Eyeworld

37 Supported by unrestricted educational grants from Alcon Laboratories and Abbott Medical Optics T he top goals of laser-assist- ed cataract surgery (LACS) are to improve the safety profile of surgery, improve refractive outcomes, and improve patient comfort and sat- isfaction. These are accomplished by performing more efficient lens fragmentation and removal and making more precise and accurate capsulotomies, cataract incisions, and astigmatic incisions. LACS literature The peer-reviewed literature per- taining to LACS is growing signifi- cantly, providing information about arcuate incisions, capsulorhexis, and reduced phacoemulsification time and energy (Figure 1). Of course, the overarching concerns are increased safety and efficacy. As with any technology, there are potential risks and a learning curve. To reduce this learning curve, it is important to learn from surgeons who have studied this technology and spend time with experienced surgeons. Loriaut et al. showed reduction of corneal astigmatism from 2.68 D before surgery to 0.58 D 6 months after intrastromal arcuate incisions were performed. 1 LACS is needed to create intrastromal incisions. In the future, we will frequently use intras- tromal incisions that will be selected automatically by the laser—with no breakage of the epithelium, no pain, and no need for antibiotics. Schultz et al. reported that the femtosecond laser produces capsu- lotomies with a more consistent size and shape compared with manual techniques. 2 In addition, the capsu- lotomy can be centered on the pupil and therefore attain better refractive outcomes. A paper by Mayer et al. showed that LACS significantly reduces effec- tive phacoemulsification time. 3 Less phacoemulsification time results in clearer corneas, less endothelial cell loss, and better safety. The safety of femtosecond laser continues to improve. It is compara- ble to that of conventional surgery and probably better; however, long- term studies are needed to docu- ment this. 4 Peter Barry, MD, Dublin, Ireland, reported at the European Society of Cataract & Refractive Surgeons (ESCRS) meeting that LACS matches but does not outperform phacoemulsification. 5 Conclusion The peer-reviewed documentation regarding LACS is growing. LACS is a more controlled procedure, offering surgeons the ability to perform bet- ter incisions, intrastromal incisions, and self-sealing wounds, as well as precise capsulotomies for improved refractive results. It can reduce phacoemulsification time and en- ergy. We're offering our patients an opportunity for better vision quality and safety and a procedure that can make a difference in their lives. With all new procedures there are risks, which we must continue to assess. There is a learning curve, as we discovered with LASIK, but manufacturers continue to advance the technology. References 1. Loriaut P, et al. Femtosecond-assisted arcuate keratotomy for the correction of postkeratoplasty astigmatism: vector analysis and accuracy of laser incisions. Cornea. 2015;34:1063–1066. 2. Schultz T, et al. Histologic evaluation of in vivo femtosecond laser-generated capsulotomies reveals a potential cause for radial capsular tears. Eur J Ophthalmol. 2015;25:112–118. 3. Mayer WJ, et al. Impact of crystalline lens opacification on effective phacoemulsification time in femtosecond laser-assisted cataract surgery. Am J Ophthalmol. 2014;157:426– 432.e1. 4. Chen M, et al. Comparing the intraoperative complication rate of femtosecond laser-assist- ed cataract surgery to traditional phacoemul- sification. Int J Ophthalmol. 2015;8:201–203. 5. Barry P. ESCRS FLACS study, European Society of Cataract & Refractive Surgeons, September 14, 2014. Dr. Donnenfeld practices with Ophthalmic Consultants of Long Island and Connecticut and is a clinical professor of ophthalmology, New York University, and trustee, Dartmouth Medical School. by Eric Donnenfeld, MD The future is now: a meta-analysis of LACS peer-reviewed literature Eric Donnenfeld, MD Figure 1. The peer-reviewed literature regarding LACS continues to increase. 200 180 160 140 120 100 80 60 40 20 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Published papers on lenticular or cataract surgery applications for femtosecond lasers 1 1 1 2 8 12 54 88 0 191 " The peer-reviewed documentation regarding LACS is growing. " –Eric Donnenfeld, MD

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