolas excimer laser 217P (Technolas Perfect Vision GmbH). Follow-up eye examinations were performed at postoperative day 1, month 1, and month 6. All 123 surgeries were uneventful. At 6 months postoperatively, uncorrected distance visual acuity was 20/20 or better in 27 (22.0%) eyes and 20/25 or better in 45 (36.6%) eyes. At 6 months postoperatively, 35 (28.5%) eyes lost 1 line and 13 (10.6%) eyes lost 2 lines of corrected distance visual acuity (CDVA). At 6 months postoperatively, uncorrected near visual acuity was 20/20 or better in 95 (77.2%) eyes and 20/25 or better in 110 (89.4%) eyes. At 6 months postoperatively, 6 (4.9%) eyes lost 1 line of corrected near visual acuity. The Supracor presbyopia procedure showed good near visual acuity outcomes over 6 months follow-up but loss of CDVA occurred in 39.1% of eyes.

Translenticular hydrodissection, lens fragmentation, and influence on ultrasound power in femtosecond laser–assisted cataract surgery and refractive lens exchange

To compare ultrasound time (UST) during femtosecond laser-assisted and conventional cataract surgery or refractive lens exchange and evaluate UST during femtosecond laser surgery with and without a new technique, translenticular hydrodissection. Centre for Sight, East Grinstead, West Sussex, United Kingdom. Comparative case series. This single-surgeon study compared consecutive femtosecond laser-assisted surgery (with and without translenticular hydrodissection to assist lens mobilization) and consecutive conventional surgery performed immediately before adoption of femtosecond laser technology. The mean US power, UST, and effective phacoemulsification time (EPT) in the 2 groups were compared. Further analysis of the femtosecond group compared translenticular hydrodissection and no translenticular hydrodissection. The mean US power, UST, and EPT were significantly longer in the conventional group (n = 108) than in the femtosecond group (n = 108) as follows: 7.30% ± 2.56% (SD) versus 5.32% ± 2.48% (P=.000); 9.89 ± 5.32 seconds versus 8.58 ± 4.66 seconds (P=.044); 0.87 ± 0.85 seconds versus 0.57 ± 0.51 seconds (P=.002), respectively. In the femtosecond group, parameters were significantly higher in eyes without translenticular hydrodissection (n = 27) than in eyes with translenticular hydrodissection (n = 81) as follows: 5.78% ± 2.23% versus 5.16% ± 2.56% (P=.046); 10.95 ± 4.66 seconds versus 7.78 ± 4.41 seconds (P=.046); 0.72 ± 0.26 seconds versus 0.52 ± 0.53 seconds (P=.002), respectively. Femtosecond laser capsulotomy and lens fragmentation statistically significantly reduced UST over conventional surgery. Translenticular hydrodissection further reduced UST.

Effectiveness and safety of femtosecond laser–assisted lens fragmentation and anterior capsulotomy versus the manual technique in cataract surgery

To evaluate the effectiveness and safety of cataract surgery using femtosecond laser-assisted lens fragmentation and anterior capsulotomy versus manual cataract surgery. MaxiVision Eye Hospital, Begumpet, Hyderabad, India. Randomized controlled open-label multisurgeon prospective trial. Patients (at least 18 years old) were randomized to femtosecond laser-assisted lens prefragmentation and capsulotomy or manual capsulorhexis and standard phacoemulsification. Measured outcomes were effective phacoemulsification time (EPT), surgeon-assessed ease of phacoemulsification, mean phaco energy, mean phaco time, balanced salt solution volume, capsulotomy precision, and adverse event rates. Fifty-six eyes had the femtosecond laser procedure, and 63 had manual cataract surgery. The mean EPT was significantly lower in the laser group (5.2 seconds ± 5.7 [SD]) than in the manual group (7.7 ± 6.0 seconds) (P=.025). There was a significant difference in the mean phaco energy between the 2 groups (13.8% ± 10.3% in laser group; 20.3% ± 8.1% in manual group) (P<.001). There were no significant between-group differences in the ease of phacoemulsification, mean phaco time, or balanced salt solution volume. Laser-assisted capsulotomies were significantly more accurate and precise (intended diameter, circularity, centration) (P<.01). The safety profiles of the procedures were equivalent, with no adverse events at the 1-day follow-up. The femtosecond laser platform was effective and safe in cataract surgery, reducing EPT and the mean phaco energy during lens fragmentation and providing precise and reproducible capsulotomies.

