December 2, 2016 Conference
Incorperating Femtosecond Laser Assisted Cataract Surgery in Your Practice
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Dr. Kathryn Hatch, Massachusetts Eye and Ear, Waltham (Presenter)
Speaker Session Topic
Key functions of the femtosecond laser include precise capsulotomy formation, lens fragmentation, arcuate and clear corneal incisions. There is much discussion among cataract surgeons today as to the benefits of femtosecond laser assisted cataract surgery (FLACS) compared to conventional manual cataract surgery (MCS). The goal of this talk will be to review the clinical scenarios where the FSL could have specific advantages and limitations. Femtosecond laser (FSL) capsulotomy formation has been described to be greater than 5x the precision compared to manual capsulorhexis.1 Clinical scenarios where this could be especially relevant include cases of capsular insufficiency such as Marfan’s syndrome, pseudoexfoliation or in eyes undergoing refractive IOL placement, including TORIC and presbyopic IOLs. In these cases, precise centration of the capsulotomy on the “scanned capsule” may allow for reproducible IOL centration with less stress on zonules. Another area where the FSL has particular benefit is in the case of the brunescent dense cataract. These cataracts are fractionated and softened with the FSL resulting in reduction in effective phaco time (EPT).2 In these cases, a more routine-feeling case is achieved in an otherwise challenging cataract surgery. EPT reduction may also be of particular benefit in patients with history of Fuchs endothelial dystrophy where high EPT could lead to an increased likelihood of endothelial decompensation.3 Additionally, precise astigmatism correction can also be achieved with the FSL. Not all types of eyes with cataracts, however, are good candidates for the FSL. These clinical situations will also be reviewed, including corneal opacities, white cataract cases and very small pupils as several examples. Additionally, the role of the FSL in the moderate or low grade, non refractive cataract surgery, which as questionable benefit, will also be discussed.