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EW CATARACT 54 September 2016 by Douglas Grayson, MD, FACS Femto laser-assisted cataract surgery with ICL in situ continued on page 56 Figure 2. Catalys softening pattern just prior to laser engagement showing accurate placement of capsulotomy beneath ICL. Source: Douglas Grayson, MD, FACS Figure 1. Catalys OCT imaging clearly delineates separation of ICL and the anterior lens capsule. Interesting case demonstrates that laser can successfully be used for cataract surgery in a young patient who also requires ICL removal I recently performed surgery on a 36-year-old high myope who developed a cataract just a few months after being implant- ed with collamer phakic IOLs (Visian Implantable Collamer Lens [ICL], STAAR Surgical, Monrovia, California) to correct his –16 D of myopia. This posterior chamber lens, which sits just beneath the iris and above the crystalline lens, is a good option for refractive correc- tion of high myopes. However, lens opacification is a known complica- tion, occurring in at least 1% to 6% of eyes with the ICL, with an even higher incidence in high myopes. 1 This patient, unfortunately, was a person who seems to form cata- racts very quickly after phakic IOL surgery. He had been well counseled by the original cornea surgeon about the risk of cataract so he understood the need for the subsequent ICL removal and cataract surgery. For a number of reasons, I want- ed to use the femtosecond laser in this case. I've performed more than 6,000 procedures with the Catalys femtosecond laser (Abbott Medical Optics, Abbott Park, Illinois). In young patients, there is a higher rate of anterior capsule tear with manu- al capsulotomy, which I wanted to avoid. The accuracy of the femtosec- ond laser capsulotomy also decreases the chance of eccentric fibrosis for improved lens centration. In an ICL patient who has already undergone a procedure that involves some trau- ma to the endothelium, I wanted to minimize the use of ultrasound en- ergy and keep the cataract procedure as atraumatic as possible. The laser could also make very accurate inci- sions to correct the small amount of astigmatism this patient had. However, the sequence of events for surgeons whose femtosecond laser is in a separate laser room can be tricky since the ICL must be

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