scholarly journals Femto Laser-Assisted Cataract Surgery

2020 ◽  
Author(s):  
Clemence Bonnet ◽  
Saba Al-Hashimi ◽  
Antoine P. Brézin ◽  
Dominique Monnet

Cataract is a leading cause of blindness in the world, and cataract extraction is one of the most commonly performed surgeries. Preferred surgical techniques have changed over the past decades with associated improvements in outcomes and safety. Phacoemulsification is a highly successful technique first introduced over 40 years ago. It is the current method of cataract surgery, with a very low reported rate of major complications and a frequency of overall intraoperative complications of less than 2%. Application of the femtosecond laser evolved to now assist in cataract surgery and has been termed FLACS (femtosecond laser-assisted cataract surgery) and occurs in three steps: corneal incisions (including optional limbal relaxing incisions to reduce astigmatism), anterior capsulotomy, and lens fragmentation. The remaining surgical steps still require the surgeon’s hands. The FLACS technique may have some advantages compared with conventional phacoemulsification. It remains however unclear whether FLACS is globally more efficient and safer than conventional surgery. The popularity of FLACS may also be limited by its higher cost compared with conventional surgery. The potential advantages of laser-assisted surgery are yet to be determined as FLACS technology is relatively new and in continuous evolution. This chapter reports scientific data as well as our own experience with this new technology. All the platforms currently available are described.


2017 ◽  
Vol 28 (2) ◽  
pp. 246-250 ◽  
Author(s):  
Simon S.M. Fung ◽  
John Brookes ◽  
Mark R. Wilkins ◽  
Gillian G.W. Adams

Purpose: To describe the use of a mobile femtosecond laser platform in assisting paediatric cataract surgery. Methods: A mobile femtosecond laser was brought into the operating room and calibrated on the day of the surgery. After general anesthesia is induced, the femtosecond laser was docked onto the eyes with a liquid-filled interface, without any perioperative adaptations or additional surgical procedures. An anterior capsulotomy was created with the femtosecond laser, followed by conventional cataract extraction and intraocular lens implantation. Results: Five eyes of 3 children with congenital cataracts were treated with this technique. Docking and capsulorhexis were successful in all cases. No perioperative or intraoperative complications were noted in any of the cases. At median follow-up of 15 months (range 6-18 months), all patients had improved best-corrected visual acuity. Conclusions: Using the mobile femtosecond laser platform, a perfectly sized anterior capsulotomy could be created with high precision and accuracy in paediatric cataract cases, while ensuring that perioperative care for the children undergoing the procedure was not compromised.



2018 ◽  
Vol 103 (4) ◽  
pp. 544-550 ◽  
Author(s):  
Soon-Phaik Chee ◽  
Nicole Shu-Wen Chan ◽  
Younian Yang ◽  
Seng-Ei Ti

Aim To report the capsulotomy and lens fragmentation outcomes of white cataracts managed with the femtosecond laser (FL).Methods Outcomes of a prospective, observational consecutive case series of white cataracts (June 2012–November 2016) that underwent FL-assisted cataract surgery (FLACS) (Victus, Bausch+Lomb, Munich, Germany) at the Singapore National Eye Centre were audited. Data collected: patient demographics, type of white cataract, levelness of docking, anterior capsule position following laser, completeness of capsulotomy and fragmentation, best-corrected visual acuity (BCVA) at 1 month, intraoperative complications. Outcome measures: capsulotomy integrity, fragmentation capability and BCVA at 1 month.Results 58 eyes of 54 patients underwent FLACS. White cataract types included dry white (24 eyes), intumescent (28 eyes) and Morgagnian (6 eyes). Docking was level in 22 eyes (38.6%). Following FL, the anterior capsule level dropped in 20 eyes (34.5%). Incomplete capsulotomies occurred in 10 eyes (17.2%). Lens fragmentation attempted in 38 eyes was effective or partially effective in 31 eyes (81.6%). No anterior or posterior capsule tears occurred. LogMAR BCVA at 1 month was 0.073 (SD 0.09). Risk factors for incomplete capsulotomy were Morgagnian cataract and lens thickness (multiple logistic regression, p<0.01 and p=0.03, respectively).ConclusionThe main complication of FLACS in white cataracts was incomplete capsulotomy (17.2%), significantly associated with Morgagnian cataracts and increased lens thickness. Lens fragmentation was effected in four-fifths of white cataracts but should be avoided in Morgagnian cataracts due to possible overlap of the lens fragmentation plan and the anterior capsule.



