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    Evolutions in laser technologies making cataract surgery safer

    Superior outcomes can be achieved precisely, consistently, predictably

     

    I have been involved in several research efforts aimed at understanding how the various features can be utilised to optimise patients’ outcomes and facilitate greater efficiency in the operating room. As I have learned, the features can be harnessed to create new surgical techniques that make the surgery safer and easier to perform in routine cases and especially in complex ones.

    One example is the ability to perform cataract surgery without the use of OVDs. Because the femtosecond laser can be used to emulsify the lens, which in turn reduces the reliance on ultrasound energy, OVDs may not be necessary to protect the corneal endothelium during the capsulotomy and fragmentation steps.1 An intra-individual comparison of 74 eyes of 37 patients randomised to either standard phaco with OVD or LCS without OVD indicated no difference in endothelial cell loss and a trend toward lower IOP in the group without OVD.12

    Another example is to use laser-cut capsulotomies as a rescue technique in cases in which the initial capsulotomy is too small. A case series demonstrated the ability to safely perform phaco and IOL insertion before using laser to enlarge the capsulotomy without causing a capsule tear.13 Such a technique may be applicable and beneficial for eyes in which there is a small anterior capsule opening.

    A potential benefit of laser-cut capsulotomies is the ability to achieve an IOL’s effective lens position more rapidly after implantation, thus ensuring faster visual recovery and more predictable outcomes.14

    However, while all of the femtosecond laser platforms on the market offer the ability to cut a capsulotomy, the onboard imaging capabilities of the Catalys with regard to its 3-D SC-OCT creates particularly precise positioning.

    Another example of complementary functions and their application to cataract surgery is in the ability to perform a posterior capsulotomy. Because this platform’s imaging system can map anterior and posterior capsulotomies, there are several ways to perform a primary posterior capsulotomy with the Catalys, both in adults15 and in paediatric eyes.16 The fluid interface means that it is also possible to first aspirate the cataract then safely re-dock the eye, cut a posterior capsulotomy and perform a bag-in-the-lens implantation.17

    Overall, the unique features of Catalys have permitted the expansion of indications for LCS and have made the procedure safe for even complex cases, such as brunescent18 and intumescent white cataracts,19,20 in paediatric patients with Marfan syndrome,21 eyes with a small pupil22 and following trauma cases involving penetrating injury to the cornea and capsule.23

     

     

    Posterior laser capsulotomy. (Image courtesy of Dr H Burkhard Dick)

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

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