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Learning curve and complications of first cases of femtosecond laser cataract surgery

Session Details

Session Title: Femtolaser Cataract Surgery

Session Date/Time: Tuesday 08/10/2013 | 14:00-16:15

Paper Time: 14:10

Venue: Auditorium (First Floor)

First Author: : H.Abou Zeid SWITZERLAND

Co Author(s): :    W. Ferrini              

Abstract Details

Purpose:

To analyse the rate of intraoperative complications and to report the learning curve on the initial eyes undergoing Femtosecond laser cataract surgery.

Setting:

Cataract Unit, The Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland

Methods:

Prospective consecutive case series study of the initial 26 eyes undergoing Femtosecond laser cataract surgery by one experienced surgeon with previous refractive surgery expertise at the Jules-Gonin Eye Hospital from January 2013 to March 2013. Exclusion criteria for the femtolaser procedure were: age < 25 years old, pupil dilation < 5 mm, white cataract, corneal opacities, previous arcuate corneal relaxing incision, previous refractive corneal surgery, nystagmus or hemifacial spasm, advanced glaucoma and ocular hypotony (? 5mmHg). We intended to have corneal incisions, anterior capsulotomy and lens fragmentation performed with the femtosecond laser LenSx (Alcon LenSx laser system). The procedure was completed by standard phacoemulsification and insertion of an intraocular lens. The manual surgical steps were adapted to the use of the femtosecond laser with special care given to soft hydrodissection after significant decompression of the anterior chamber and with the use of a pre-chopper to complete the laser fragmentation and allow the gas bubbles to come forward.

Results:

The mean age of patients was 71.8±6.4 years. The mean time in the operating room including phacoemulsification time was 31.5±2.9 minutes. The mean number of docking attempts was 1.3 (range 1 to 3). None had a suction break during the laser procedure. All the 26 eyes underwent a complete laser procedure achieving capsulotomy, lens fragmentation and corneal incisions. All eyes had a complete primary incision and 26% required a keratome for secondary incisions to enter the anterior chamber. One case had a peroperative post-laser pupillary constriction. The number of incomplete capsulotomy was 4 (15%). No anterior radial tears, posterior capsular rupture or lens dislocation was observed.

Conclusions:

Our data show that with modified manual surgical techniques, proper selection of patients, and an experienced surgeon with previous refractive surgery expertise, Femtosecond laser cataract surgery is a safe procedure even for the first performed cases, with a steep learning curve. No capsular block syndrome occurred in the described series. Our rate of complications is lower than the published results of early series to date, although the later are often larger ones. The fact that primary incisions appear to be more reliable than the secondary incisions may be explained by a learning curve effect.

Financial Interest:

NONE