A Review of Laser-Assisted Versus Traditional Phacoemulsification Cataract Surgery

Abstract

The use of femtosecond laser surgery improves the precision and reproducibility of corneal incisions and the capsular opening; it also reduces the amount of ultrasound energy required for lens nucleus work-up. The rate of complications reported so far appears to be low. There are a number of contraindications such as a history of cornea and/or glaucoma surgery and certain anatomical features like deep-set eyes, kyphosis, tremor, and obesity. Visual recovery and refractive results of both techniques are excellent. Comparing laser cataract surgery (LCS) with manual cataract surgery (conventional phacoemulsification) based on meta-analysis currently reveals slight differences in refractive and visual outcome. Both methods are extremely successful and safe. LCS is a technique still on the rise, with its full potential not yet tapped.

Keywords: Capsulorhexis; Capsulotomy; Cataract; Effective phaco time; Endothelial cell count; Femtosecond laser; Intraocular lens; Laser cataract surgery; Manual phacoemulsification; Prostaglandin; Ultrasound.

Fig. 1

Round, circular, centered capsulotomy in LCS with a 360° overlap on the IOL optic (intraoperative view through the OR microscope)

Fig. 2

Preoperative planning of the intrastromal arcuate corneal incision in the femtosecond laser machine

Fig. 3

Intraoperative position check of the intrastromal incision using 3-D SD LIVE OCT (after docking). A change of length, depth, arc, centration method, and position is still possible

Fig. 4

Full fragmentation of the advanced cataractous lens using a two main cut pattern (with multiple repetitions herein) in LCS. Cavitation gas bubbles appear at the end of the lasing

Fig. 5

Screenshot of the planning in LCS (with main incision, two sideports, two arcuate incisions, capsulotomy, and lens fragmentation)

Fig. 6

Mini-capsulotomy on intraoperative laser system screen view demonstrating its centration, position, and size

Fig. 7

Primary posterior laser-assisted capsulotomy with the IOL in the capsular bag and some cavitation bubbles (intraoperative view through the OR microscope at the end of the surgery)