DEC 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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December 2013 However, femto does not work well near limbus, corneal vascularization/pannus or scars. In such cases a more central corneal incision is created by femto. This induces more astigmatism. Also, the clear corneal or limbal relaxing incisions for treating astigmatism are not very predictable and using toric IOLs may be a better option. The femtosecond laser is able to create a near perfect, round opening in the anterior capsule, which is believed to reduce the incidence of posterior extension of the tear and decentration of the IOL. On the contrary, decentration of the IOL is multifactorial, depending upon capsular fibrosis/contraction, size and type of IOL, position of haptics, zonular stability, and so on. In cases of incomplete rhexis following femtolaser, forceps are needed to remove the anterior capsule. Femtolaser also cannot be used in smaller pupils. As far as lens fragmentation is concerned, femtolaser is thought to reduce the average time and ultrasonic energy required to break up and remove the lens. However, one needs to focus the laser at least 800 microns away from the posterior capsule or there is a high risk of PC tear and nucleus drop. It has also been seen that the femtolaser is unable to separate the posterior plate in hard cataracts causing incomplete fragmentation. Most of the complications during standard phaco such as PC rent occur during I/A and this cannot be avoided with the femto. As far as patient experience is concerned, there is increased pain and discomfort due to the large suction cup. At the end of the surgery, the eye looks red—not cosmetically acceptable in a premium surgery. Other downsides of femto cataract include increased operative time, longer patient waiting time, and a two-stage procedure. There is no clinically significant difference in vision compared to phaco, but a significant increase in cost of surgery. Newer technology should improve surgical efficiency, patient comfort and safety or provide a significant clinical benefit or reduced cost of treatment. This is yet to be clearly established with femtoassisted cataract surgery. EW Editors' note: Dr. Espiritu has no financial interests related to this article. Dr. Ganesh has no financial interests related to this article. The physicians' comments are their own, and do not reflect an official editorial position from EyeWorld. EW International Contact information Espiritu: espiritueyemd@mac.com Ganesh: chairman@nethradhama.org 49

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