Initial Clinical Evaluation of an Intraocular Femtosecond Laser in Cataract Surgery

1st Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
Journal of refractive surgery (Thorofare, N.J.: 1995) (Impact Factor: 3.47). 12/2009; 25(12):1053-60. DOI: 10.3928/1081597X-20091117-04
Source: PubMed


To evaluate femtosecond laser lens fragmentation and anterior capsulotomy in cataract surgery.
Anterior capsulotomy and phacofragmentation procedures performed with an intraocular femtosecond laser (LenSx Lasers Inc) were initially evaluated in ex vivo porcine eyes. These procedures were then performed in an initial series of nine patients undergoing cataract surgery. In addition to standard intraoperative assessments (including capsulotomy diameter accuracy and reproducibility), optical coherence tomography was used to evaluate human procedures.
For an intended 5-mm capsulorrhexis in porcine eyes, average achieved diameters were 5.88+/-0.73 mm using a standard manual technique and 5.02+/-0.04 mm using the femtosecond laser. Scanning electron microscopy revealed equally smooth cut edges of the capsulotomy with the femtosecond laser and manual technique. Compared to control porcine eyes, femtosecond laser phacofragmentation resulted in a 43% reduction in phacoemulsification power and a 51% decrease in phacoemulsification time. In a small series of human clinical procedures, femtosecond laser capsulotomies and phacofragmentation demonstrated similarly high levels of accuracy and effectiveness, with no operative complications.
Initial results with an intraocular femtosecond laser demonstrate higher precision of capsulorrhexis and reduced phacoemulsification power in porcine and human eyes.

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    • "Nagy and colleagues first documented the use of femtosecond lasers in cataract surgery in 2008 [31]. The FDA subsequently approved the use of femtosecond lasers in anterior capsulotomy and lens fragmentation in 2010. "
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    ABSTRACT: The introduction of femtosecond lasers is potentially a major shift in the way we approach cataract surgery. The development of increasingly sophisticated intraocular lenses (IOLs), coupled with heightened patient expectation of high quality postsurgical visual outcomes, has generated the need for a more precise, highly reproducible and standardized method to carry out cataract operations. As femtosecond laser-assisted cataract surgery (FLACS) becomes more commonplace in surgical centers, further evaluation of the potential risks and benefits needs to be established, particularly in the medium/long term effects. Healthcare administrators will also have to weigh and balance out the financial costs of these lasers relative to the advantages they put forth. In this review, we provide an operational overview of three of five femtosecond laser platforms that are currently commercially available: the Catalys (USA), the Victus (USA), and the LDV Z8 (Switzerland).
    Journal of Ophthalmology 10/2015; 2015(3):616478. DOI:10.1155/2015/616478 · 1.43 Impact Factor
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    • "A reproducible, well-centered, and properly positioned circular capsulorhexis that overlaps the optics of the IOL at 360° is a prerequisite for good postoperative refraction, or in other words, predicting the refractive difference between the intended and achieved refraction.4 As mentioned in an earlier study, authors achieved the desired rhexis diameter in 100% of treated eyes using the femtolaser capsulotomy technique.2 Friedmann et al described similar accuracy in rhexis diameter and circularity performed by the femtosecond laser.30 "
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    ABSTRACT: Femtosecond lasers represent a new frontier in cataract surgery. Since their introduction and first human treatment in 2008, a lot of new developments have been achieved. In this review article, the physical principle of femtolasers is discussed, together with the indications and side effects of the method in cataract surgery. The most important clinical results are also presented regarding capsulotomy, fragmentation of the crystalline lens, corneal wound creation, and refractive results. Safety issues such as endothelial and macular changes are also discussed. The most important advantage of femtolaser cataract technology at present is that all the important surgical steps of cataract surgery can be planned and customized, delivering unparalleled accuracy, repeatability, and consistency in surgical results. The advantages of premium lenses can be maximally used in visual and presbyopia restoration as well. The advantages of premium lenses can be maximally used, not only in visual, but in presbyopia restoration as well. Quality of vision can be improved with less posterior chamber lens (PCL) tilt, more centralized position of the PCL, possibly less endothelial damage, less macular edema, and less posterior capsule opacification (PCO) formation. This technological achievement should be followed by other technical developments in the lens industry. Hopefully this review article will help us to understand the technology and the results to demonstrate the differences between the use of femtolasers and phacoemulsification-based cataract surgery. The most important data of the literature are summarized to show ophthalmologists the benefits of the technology in order to provide the best refractive results to the patient.
    Clinical ophthalmology (Auckland, N.Z.) 06/2014; 8:1157-67. DOI:10.2147/OPTH.S36040
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    • "A number of other ophthalmological applications of ultrafast laser surgery are either being developed or are in the early stages of clinical acceptance. These applications include the use of ultrafast lasers to: 1) replace continuous curvilinear capsulorhexis during cataract surgery [63]–[66] "
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    ABSTRACT: Ultrafast pulsed lasers can be used to achieve remarkable precision during surgical ablation. Through nonlinear interactions with tissue, ultrafast lasers can provide a largely non-thermal mechanism of ablation and a unique ability to create targeted damage within bulk tissue. These advantages have made ultrafast lasers the ideal surgical tool for various novel applications in ophthalmology. Clinical adoption of ultrafast lasers in other surgical applications remains limited in part due to the lack of a means for fiber delivery of ultrafast laser pulses as a flexible, hand-held surgical endoscope. This review provides an overview of the recent advances in bringing this unique surgical tool into the clinic. We discuss fundamental mechanisms and limitations of ultrafast laser ablation, novel techniques for overcoming these limitations, the current state of clinical applications, and conclude with our recent efforts in developing fiber-coupled probes for flexible ultrafast laser surgery and imaging.
    IEEE Journal of Selected Topics in Quantum Electronics 12/2013; 20(2):1-14. DOI:10.1109/JSTQE.2013.2287098 · 2.83 Impact Factor
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