2020 ◽  
Vol 40 (11) ◽  
pp. 3097-3104 ◽  
Author(s):  
Marc Schargus ◽  
Svetlana Ivanova ◽  
Gesa Stute ◽  
H. Burkhard Dick ◽  
Stephanie C. Joachim

Abstract Purpose Dry eye symptoms after conventional cataract surgery are a very common problem. Until now, only few data are available on objective tear film parameters in regard to femtosecond laser-assisted cataract surgery (LCS). Aim of this study was therefore to analyze and compare tear film parameter changes between LCS and conventional cataract surgery. Methods A consecutive group of 34 patients, scheduled for cataract surgery, were randomly selected for either LCS or conventional cataract surgery (17 patients/group). Tear film assessments including tear film osmolarity, Schirmer test, MMP-9 analysis via quantitative ELISA, corneal sensitivity, corneal fluorescein staining, and conjunctival fluorescein staining were sequentially evaluated pre- as well as 1 and 3 months postoperatively. Results Both groups showed no significant difference in baseline characteristics. All surgeries were performed without any complications. After 1 and 3 months, there was no statistically significant difference in regard to tear film osmolarity (1 month: p = 0.81, 3 months: p = 1.0), Schirmer test (1 month: p = 0.35, 3 month: p = 0.08), and MMP-9 concentration (1 month: p = 0.36, 3 month: p = 0.28) between the two groups. Conclusions Neither LCS nor conventional cataract surgery affected objective tear film parameters significantly during our 3-month postoperative observation period. Hence, both surgical techniques can be equally used to treat patients without prior dry eye symptoms.



Author(s):  
Sancy Low ◽  
John Tran ◽  
Catherine McGurk ◽  
Ayushi Gupta ◽  
Harry W Roberts ◽  
...  




2012 ◽  
Vol 69 (5) ◽  
pp. 385-388 ◽  
Author(s):  
Vladimir Draganic ◽  
Miroslav Vukosavljevic ◽  
Milorad Milivojevic ◽  
Mirko Resan ◽  
Nenad Petrovic

Background/Aim. Cataract surgery has become one of the safest procedures in medicine thanks to advances in technology and surgical techniques. Although minimal, we still witness different complications. The aim of this study was to compare visual outcome and complication rate in different techniques of cataract surgery, ie in cataract surgeries with various corneal incision width. Methods. The study included 3,457 consecutive patients, ie 4,670 eyes that had undergone cataract surgery. The used surgical techniques were: extracapsular cataract extraction, phacoemulsification/ forceps IOL implantation, phacoemulsification/ injector IOL implantation, microincision cataract surgery (MICS). Patient follow up was 6 months. Patients were evaluated for: visual aquity, corneal astigmatism, cellular reaction in the anterior chamber, IOL position. Results. Uncorrected visual aquity 30 days postoperatively was ? 0.5 in 30% of the eyes - ECCE; 54.7% of the eyes - phacoemulsification/forceps IOL implantation; 63.0% of the eyes - phacoemulsification/injector IOL implantation; 5/8 of the eyes - MICS. Endophthalmitis was detected in 0.15% of the eyes - ECCE and 0.1% of the eyes - phacoemulsification/forceps IOL implantation. In eyes with phacoemulsification/injector IOL implantation or microincision cataract surgery (MICS) there were no cases of endophthalmitis. After a 6-month period intraocular lens were dislocated in 7.2% of the eyes - ECCE, and 0.6% of the eyes - phacoemulsification/PMMA IOL. There was no IOL dislocation in other surgical techniques. Conclusion. Shorter corneal incision implies less complications, less operative trauma, faster visual rehabilitation and better visual outcome.



2021 ◽  
Vol 4 (1) ◽  
pp. 227-232
Author(s):  
Felicia Tai ◽  
Nistha Jaki ◽  
Sohel Somani ◽  
Hannah Chiu ◽  
Eric Tam

Purpose: To assess the effect of brimonidine tartrate 0.15% on reducing subconjunctival hemorrhage, measured with a bulbar redness score, following femtosecond laser assisted cataract surgery (FLACS). Patients and Methods: A prospective, masked randomized controlled study was done using single-blinded simple randomization. All FLACS cases completed between June and August 2019 were included except those on anticoagulation or with prior conjunctival surgery. All operated eyes received usual preoperative eye drops, while Study group received added brimonidine. Exclusion criteria included >1 vacuum attempt during FLACS and any intraoperative complications. All subjects received Bulbar Redness (BR) Score and Analyzed Area (AA) imaging by Oculus 5M Keratograph preoperatively and postoperatively. AA including non-conjunctival structures, <25mm2, or postoperative AA values >10% different from preoperative values were excluded from final analysis. Absolute values and differences between mean postoperative and preoperative BR and AA were compared using Student’s t-test. Results: 62 eyes (Study group=25, Control group=37) of 56 patients were randomized and included for analysis. Baseline demographic comparison between the two groups were similar. Preoperative BR score in the Study group trended higher (1.62) than Control (1.40, p=0.07), while postoperative BR score remained similar between groups (p=0.70). Difference in postoperative and preoperative BR score was significantly larger in the study group (-0.21±0.56) than controls (+0.06±0.43, p=0.036). Conclusions: The use of preoperative brimonidine in FLACS reduces the amount of postoperative subconjunctival hemorrhage following FLACS, as observed by reduced bulbar redness. Oculus 5M BR scoring has potential to be used as an objective method of quantifying subconjunctival hemorrhage after ophthalmic surgeries and procedures.



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