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Lens fragmentation reduces energy required to remove dense cataracts
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CHICAGO — Femtosecond laser lens fragmentation appreciably reduced the amount of ultrasound energy required to remove dense cataracts, according to a clinician speaking here.
In a prospective study of 153 eyes that underwent lens fragmentation with the Lensar femtosecond laser and 39 control eyes, cumulated dissipated energy was significantly reduced in the laser group (12.9 ± 15.8) compared with the control group (21.6 ± 15.8).
"Phacoemulsification can be done with basically just aspiration of the material without applying any phaco energy," Harvey S. Uy, MD, said at the joint meeting of the American Academy of Ophthalmology and Middle East Africa Council of Ophthalmology.
In the study, choice of lens-cutting pattern was significant for reducing cumulative dissipated energy, Dr. Uy said. The reduced energy required to break up cataracts as dense as grade 4 in the study might translate to lower risk of inflammation and corneal edema, he said.
Many papers regarding the use of femtosecond lasers for cataract surgery were presented at AAO this year. Dr. Uy’s paper is notable, as he reported on 153 patients on which he personally performed femtosecond nucleus fragmentation. Many patients had 3- to 4-grade nuclear cataracts. The laser was successful at dividing these nuclei into pie-shaped fragments, permitting either pre-chop or other chopping techniques. The total power required for emulsification was decreased by 40% in these hard cataracts.
Femtosecond lasers have been shown to perform capsulorrhexis with 100th of a micron precision. They create nuclear fragmentation, enabling phacoemulsification with a considerable decrease in both power and time. They increase the precision of wound construction and astigmatism management.
The future impact on cataract surgery will be exciting, and implementation is beyond doubt. Surgeons should get ready to incorporate them into their surgical strategy.
– William J. Fishkind, MD, FACS
OSN
Cataract Surgery Board Member