Keratectasia After Treating Presbyopia With INTRACOR Followed by SUPRACOR Enhancement

To report a case of unilateral keratectasia after INTRACOR, which was followed by an additional excimer LASIK enhancement with a new presbyopia-correcting ablation profile. The non-dominant eye of a 49-year-old man with emmetropia was treated with the INTRACOR procedure using the Technolas femtosecond laser (Technolas Perfect Vision GmbH, Munich, Germany) for presbyopia. Neither eye had risk factors for keratectasia. Two years later, a presbyopia-correcting LASIK (SUPRACOR LASIK; Technolas Perfect Vision GmbH) enhancement was performed in the same eye because of deteriorated distance and near visual acuity. The eye treated with INTRACOR followed by SUPRACOR LASIK developed marked keratectasia topographically limited to the area altered by INTRACOR, whereas the fellow eye remained stable and still has no signs of keratoconus. This case emphasizes the incomplete knowledge of the risk factors for keratectasia following INTRACOR alone and in combination with a SUPRACOR LASIK enhancement. It also suggests that the combined weakening effect of both procedures on corneal mechanical stability may be too strong even in the absence of established risk factors for LASIK surgery.

Comparison of visual acuity, refractive results and complications of femtosecond laser with mechanical microkeratome in LASIK.

To compare the outcomes of laser in situ keratomileusis (LASIK) performed with a femtosecond laser (Femtec, Technolas Perfect Vision GmbH, Germany) versus a mechanical microkeratome (Hansatome, Bausch and Lomb, USA) for the correction of myopia and astigmatism. In this retrospective study, patients who had undergone LASIK using the 80-kHz Femtec femtosecond laser were compared to age- and refraction-matched patients in whom the Hansatome microkeratome was used. Refractive and visual results 1 month and 3 months postoperatively, and complication rates were compared between the two groups. A total of 280 eyes were analyzed (140 in each group). At 3 months postoperatively in the Femtec vs Hansatome group, spherical equivalent refraction was within ±1.00D of emmetropia in 140 vs 138 eyes (P=0.498), the cylinder was within ±0.50D in 137 vs 139 eyes (P=0.622), and the UDVA was 20/20 or better in 136 vs 137 eyes (P=0.724), respectively. There was no statistically significant difference in the complication rates between the two groups (P=0.099). LASIK performed both with Femtec femtosecond laser and Hansatome microkeratome achieved satisfactory refractive and visual results at 3 months postoperatively, without significant differences in efficacy, safety, and complication rates between the two procedures.

Femtosecond Laser Correction of Presbyopia (INTRACOR) in Emmetropes Using a Modified Pattern

To evaluate functional results and corneal changes after femtosecond laser correction of presbyopia (INTRACOR, Technolas Perfect Vision GmbH) in emmetropes using a modified treatment pattern over a 12-month period. Twenty eyes from 20 emmetropic patients were treated with a modified intrastromal INTRACOR pattern consisting of 5 central rings and 8 radial cuts in a prospective, nonrandomized, uncontrolled, open, single-center, clinical study. Refraction, visual acuity, endothelial cell density, corneal pachymetry, total corneal power, and stray light were evaluated preoperatively and 1 (except endothelial cell density and stray light), 3, 6, and 12 months postoperatively. Patients filled out a subjective questionnaire at 12 months postoperatively. Comparison of preoperative versus 12-month postoperative median values revealed a significant improvement in uncorrected near visual acuity (UNVA) from 0.60 (20/80) to 0.10 logMAR (20/25) (P<.0001) and a significant decrease in corrected distance visual acuity (CDVA) from -0.10 (20/16) to 0.00 logMAR (20/20), which equals a median loss of one line (P=.0005). Fifteen percent of patients lost two lines of CDVA in the treated eye. Subjective spherical equivalent refraction remained unchanged at 0.00 diopters (D) (P=.194). After INTRACOR treatment, significant corneal steepening of 1.40 D and midperipheral flattening of 0.50 D occurred (both P<.0001). Corneal pachymetry at the thinnest point and endothelial cell density did not change significantly (P=.829 and P=.058, respectively). After 12 months, the modified INTRACOR pattern improved UNVA in emmetropic patients without inducing a myopic shift or significant changes in endothelial cell density or pachymetry.

Visual outcomes and corneal changes after intrastromal femtosecond laser correction of presbyopia

