EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/276058
E W FEATURE 108 by Vanessa Caceres EyeWorld Contributing Writer Femtosecond phaco techniques and outcomes Seasoned surgeons share their first-hand experience and observations E veryone seems to love lasers—femtosecond lasers for cataract surgery, that is. "It's been a wonderful, game-changing technol- ogy," said William B. Trattler, MD, director of cornea, Center for Excellence in Eye Care, Miami. "We're using the laser with more than 90% of our cataract pa- tients, and it's worked out well," said Stephen G. Slade, MD, director, Laser Center of Houston, Houston. "Today's cataract patient wants to see as well as possible with mini- mal use of glasses," said Robert J. Weinstock, MD, the Eye Institute of West Florida, Largo. "To have this device that's more precise is a tremendous advantage." Still, for all the praise, there is a learning curve involved—and, like anything, it takes some time to get accustomed to new technology. EyeWorld interviewed physicians using various femto laser platforms for cataract surgery to find out how their technique differs with the laser compared with manual phaco and how their outcomes are different now. Here's what they shared. Technique changes Using a femtosecond laser in cataract surgery patients does change the procedure—however, it's not as drastic of a change as that faced by surgeons who may have at one time switched from extracapsu- lar cataract extraction to phacoemul- sification, said Dr. Weinstock, who uses the VICTUS laser (Bausch + Lomb, Rochester, N.Y.), the LenSx laser (Alcon, Fort Worth, Texas), and the LENSAR Laser System (LENSAR, Orlando, Fla.). "I don't think it's something surgeons should be intimidated by. It's very germane to what we're already doing," he said. "For the cataract surgeon who's never made a femtosecond LASIK flap, there's going to be a quick learning curve, but they are not very difficult lasers to operate and it's not a challenging procedure in itself." "The laser does the first half of the surgery," said Dr. Slade, who uses the LenSx laser. "It makes the inci- sion, does the capsulorhexis, and fragments the nucleus. It also does arcuate incisions that we would have done by hand." "Having the cataract fragmented by the laser reduces the need to crack and chop," Dr. Weinstock said. "This reduces mechanical stress on the zonules. We don't need to ma- nipulate the nucleus as much. That helps to reduce phaco time and energy, leading to less mechanical stress on the capsule." Michael Lawless, MD, Vision Eye Institute, Chatswood, New South Wales, Australia, who uses the LenSx laser, said the laser ensures consistent incisions, a guaranteed capsulotomy size, and he is able to place the capsulotomy in the center of the entrance pupil with more certainty. Additionally, the surgeons inter- viewed will use the laser for arcuate incisions relative to astigmatism as necessary. Pearls for managing challenges However, for laser use to be effective, Dr. Weinstock finds that patients need to be well dilated before sur- gery. Patients sometimes need extra dilating drops after the laser because February 2011 Femtosecond phaco techniques March 2014 AT A GLANCE • Femtosecond lasers have changed s ome surgeons' approach to cataract surgery. • The use of the laser can make surgery easier, more predictable, a nd safer, surgeons say. • Areas that might present initial c hallenges include cortical cleanup, patient flow from the laser room t o the OR, patient selection, and pupil dilation. • Patients are interested in laser- assisted cataract surgery, particularly if they are having refractive cataract surgery. Status post laser capsulotomy and nuclear segmentation with softening performed with the Catalys laser system Source: Jonathan Talamo, MD With the LENSAR laser, pattern of eight pie cuts with cylinders spaced .25 mm apart, resulting in significant fragmentation of the nucleus Source: William B. Trattler, MD 108-125 Feature_EW March 2014-DL2_Layout 1 3/6/14 3:59 PM Page 108