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    How patient movement can interfere with femto laser-assisted cataract surgery

    Unexpected head movement can lead to suction loss and displaced laser beam delivery despite safety mechanisms of the femto platform, allowing the femto-laser grid pattern to be delivered into the cornea. (Video courtesy of Sonia Yoo, MD)

    Femtosecond laser-assisted cataract surgery (FLACS) is a latest advance in technology that is transforming traditional cataract surgery into a refractive procedure. Multiple studies have shown that laser-assisted cataract surgery can increase precision and reproducibility of the anterior capsulotomy, reduce effective phacoemulsion time, cause less postoperative inflammation to the anterior chamber, and possibly reduce surgically-induced endothelial cell damage.

    Sonia Yoo, MD

    However, it is discussed much less often that the safeguards built into FLACS instruments can fail and allow the femto laser grid pattern to be delivered into the cornea.

    “We think this is what happened to one of my patients,” said Sonia Yoo, MD, professor of ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine. “Suction was lost during lens segmentation. The segmentation pattern that was intended for the lens nucleus unintentionally treated the cornea.”

    Recent: Trends in U.S. refractive surgery: 2015 ISRS survey

    The good news is that the unintentional corneal scoring had no effect on the visual outcome, Dr. Yoo noted.

    The patient had uncorrected 20/20 vision the day after surgery and still had 20/20 vision on her last exam a year after the incident. But because of the unexpected treatment of the patient’s cornea, she implanted a monofocal lens rather than the planned multifocal lens.

    “The patient was quite happy with 20/20 vision,” Dr. Yoo said. “Even with the monofocal lens, her vision was so much better than it was pre-op that she was perfectly happy with the result. But this still points out that unexpected head movement can lead to suction loss and displaced laser beam delivery despite the safety mechanism of the femto platform. This is a potential development that you should discuss with your patient as part of your informed consent.”

     

    Misplaced laser delivery

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