Femtosecond laser in cataract surgery

1. The role of femtosecond lasers cataract surgery is to assist or replace several aspects of the manual small incision cataract surgery. These include the creation of the initial surgical incision in the cornea, the creation of the capsulotomy and the phacofragmentation, the initial fragmenting of the lens. The femtosecond laser may also produce incisions within the peripheral cornea to aid the correction of pre-existing astigmatism .
   Femtosecond laser currently has four applications in cataract surgery: astigmatic limbal relaxing incisions (LRIs), corneal wound construction, anterior capsulotomy (or laser-incised capsulorhexis), and lens fragmentation.
    
2. Femtosecond laser energy is absorbed by the tissue, resulting in plasma formation. This plasma of free electrons and ionized molecules rapidly expands, creating cavitation bubbles. The force of the cavitation bubble creation separates the tissue. The process of converting laser energy into mechanical energy is known as photodisruption.
    
3. We stand at the threshold of a revolution, which is guided by the femtosecond laser.Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery.
    
4. Further studies are recommended for the safety and efficacy of FLACS. Also, it is important to research the difference in postoperative endophthalmitis rates after laser-assisted corneal incision. this is a key question because postoperative endophthalmitis is the terminal outcome measure that will ultimately justify FSL use in corneal incisions.

In attached file we give an overview of Femtosecond laser cataract technology and clinical practice.

REFERENCES

1. Roberts RV, Sutton G, Lawless MA, et al. Capsular block syndrome associated with femtosecond laser assisted cataract surgery. J Cataract Refract Surg. 2011;37:2068-2070.
2. Ashok Garg, Jorge L. Alio, Femtosecond Laser Techniques and Technology, ISBN-10: 9350258765 | ISBN-13: 978-9350258767
3. Sugar A. Ultrafast (femtosecond) laser refractive surgery. Curr Opin Ophthalmol. 2002;13:246–9.
4. He L, Sheehy K, Culbertson W. Femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2011;22:43–52.
5. Krasnov MM. Laser-phakopuncture in the treatment of soft cataracts. Br J Ophthalmol. 1975;59:96–8.
6. Peyman GA, Katoh N. Effects of an erbium: YAG laser on ocular structures. Int Ophthalmol. 1987;10:245–53.
7. Walkow T, Anders N, Pham DT, Wollensak J. Causes of severe decentration and subluxation of intraocular lenses. Graefes Arch Clin Exp Ophthalmol. 1998;236:9–12.
8. Cekic O, Batman C. The relationship between capsulorhexis size and anterior chamber depth relation. Ophthalmic Surg Lasers. 1999;30:185–90.
9. Wolffsohn JS, Buckhurst PJ. Objective analysis of toric intraocular lens rotation and centration. J Cataract Refract Surg. 2010;36:778–82.
10. Gale RP, Saldana M, Johnston RL, Zuberbuhler B, McKibbin M. Benchmark standards for refractive outcomes after NHS cataract surgery. Eye (Lond) 2009;23:149–52.
11. Murphy C, Tuft SJ, Minassian DC. Refractive error and visual outcome after cataract extraction. J Cataract Refract Surg. 2002;28:62–6.
12. Cullen K, Hall M, Golosinskiy A. Ambulatory surgery in the United States, 2006. [Last Accessed on 2011 Jul 7];Natl Health Stat Rep. 2009 28:1–25. Available from: http://www.cdc.gov/nchs/data/nhsr/nhsr011.pdf .
13. Juhasz T, Loesel F, Kurtz R, Horvath C, Bille J, Mourou G. Corneal refractive surgery with femtosecond lasers. IEEE J Sel Top Quantum Electron. 1999;5:902–10.
14. Friedman NJ, Palanker DV, Schuele G, Andersen D, Marcellino G, Seibel BS, et al. Femtosecond laser capsulotomy. J Cataract Refract Surg. 2011;37:1189–98.
15. Palanker DV, Blumenkranz MS, Andersen D, Wiltberger M, Marcellino G, Gooding P, et al. Femtosecond laser-assisted cataract surgery with integrated optical coherence tomography. Sci Transl Med. 2010;2:58ra85.
16. Taban M, Behrens A, Newcomb RL, Nobe MY, Saedi G, Sweet PM, et al. Acute endophthalmitis following cataract surgery: A systematic review of the literature. Arch Ophthalmol. 2005;123:613
17. Liampiri Efrosini: Femtosecond laser cataract surgery technology and clinical practice. Master Thesis, Comenius Univ., Med. School, Bratislava, 70 pp. https://ais2.uniba.sk/ais/files/furdova11402171551869?appId=16707446&contentType=application/pdf&antiCache=-58556051644000&file=furdova11402171551869

LIST OF ABBREVIATIONS

Laser in situ Keratomileusis (LASIK)
Manual Small Incision Cataract Surgery (MSICS)
Femtosecond laser(FSL)
Cataract Laser Extraction (CLE)
Clear Corneal Incision (CCI)
Femtosecond Laser-Assisted Cataract Surgery (FLACS)
Femtosecond-Assisted (FSL-Assisted)
Optical Coherence Tomography (OCT)
Intraocular Pressure (IOP)
Best corrected visual acuity (BCVA)
Refractive Cataract Surgery (FCS)

Supported by KEGA Grant 008UK - 4/2014

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