Eyeworld

"prechopped" nucleus is easier to fragment and easier to segment, and it uses less energy and time than if it were done manually. As we gain more experience with the LenSx Laser, we are coming to realize its utility in complicated and difficult cases. I recently saw a patient who had a dislocated, cataractous lens resulting from a traumatic injury. The LenSx Laser allowed me to perform a capsulorhexis much more easily than I would have been able to do manually. Being able to perform the capsulorhexis exactly in the portion of the lens that I wanted and to make it exactly the size that I wanted allowed me to use capsular retraction hooks more effectively and without the concern of these tearing out. It was done more easily and accurately with the femtosecond laser. Similarly, I used the LenSx Laser in another case where the patient had an intumescent, white lens that clinically appeared to have significant intralenticular pressure. I was concerned that this case could be complicated, producing an Argentinian flag sign. This phenomenon is well-known and is a concern because of the high intralenticular pressure. When the capsule is punctured after having applied trypan blue to enhance capsular visibility (even in the presence of viscoelastic and a pressurized chamber), the capsule can tear out, creating a central white band (the white lens) with a blue band on either side resembling the Argentina flag. This is not a concern with a femtosecond laser, however. A perfect capsulorhexis can be performed without having it tear out because the pressure inside the eye is maintained and constant. This significantly improves the safety margin in these type of cases. Recent advancements have made femtosecond laser technology even more exciting. When you think about it, phacoemulsification has been around for 30 or 40 years. Femtosecond laser technology has only been around for 4 or 5 years, and it is amazing that it can perform the steps of the procedure more precisely than manual techniques. Most surgeons who perform these steps manually believe that they can be better, more consistent, more accurate, more precise, and more reliable with femtosecond technology. Why isn't everyone using it? A big question is the economics of the technology. We are finding that this can be overcome and that discussing the use of the femtosecond laser with patients is not as difficult as we once thought. We continue to see remarkable improvements in the upgrades of the instruments. There have been numerous upgrades to the current LenSx Laser system since its inception, and each one has made a powerful impact on the improve- ment of the procedure. I expect that this technology will continue to evolve and as a result provide the opportunity to enhance our practices and our patient outcomes. Reference 1. Kranitz K, Mihaltz K, Sandor GL, Takacs A, Knorz MC, Nagy ZZ. Intraocular lens tilt and decentration measured by Scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy. J Refract Surg. 2012;28(4):259–263. Stephen Lane, MD Dr. Lane is in practice in St. Paul, Minn. He can be contacted at sslane@associatedeyecare.com. 7 The LenSx Laser shown with the Verion Digital Marker

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