Femtosecond Laser-Assisted Cataract Surgery with Integrated Optical Coherence Tomography (original) (raw)
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Purpose: To assess the stability and reliability of femtosecond laser-assisted cataract surgery (FLACS) incisions design and dimensions using anterior segment optical coherence tomography (AS-OCT) imaging. Setting: Renato Ambrósio Ophthalmologic Study Center from Hospital Oftalmológico de Brasília, Brasília, Brazil. Design: Prospective nonrandomized controlled case series. Methods: Eyes undergoing FLACS with triplanar main temporal clear corneal incision (CCI) were evaluated at the end of the case. Eyes that required any incision hydration, surgical complications or lacked follow-up were excluded. The AS-OCT was performed after femtosecond delivery; at the end of the case; at 1 day and at 30 days after surgery. Data of pachymetry, endothelial and epithelial gaps, Descemet detachment and CCI architecture were compared. Results: Eleven eyes from 11 patients completed follow-up. Corneal thickness was statistically different between after femtosecond delivery and the end of the case (P-value ,0.05), but without difference compared to 30 days evaluation. There was an increase of Descemet detachments (P-value ,0.05) and endothelial gaps (P-value =0.0133) at the end of the case compared to post-femtosecond delivery. As for the architecture of the CCI, significant difference was found between the parameters of entry angle and exit angle measured with AS-OCT and the programmed. Conclusion: The AS-OCT was capable of visualizing changes in the cornea at the CCI. Despite the stress caused by manipulation, results indicated good stability of incision and reproducibility of tunnel length. Synopsis: Difference of corneal thickness at the CCI between after femtosecond and after phacoemulsification measurements (P-value ,0.05), with increase of endothelial gaps (P-value =0.0133) and Descemet detachments (P-value ,0.05).
Femtosecond Laser Versus Manual Clear Corneal Incision in Cataract Surgery
Journal of Refractive Surgery, 2014
everal factors can lead to poor incision architecture during phacoemulsification. These include incorrect construction by an inexperienced or even an experienced surgeon and stretching of the wound during difficult surgical cases. 1 A study showed that when experienced surgeons attempted three-plane incisions only 32% were threeplane tunnels, 64% were two-plane tunnels, and 4% were one-plane tunnels. 1 Studies using anterior segment optical coherence tomography (AS-OCT) after cataract surgery for corneal assessment at the incision site disclosed the most frequent architectural features of the cornea. 2 Although contact ultrasound pachymetry is widely considered the gold standard for measurement of central corneal thickness, AS-OCT presents advantages in corneal imaging over ultrasonic devices, including twodimensional imaging of the anterior segment that allows measurements from a cross-sectional image through a precise selected corneal location and the absence of any contact with the surface of the eye during examination. 3-5 Recently, the use of femtosecond laser was introduced in cataract surgery to perform corneal incisions, capsulorhexis, and nuclear fragmentation. 6,7 In a preliminary study on cadaver eyes, Masket et al. demonstrated that femtosecond laser-assisted cataract incisions were reproducible and stable, particularly for corneal incisions with a length of 2.0 mm. 8 Femtosecond laser performance of CCI could potentially improve incision architecture by increasing the precision with which the automated incision is made and reducing S ABSTRACT PURPOSE: To compare functional and morphological outcomes of femtosecond laser clear corneal incision (CCI) versus manual CCI during cataract surgery. METHODS: Sixty eyes of 60 patients who underwent CCI during cataract surgery were randomized into two groups: femtosecond laser CCI (30 eyes) and manual CCI (30 eyes). RESULTS: There were no significant between-group differences in uncorrected distance visual acuity, corrected distance visual acuity, surgically induced astigmatism, and corneal aberrations. Keratometric astigmatism was significantly lower in the femtosecond laser CCI group compared to the manual CCI group at 30 and 180 days (P < .05). Central endothelial cell count was significantly higher in the femtosecond laser CCI group compared to the manual CCI group at 7 and 30 days postoperatively (P < .05). A lower increase of corneal thickness at the incision site was observed at 30 and 180 days postoperatively in the femtosecond laser CCI group compared to the manual CCI group (P < .05). In addition, femtosecond laser CCI showed a better morphology (lower percentage of endothelial and epithelial gaping and endothelial misalignment) compared to manual CCI at different time points. Total phacoemulsification time was significantly lower in the femtosecond laser CCI group (P < .05). CONCLUSIONS: The femtosecond laser procedure was safe, efficient, and less damaging, as evidenced by lower central endothelial cell loss, lower increase of corneal thickness at the incision site, and better tunnel morphology compared to the manual technique.
