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Intrastromal arcuate incisions with a femtosecond laser for cataract surgery

Session Details

Session Title: Femtolaser Cataract Surgery

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

Paper Time: 15:36

Venue: Auditorium (First Floor)

First Author: : M.Blecher USA

Co Author(s): :    R. Bailey   D. Salz           

Abstract Details

Purpose:

To evaluate the efficacy of and safety for intrastromal arcuate incisions created by a femtosecond laser for cataract surgery. The study is designed to assist in future nomogram development for these incisions through a larger prospective clinical trial. The results will help accurately predict astigmatic correction in patients undergoing cataract surgery.

Setting:

Wills Eye Hospital, Philadelphia, PA

Methods:

A pilot study of 10 cataract patients with pre-operative astigmatism of 0.5 D to 3 D was conducted. Pre-operatively, patients were assessed with corneal topography, manual keratometry, slit lamp, and dilated fundoscopic exam. Based on these measurements, astigmatic correction was calculated using the Donnenfeld nomogram for limbal relaxing incisions. Capsulotomy, fragmentation, primary and intrastromal arcuate incisions were performed with a laser for cataract surgery (Catalys, Sunnyvale, CA). All incisions were guided using full volume 3D OCT mapping. Capsulotomy diameter was set to 5 mm. Fragmentation volume was maximized based on dilation and lens thickness. Arcuate incisions were placed at an optical zone of 8mm with a side cut angle of 90 degrees. Uncut anterior and posterior regions were set to 20% of calculated corneal thickness based on OCT guidance. Following laser pre-treatment, lens removal and IOL insertion was completed using standard technique. Postoperative follow-up was completed at multiple time points to assess incision architecture, patient comfort, and preliminary refractive outcomes.

Results:

All patients were treated successfully with intrastromal arcuate incisions. Intrastromal incisions were of the correct geometry and placed at the correct optical zone, arc length, and position. Uncut regions of 20% were left from the posterior and anterior corneal surfaces. Patient comfort was improved over anterior penetrating incisions during follow-up. 9 out of 10 patients showed a decrease in astigmatism .

Conclusions:

Intrastromal arcaute incisions pose the potential benefits of minimizing risk of infection and increasing patient comfort, particularly related to foreign body sensation. The results of this pilot study were used to create a prospective clinical trial involving 50 eyes, whose enrollment is now ongoing. Preliminary results from that larger trial will be presented.

Financial Interest:

NONE