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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    • "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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    • "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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