Femtosecond laser-assisted cataract surgery provides greater prediction of rhexis, effective lens position

Issue: May 10, 2010

BOSTON — An underappreciated advantage of femtosecond laser-assisted cataract surgery is the ability to accurately center the capsulorrhexis, ultimately leading to better centration of the implanted lens, according to a speaker here.

Stephen G. Slade

Effective lens position misalignment is a frequent source of IOL power error postoperatively, and accuracy is therefore important to final refraction, Stephen G. Slade, MD, FACS, said at the annual meeting of the American Society of Cataract and Refractive Surgery.

In a study of 60 eyes operated with a manual rhexis and 60 eyes with a laser rhexis, 100% of laser-cut rhexes were at the exact diameter attempted, whereas only 10% of manual rhexes achieved diameter accuracy within a tolerance of ± 0.25 mm, Dr. Slade said.

"If you look at anterior chamber depth and axial length at 1 week and 1 month, we're getting a more predictable effective lens position with this technology," he said. "We believe we will have a more accurate spherical component simply because of the placement predictability of effective lens position."

The promise of this technology is a dramatic increase in the accuracy, safety and reproducibility of all the corneal and capsular incisions required to take out a cataract (or clear lens). The image-guided femtosecond laser aims to correct pre-existing and surgically induced astigmatism, precisely open the anterior capsule and atraumatically prepare the lens for aspiration. The result of a single, rapid application of femtosecond laser energy is an eye fully prepared to disgorge its presbyopic or cataractous crystalline lens and ready to receive a next-generation accommodative intraocular lens or futuristic flexible, injectable polymeric lens replacement.

– Mark Packer, MD, FACS
Drs. Fine, Hoffman & Packer, Eugene, Ore.

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