To assess the effect of intrastromal femtosecond laser presbyopia treatment on uncorrected near visual acuity (UNVA) and corneal integrity over an 18-month period. Department of Ophthalmology, International Vision Correction Research Centre, University of Heidelberg, Heidelberg, Germany. Clinical trial. The UNVA (at 40 cm), corneal pachymetry, and true net power were evaluated preoperatively and 1, 3, 6, 12, and 18 months after femtosecond intrastromal presbyopic treatment (Intracor). Endothelial cell density (ECD) was measured preoperatively and 3, 6, and 12 months postoperatively. Data were analyzed with the Wilcoxon test at a P=.01 level of significance. The median UNVA improved significantly from 0.7 logMAR preoperatively to 0.4 logMAR, 0.2 logMAR, 0.2 logMAR, 0.3 logMAR, and 0.2 logMAR at 1, 3, 6, 12, and 18 months, respectively (all P<.001). The median corneal true net power increased significantly by 1.1 diopters (D) to 0.7 D, 0.8 D, 1.0 D, and 0.9 D, respectively (all P<.001); pachymetry showed no significant thinning postoperatively. There was no significant difference in ECD between preoperatively and postoperatively. Intrastromal femtosecond presbyopic treatment yielded a significant and stable gain of UNVA and corneal steepening without significant loss of endothelial cells or corneal thinning up to 18 months postoperatively. No significant regression of visual acuity or further corneal steepening occurred during the follow-up period. Dr. Auffarth and Dr. Holzer received lecture and consulting fees from Technolas Perfect Vision GmbH. No author has a financial or proprietary interest in any material or method mentioned.

Intrastromal Femtosecond Laser Presbyopia Correction: 1-year Results of a Multicenter Study

To investigate functional outcomes of the INTRACOR femtosecond laser-based intrastromal procedure to treat presbyopia. Sixty-three eyes from 63 presbyopic patients (median age: 54 years) with mild hyperopia were enrolled in this prospective, ethics committee-approved, multi-center, nonrandomized clinical trial. The INTRACOR procedure was performed using the Technolas femtosecond laser (Technolas Perfect Vision GmbH) in the nondominant eye. Postoperatively, follow-up was performed at 1 day, 1 week, and 1, 3, 6, and 12 months and included near and distance visual acuity tests, slit-lamp examinations, and corneal topography. All 63 surgeries were uneventful. Twelve months postoperatively, outcomes of 58 (92.1%) eyes were available for evaluation. Median uncorrected distance visual acuity (0.1 logMAR [range: 0.5 to 0.0 preoperatively and 0.5 to -0.1 postoperatively]) and corrected distance visual acuity (CDVA) (0.0 logMAR [range: 0.2 to -0.2 preoperatively and 0.3 to -0.1 postoperatively]) remained stable. Median spherical equivalent changed from +0.63 diopters (D) preoperatively to 0.00 D postoperatively. Median uncorrected near visual acuity increased significantly from 0.7 logMAR (range: 1.0 to 0.2) preoperatively to 0.2 logMAR (range: 0.8 to -0.1) postoperatively and eyes gained a median of 4 lines (range: 1 to 9 lines). Losses of 2 lines of CDVA were noted in 7.1% of eyes. Ring cuts were faintly visible at 12 months. The INTRACOR presbyopia procedure showed good and stable visual acuity outcomes over 12-month follow-up but loss of CDVA occurred in 7% of eyes. Overall patient satisfaction with the procedure was approximately 80%. Short treatment time and maintained corneal surface integrity are advantages of this procedure.

Use of the Femtosecond Laser for Cataract Surgery with Intraocular Lens Implantation

