Eyeworld

EW CATARACT 36 July 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Presentation spotlight "Femtosecond laser-assisted cataract surgery (FLACS) provides surgeons an exciting new option to potentially improve patient outcomes and safety," said Salvador Garcia-Delpech, MD, University and Polytechnic Hospital La Fe, and AIKEN Clinic, Valencia, Spain, in his poster presentation. "The introduc- tion of FLACS has been accompa- nied by a host of new clinical, lo- gistical, and financial challenges for surgeons. In this study, we evaluated the efficacy and safety of FLACS in the treatment of cataract in special situations." Dr. Garcia-Delpech performed FLACS using the Victus femtosecond laser (Bausch + Lomb, Bridgewater, New Jersey) with posterior chamber lens implantation, in patients who had previously undergone endothe- lial keratoplasty, penetrating kera- toplasty, phakic lens implantation, and the implantation of intracorneal rings. He used a Scheimpflug camera (Pentacam HR, Oculus, Wetzlar, Germany) and anterior segment OCT to visualize morphologic changes in the anterior segment. "The total number of patients treated with the femtosecond laser for cataract at our clinic is 800, of which 350 were treated by myself. We used two different femto lasers for more than 150 corneal ring implants as well. However, 21 of the cataract patients we treated at the clinic had a combined pathology of cataract and previous corneal surgery and were treated with FLACS for the cataract with excellent, complication-free outcomes," Dr. Garcia-Delpech said. Dr. Garcia-Delpech performed FLACS on 15 patients with previous endothelial keratoplasty, four with penetrating keratoplasty, and two patients with intracorneal rings. The mean patient age was 68 years. In this study population, femto laser technology had obvious ben- eficial effects compared to standard phacoemulsification. "FLACS in these special cases reduced the mean phaco energy and the effective phaco time required in the surgery, sparing the endothelial cells in post- op corneal transplants. The central corneal thickness was significantly lower in FLACS at 1 day of follow- up, but comparable at 1 week of follow-up or longer," he said. Femtosecond laser technology allows complication-free cataract surgery, even in tricky, previously risky cases, surgeon says W hen you need to spare the cornea at all costs in cataract patients, the lower the energy input into the eye, the FLACS in special cases continued on page 38 Treatment planning Performing the capsulorhexis Source: Salvador Garcia-Delpech, MD better. There are few safe options, however, especially for eyes that have had corneal surgery. Corneas that have undergone procedures like Descemet's membrane endothelial keratoplasty (DMEK) and perforat- ing keratoplasty (PKP) will in most cases have endothelial cell loss and a reduced endothelial cell count. In these cases, high phaco energy input can additionally damage the endothelium and needs to be avoid- ed. Choosing a low-energy option behooves the surgeon, protecting the eye from undue inflammation and unnecessary heat damage. Femtosecond laser surgery affords the surgeon a better safety margin, which is essential in eyes with more sensitive corneas. In a presentation at the 21st Winter Meeting of the European Society for Cataract and Refractive Surgeons (ESCRS) in Maastricht, Holland, a Spanish eye surgeon shared his experiences using the femtosecond laser to perform cataract surgery in special cases.

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