April 20, 2018 Conference
The femtosecond laser can be used to perform several steps of cataract surgery. This technology presents unique challenges and opportunities in patients with coexisting glaucoma and related conditions. Advantages include precise and atraumatic capsulotomies in eyes with intumescent cataracts, shallow anterior chambers, or zonular weakness with or without lens subluxation. Laser nuclear fragmentation reduces effective phacoemulsification time and endothelial cell loss, a potential benefit in eyes with dense cataracts or endothelial compromise. Glaucoma procedures including MIGS, trabeculectomy or tube shunts can be combined with laser-assisted cataract surgery with only minor changes in technique. Potential challenges include applanating the ocular surface with the laser interface in eyes with severe periorbital fat atrophy. High limbal blebs or patch grafts can also interfere with the docking procedure. The laser capsulotomy size can be changed in eyes with poor dilation but mechanical pupil dilation requires additional modifications. IOP rise is transient, but caution is advised in patients with advanced field loss.