Femtosecond laser technology offers a promising approach to minimally invasive corneal surgery. Recently, femtosecond laser-assisted cataract surgery has been approved by the FDA. Femtosecond laser systems can create more precise and reproducible surgical incisions under computer control than with the conventional manual technique. Femtosecond laser-assisted cataract surgery may become a standard procedure for cataract surgery with intraocular lens implantation. *Corresponding author: Tatsuya Mimura, MD, Ph.D, Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan, Tel: +81 35800-5108; Fax: +81 33817-0798; E-mail: mimurat-tky@umin.ac.jp Received October 10, 2012; Accepted October 12, 2012; Published October 15, 2012 Citation: Mimura T, Yamazaki K (2012) Use of the Femtosecond Laser for Cataract Surgery with Intraocular Lens Implantation. J Transplant Technol Res 2:e116. doi:10.4172/2161-0991.1000e116 Copyright: © 2012 Mimura T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Cataract is one of the major causes of preventable blindness in both developing and industrialized countries. Today most cataracts can be treated safely by modern surgical techniques involving phacoemulsification of the lens and intraocular lens (IOL) implantation. The management of cataract has changed considerably over the last few years with various improvements in surgical techniques, especially adoption of the femtosecond laser. This laser was first introduced for flap creation during laser in-situ keratomileusis (LASIK) [1-6]. Since then, the femtosecond laser has been used in a variety of procedures for corneal surgery, including predissection of corneal grafts for penetrating keratoplasty [7], anterior and posterior lamellar keratoplasty [8-12], and Descemet’s stripping automated endothelial keratoplasty. It has also been used for refractive surgery [13], including LASIK, limbal relaxing incisions, intrastromal ring segment implantation [14], and correction of presbyopia. Most recently, use of the femtosecond laser has been expanded to include cataract surgery [15]. The name femtosecond laser indicates the short duration of its laser pulses (1 femtosecond (fs) = 1 × 10−15 seconds). Other lasers used for ocular surgery, such as the argon (photocoagulation), excimer (photo ablation), and ND: YAG (photo disruption) lasers have a longer pulse time of 10-9 seconds. Several companies have developed femtosecond laser units for cataract surgery. These include the LenSx (Alcon, Fort Worth, TX), Optimedica Catalyst (Optimedica Corporation, Sant Clara, CA, USA), Technolas Workstation and IntraCor (Technolas Perfect Vision GmbH, Munich, Germany), and LensAR Laser System (LensAR Inc., Winter Park, FL). The femtosecond laser first received FDA approval for use in lamellar corneal surgery and additional approval for femtosecond laser-assisted cataract surgery was granted in 2010. Femtosecond laser systems can create precise and reproducible surgical incisions under computer control. The chief benefit of using a femtosecond laser for cataract surgery is that it replaces manual incision with a dedicated knife or forceps for creation of the initial corneal incisions, capsulotomy, and initial lens fragmentation. Successful intraocular use of the femtosecond laser for lens fiber disruption [16], treatment of presbyopia [17], and accommodation surgery [18] has been achieved in animal models. The first surgeon to report the performance of femtosecond laser-assisted cataract surgery in humans was Nagy in 2009 [19]. Since this initial report, many further reports and reviews of femtosecond laser-assisted cataract surgery have been published [20-41]. The first advantage of femtosecond-assisted cataract surgery is more precise capsulorrhexis and phacoemulsification at a lower power than with the conventional manual technique [19,41]. For accurate centration and fixation of advanced IOLs, including toric, multifocal, and accommodating IOLs, use of the femtosecond laser to achieve accurate capsulorhexis may be an effective option. A second advantage is that the femtosecond laser creates precise corneal incisions. Three-dimensional computer control of the corneal incision using a femtosecond laser may reduce the risk of endophthalmitis associated with manual self-sealing clear corneal incisions. The third advantage is that the femtosecond laser allows precise placement of limbal relaxing incisions, which are effective for reducing astigmatism after cataract surgery. The fourth advantage is that femtosecond laser light is not absorbed by the surrounding tissues, including the cornea, resulting in no risk of corneal damage. Despite all these positive aspects, the laser units are still relatively large and under development. Additionally, femtosecond laser machines equipped with a rotating Scheimpflug camera or optical coherence tomography incur additional costs for spare parts and annual maintenance, and are considerably more expensive compared with the current standard method of cataract surgery. Further investigation of postoperative complications such as endophthalmitis is also necessary. If these issues can be solved, femtosecond laser-assisted cataract surgery may become a standard procedure for treating cataract in the near future. Development of a femtosecond laser combined with a phacoemulsification unit is also expected.

Surface Ablation with Iris Recognition and Dynamic Rotational Eye Tracking–Based Tissue Saving Treatment with the Technolas 217z Excimer Laser

To evaluate the visual and refractive outcomes and expected benefits of Tissue Saving Treatment algorithm-guided surface ablation with iris recognition and dynamic rotational eye tracking. This prospective, interventional case series comprised 122 eyes (70 patients). Pre- and postoperative assessment included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, and higher order aberrations. All patients underwent Tissue Saving Treatment algorithm-guided surface ablation with iris recognition and dynamic rotational eye tracking using the Technolas 217z 100-Hz excimer platform (Technolas Perfect Vision GmbH). Follow-up was performed up to 6 months postoperatively. Theoretical benefit analysis was performed to evaluate the algorithm's outcomes compared to others. Preoperative spherocylindrical power was sphere -3.62 ± 1.60 diopters (D) (range: 0 to -6.75 D), cylinder -1.15 ± 1.00 D (range: 0 to -3.50 D), and spherical equivalent -4.19 ± 1.60 D (range: -7.75 to -2.00 D). At 6 months, 91% (111/122) of eyes were within ± 0.50 D of attempted correction. Postoperative UDVA was comparable to preoperative CDVA at 1 month (P=.47) and progressively improved at 6 months (P=.004). Two eyes lost one line of CDVA at 6 months. Theoretical benefit analysis revealed that of 101 eyes with astigmatism, 29 would have had cyclotorsion-induced astigmatism of ≥ 10% if iris recognition and dynamic rotational eye tracking were not used. Furthermore, the mean percentage decrease in maximum depth of ablation by using the Tissue Saving Treatment was 11.8 ± 2.9% over Aspheric, 17.8 ± 6.2% over Personalized, and 18.2 ± 2.8% over Planoscan algorithms. Tissue saving surface ablation with iris recognition and dynamic rotational eye tracking was safe and effective in this series of eyes.