Femtosecond laser-assisted cataract surgery compared with conventional cataract surgery
Clinical & Experimental Ophthalmology, 2012
T he femtosecond laser (FSL) is useful in ocular surgeries due to its ultrafast pulses in the range of 10-15 seconds and its decreased energy requirements for tissue destruction, allowing for reduced unintended destruction of surrounding tissues. 1,2 While FSLs were previously FDA-approved for use in lamellar corneal surgery, the modality was approved in 2010 for cataract surgery. There are three companies-OptiMedica (Santa Clara, CA), LenSx (recently acquired by Alcon, Fort Worth, TX), and LensAR (Winter Park, FL)-which will be discussed in this review. LensAR recently received 501(k) FDA approval for lens fragmentation and anterior capsulotomy. LenSx is now approved for lens fragmentation, anterior capsulotomy, and corneal incisions. OptiMedica is currently seeking FDA approval and is already available outside of the United States. Although there may be other laser platforms, this review will focus on these three companies due to their presence in published literature. Lasers have been utilized in cataract surgery since the 1970s, when Krasnov reported a laser modality for phacopuncture. 3 Subsequently in 1987, Peyman and Katoh focused an Erbium:YAG laser on the lens nucleus, inducing photoablation. 4 These efforts were harbingers of laser use in ocular surgery, which eventually led to investigations into FSL-assisted cataract surgery (FLACS). Methods to increase accuracy and precision in cataract surgery are being investigated because as lens implants become more advanced, patient expectations for near-perfect vision are increasing. These premium intraocular lenses (IOLs) also depend more on precise centration for optimal performance. 5-7 Accuracy standards for cataract surgery were set in the United Kingdom by Gale et al. in 2006 to reach ±0.50 diopter (D) for 55% of cases, and ±1.00 D for 85% of cases. 8 In comparison to these guidelines, Murphy et al. showed that with standard cataract surgery methods, 45% of patients were within the 0.50 D range, and 72% of patients were in the 1.00 D range. 9 As cataract surgery is the most common operation in the United
The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn?
Br J Ophthalmol, 2013
Femtosecond laser-assisted cataract surgery (FLACS) represents a potential paradigm shift in cataract surgery, but it is not without controversy. Advocates of the technology herald FLACS as a revolution that promises superior outcomes and an improved safety profile for patients. Conversely, detractors point to the large financial costs involved and claim that similar results are achievable with conventional small-incision phacoemulsification. This review provides a balanced and comprehensive account of the development of FLACS since its inception. It explains the physiology and mechanics underlying the technology, and critically reviews the outcomes and implications of initial studies. The benefits and limitations of using femtosecond laser accuracy to create corneal incisions, anterior capsulot-omy, and lens fragmentation are explored, with reference to the main platforms, which currently offer FLACS. Economic considerations are discussed, in addition to the practicalities associated with the implementation of FLACS in a healthcare setting. The influence on surgical training and skills is considered and possible future applications of the technology introduced. While in its infancy, FLACS sets out the exciting possibility of a new level of precision in cataract surgery. However, further work in the form of large scale, phase 3 randomised controlled trials are required to demonstrate whether its theoretical benefits are significant in practice and worthy of the necessary huge financial investment and system overhaul. Whether it gains widespread acceptance is likely to be influenced by a complex interplay of scientific and socio-economic factors in years to come.
