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    Femtosecond laser surgery still raising bar for cataract surgery outcomes

    Surgeons, technologies striving to meet patient demands; key to safety, effectiveness, efficiency


    Dr. Packer and colleagues undertook at laboratory study to determine the ideal femtosecond laser capsulotomy based on the capsular histology and biomechanics. Criteria for defining a capsulotomy as ideal were that the capsulotomy should prevent posterior capsular opacification (PCO), maintain the effective lens position, and optimize capsular strength.

    Results indicated that ideal capsulotomy construction should completely overlap the IOL to prevent PCO, centration should be on the clinical approximation of the optical axis of the lens to ensure concentricity with the capsular equator, and the maximal capsular thickness should be at the capsulotomy edge to maintain integrity, according to Dr. Packer. The results were reported in the British Journal of Ophthalmology (2015;99:1137-1142).

    A comparison of the effective phaco time between manual phacoemulsification and femtosecond laser cataract surgery showed that the mean phaco time was significantly lower in the femtosecond laser cataract surgery group compared with the manual phacoemulsification group (1.58 versus 4.17 seconds: p = 0.001) and the endothelial cell loss in the femtosecond laser cataract surgery group was also significantly (p = 0.02) lower (Mayer et al. Am J Ophthalmol. 2014;157:426-432).

    The morphologic features of corneal incisions were found to be significantly improved in association with femtosecond laser cataract surgery with lower endothelial gaping, endothelial misalignment, Descemet’s membrane detachment, and posterior wound detachment than the clear corneal incisions that were created with a microkeratome.

    In addition, the incisions were within 10% of the intended length, said Dr. Packer, citing a study by Grewal and Basti (J Cataract Refract Surg 2014; 40:521-530).

    “The overall complication rates are comparable to standard phaco, anterior capsule tears are a learning curve issue, corneal Incisions are associated with improved morphology, and there is a significant reduction in the effective phaco time,” he said.


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