Femtosecond laser cataract surgery

Abstract

Femtosecond laser (FSL) cataract surgery is in its infancy but is rapidly gaining popularity due to the improved consistency and predictability for corneal incisions and anterior capsulorhexis. It enables subsequently less phacoemulsification energy and time to be employed, which has gains in terms of reduced corneal oedema. In addition, the FSL allows better circularity of the anterior capsulotomy, capsule overlap, intraocular lens (IOL) placement and centration of the IOL. These advantages have resulted in improved visual and refractive outcomes in the short term. Complication rates are low which reduce with surgeon experience. This review article focuses on the Alcon LenSx system.

Keywords: Capsulorhexis; Cataract surgery; Corneal incisions; Corneal oedema; Femtosecond; Femtosecond laser; Macular oedema; Phacoemulsification.

Fig. 1

Lasers in ophthalmology; excimer lasers operate in the ultraviolet range whereas femtosecond lasers operate in the infrared range of the electromagnetic spectrum

Fig. 2

Corneal surgery based on photodisruption. Excimer lasers produce precise superficial effects whereas femtosecond lasers produce precise deeper effects within the cornea and the crystalline lens

Fig. 3

The LenSx femtosecond laser

Fig. 4

The optical coherence tomography (OCT) system provides information for the surgeon and the surgical plan is based on the pre-operative OCT measurements (size and centration of capsulotomy, fragmentation pattern, corneal wound structure and geometry, and arcuate astigmatic incisions)

Fig. 5

Femtosecond laser created capsulotomy versus a traditional manually created capsulotomy