Safety and surgical outcomes of femtosecond laser-assisted cataract surgery
2021
Results In this study, we have reported no cases of programming errors, and only one (2%) eye had incomplete capsulotomy that necessitated completion using capsulurhexis foreceps. Seven (14%) eyes had incomplete corneal incisions that were completed using a sharp keratome, and lens fragmentation was complete in all cases except only one (2%) case. Thirty four (68%) eyes showed postdocking conjunctival echymosis (Fig. 3), which is considered as a minor complication that necessitates only goodcounseling of the patients. Department of Ophthalmology, Minia
Femtosecond Laser-Assisted Cataract Surgery and Its Learning Curve
The Annual ASCRS and ASOA Symposium and Congress, 2014
Background: Cataract surgery after penetratingkeratoplasty (PKP) is often challenging due to changes in the integrity of the cornea caused by PKP. For example, corneal endothelial cell (CEC) loss and corneal edema commonly occur after traditional phacoemulsification cataract surgery in patients that previously had successful PKP. Recent studies have reported that femtosecond laser-assisted cataract surgery (FLACS) significantly reduces the need for ultrasound energy minimizing mechanical damage to the cornea and results in a reduction of CEC loss and corneal edema. Case presentation: We report a case in which FLACS was used in a patient with previous PKP. Conclusion: This case supports the suggestion that the use of the femtosecond laser improves the surgical outcome of cataract surgery after PKP. This improvement may be result of the precise incision, controlled capsulorhexis, and reduced lens fragmentation experienced with the femtosecond laser which helps to reduce potential complications of cataract surgery after PKP.
Evaluation of Femtosecond Laser Clear Corneal Incision: An Experimental Study
Journal of Refractive Surgery, 2013
PURPOSE: To evaluate the changes of corneal topography following femtosecond laser and manual clear corneal incision (CCI). METHODS: Infl ation testing was performed in 14 human eye globes to evaluate the topographic response of the cornea to CCIs. In seven samples (femtosecond laser group), a 2.75-mm three-plane CCI was created using the iFS femtosecond laser (Abbott Medical Optics, Inc., Santa Ana, CA); the remaining seven samples (control group) received a 2.75-mm manual CCI using disposable angled knives. Topographic maps of the anterior and posterior cornea were acquired using a Scheimpfl ug topographer Pentacam HR (Oculus Optikgeräte GmbH, Wetzlar, Germany). Keratometric data were used to analyze the curvature changes of the cornea. The changes of corneal astigmatism were analyzed by vector analysis. RESULTS: After CCI, the mean change of the anterior keratometric power was 0.04 ± 0.39 and 0.05 ± 0.51 diopters (D) (analysis of variance, P > .05) in the femtosecond laser and control groups, respectively. The mean change (P > .05) of the posterior corneal keratometric power was 0.16 ± 0.19 and 0.15 ± 0.18 D, respectively. The average change of the anterior and posterior corneal astigmatism vector magnitude was 0.17 D or less in both groups (P > .05). A slight against-the-rule astigmatic change of the anterior and posterior corneal interfaces was found after both CCI techniques. CONCLUSION: The 2.75-mm three-plane CCI created with femtosecond laser showed minimal changes of the anterior and posterior corneal topography, comparable with those of single-plane angled manual incision.
Current Opinion in Ophthalmology, 2014
Purpose of review This review outlines the advantages and the differences of femtosecond laser-assisted cataract surgery (FLACS) following a coaxial or microincision cataract surgery phacoemulsification in the surgical outcome and greater control of cataract surgery. Recent findings FLACS offers minimal tissue damage and extreme precision during corneal incision creation, continuous circular capsulorhexis (CCC) and nuclear fragmentation. It also allows diminishing the mean average ultrasound power to emulsify the nucleus followed by a coaxial or a biaxial procedure. The impact of reduced phacoemulsification energy on the corneal endothelium is an interesting topic that is being investigated. Despite its benefits, this technology has relevant financial issues and a high learning curve. Summary FemtoMICS appears to be surgically and statistically more efficient than the FemtoCoaxial technique and Femtoincisions prove to be stable and do not change the corneal high order aberration significantly with favorable results of the triplanar configuration.