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Femtosecond laser has applications in glaucoma surgery
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BOSTON — Considering the recent technological progress of femtosecond laser platforms, aided by 3-D imaging, glaucoma surgeons may now find femtosecond lasers beneficial in their own practices, according to a speaker here at Glaucoma Day preceding the American Society of Cataract and Refractive Surgery annual meeting.
“Femtosecond laser cataract surgery is a novel technology,” Eric D. Donnenfeld, MD, told attendees. “Patients are enjoying it. It’s computer-controlled with laser accuracy, it improves capsulotomies in difficult eyes, it reduces phacoemulsification time and energy, and treats astigmatism. I think it may be very advantageous for some of those difficult glaucoma and cataract patients glaucoma surgeons handle on a regular basis.”
Eric D. Donnenfeld
There are, however, some issues to be noted with the surgery, Donnenfeld explained.
“First of all, there is IOP elevation, which can be minimal depending upon the technology you choose,” he said. Using a water bath can reduce the pressure in eyes.
Secondly, “you have to realize that there is a cost involved with the surgery with the safe harbor for performing the surgery,” Donnenfeld said. “You could have the most advanced case come in, but unless it’s a refractive IOL or an astigmatic incision, you can’t bill a patient for this technology. For the right patient, we’ll eat that cost, but most of the time, we’re doing this primarily on patients who are having a refractive outcome.”
Pupil constriction can also be a problem, he said. “You have to stay away from the iris. You can’t touch the iris with the laser, so we stay half a millimeter away.”
Incomplete capsulotomy is also a risk, although it is less with the new technologies, Donnenfeld said. “If you’re concerned about an incomplete capsulotomy, be certain to complete the capsulotomy and don’t just take it for granted.”
Retained nuclear fragments is a new complication associated with femtosecond laser-assisted cataract surgery, according to Donnenfeld.
“This is one of the concerns that you should be aware of. One of the advantages of the laser is that it will take the lens and make it into small cubes. These cubes can become hidden sometimes, so when you’re doing your surgery, be sure to look for them,” he said.
Disclosure: Donnenfeld is a consultant for Alcon, Bausch + Lomb and Abbott Medical Optics.