Back to Freepaper Session

Femtosecond laser cataract surgery with a broad inclusion criteria

Session Details

Session Title: Femtolaser Cataract Surgery

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

Paper Time: 16:00

Venue: Auditorium (First Floor)

First Author: : B.Dick GERMANY

Co Author(s): :    T. Schultz   I. Conrad-Hengerer           

Abstract Details

Purpose:

Femtosecond laser cataract surgery can improve capsulotomy shape, size, and centration over a manual approach. Lens fragmentation significantly reduces ultrasound energy during lens removal. The purpose of this study is to evaluate the ability of this technology to provide these advantages to all patients using a broad inclusion criteria. Furthermore, we aim to assess specific physiological and laser parameters that allow laser cataract pre-treatment in patients with various comorbidities and challenging surgical scenarios.

Setting:

Ruhr University Eye Clinic, Bochum, Germany

Methods:

850 cases of capsulotomy, lens fragmentation, cataract and/or arcuate incisions were completed and documented by video with a laser for cataract surgery (Catalys Precision Laser System, OptiMedica, Sunnyvale, CA). Patients were evaluated for comorbidities, capsulotomy precision, intra and postoperative complications. Cases that would typically be considered surgically challenging were noted and results were recorded following treatment with the laser. All cataracts were graded with slit lamp using the LOCS III scale by the same surgeon. IOP was assessed in 100 patients who underwent measurements with a Schiotz tonometer placed directly on the cornea through the non-applanating suction ring. The liquid optics interface integrated into the system allowed for intraocular pressure measurements, before, during, and after the laser procedure. To assess EPT, cases with entirely manual procedures were compared to cases with laser pretreatment before cataract removal. EPT was evaluated with both a 500 micrometer grid spaced pattern and a 350 micrometer grid spaced pattern to note differences. EPT reduction was determined in each grade of cataract and compared to manual, with 150 patients with LOCS III Grade 2 cataracts, 276 patients with LOCS III grade 3 cataracts, and 409 patients with LOCS III Grade 4 cataracts.

Results:

The first 850 eyes included cases of glaucoma (N=53), mature cataracts (N=31), Fuchs Dystrophy (N=5), Cornea Guttata (N=55), pseudoexfoliation (N=38), IFIS (N=62), small pupils (N=40), post vitrectomy (N=15), anticoagulation (N=91), and scars (N=12). We show 99% free capsulotomy, minimal conjunctival alteration, and clear cornea post operatively. Arcuate corneal incisions were placed within 1% of intended optical zone location. Primary cataract incisions were dissectable with a blunt tool. Upon application of the suction ring, intraocular pressure rose by only 10mm Hg. EPT, across all grades of cataract was reduced by 96% with substantial reductions in even the hardest grades. Ultrasound energy was eliminated in 40% of the first 850 cases. Furthermore, brunescent grade 5+ cataracts required a mean EPT of 2.24±2.85, comparable to grade 3 cataracts with a manual approach.

Conclusions:

Image guided laser catraract surgery provides high precision, elimination of EPT, and low IOP. A gentle liquid optics patient interface, precise femtosecond laser, and image guidance improved safety and allow treatment of challenging cases with a broad inclusion criteria.

Financial Interest:

... gains financially from competing product or procedure, ... travel has been funded, fully or partially, by a competing company, ... receives consulting fees, retainer, or contract payments from a competing company, ... gains financially from product or procedure presented