Femtosecond laser-assisted cataract surgery not feasible in infants at present time, specialist says

BASSANO DEL GRAPPA, Italy — The use of femtosecond laser in congenital cataract surgery deserves consideration but is not feasible at the current stage of development of the technique, according to a pediatric ophthalmology specialist.

“There is no reported experience in infants, but theoretically, the disadvantages would by far outweigh the potential advantages,” Paolo Nucci, MD, said at an ophthalmology meeting organized at the San Bassiano Hospital here.

At the current stage, femtosecond laser-assisted cataract surgery requires longer times and moving the patient from the laser to the operating bed.

“This is hardly possible and certainly not desirable with infants under general anesthesia,” Nucci said.

Neither nucleus fragmentation nor the cataract incision would benefit from the use of the laser.

“Incision-induced astigmatism is minimal in children, and there are no studies on endothelial cell loss with the femtosecond procedure,” he said.

The only possible advantage could be in the performance of the capsulorrhexis, which is a difficult step when operating on very young eyes, according to Nucci. Tears often occur due to the high sphericity of the crystalline lens.

With the use of femtosecond laser there would be no tear occurring while the machine performs the rhexis; however, “we cannot be sure that detaching the capsular button would not cause tears when we pull on the tiny tissue bridges around the laser cut,” Nucci said.

Disclosure: Nucci has no relevant financial disclosures.