New technology update: femtosecond laser in cataract surgery

Abstract

Femtosecond lasers represent a new frontier in cataract surgery. Since their introduction and first human treatment in 2008, a lot of new developments have been achieved. In this review article, the physical principle of femtolasers is discussed, together with the indications and side effects of the method in cataract surgery. The most important clinical results are also presented regarding capsulotomy, fragmentation of the crystalline lens, corneal wound creation, and refractive results. Safety issues such as endothelial and macular changes are also discussed. The most important advantage of femtolaser cataract technology at present is that all the important surgical steps of cataract surgery can be planned and customized, delivering unparalleled accuracy, repeatability, and consistency in surgical results. The advantages of premium lenses can be maximally used in visual and presbyopia restoration as well. The advantages of premium lenses can be maximally used, not only in visual, but in presbyopia restoration as well. Quality of vision can be improved with less posterior chamber lens (PCL) tilt, more centralized position of the PCL, possibly less endothelial damage, less macular edema, and less posterior capsule opacification (PCO) formation. This technological achievement should be followed by other technical developments in the lens industry. Hopefully this review article will help us to understand the technology and the results to demonstrate the differences between the use of femtolasers and phacoemulsification-based cataract surgery. The most important data of the literature are summarized to show ophthalmologists the benefits of the technology in order to provide the best refractive results to the patient.

Keywords: arcuate keratotomy; capsulotomy; consistency of results; corneal wound; femtosecond laser-assisted cataract surgery; lens fragmentation; safety.

Figure 1

The screen for the surgeon. Note the corneal wounds and the astigmatic incisions. On the upper right, the OCT identifies the endothelial layer, the anterior capsule (highest and lowest point); on the lower part of the image, OCT identifies the cut within the crystalline lens (yellow area). Abbreviation: OCT, optical coherence tomography.

Figure 2

The proprietary image-guided system (A) allows the surgeon to take a preoperative OCT image (B) and position the planned incisions and photolysis patterns on the patient’s eye. The blue and yellow overlays represent the lens photolysis and capsulotomy patterns (B). The red represents the corneal incisions (B). The size and position of all patterns can be preprogrammed and adjusted for ultimate surgeon control. Abbreviation: OCT, optical coherence tomography.