Speaker offers pearls for femtosecond laser-assisted cataract surgery

NEW YORK — Surgeons should begin adopting femtosecond laser-assisted cataract surgery, according to a speaker here.

“The technology is beginning to come into its own and mature, and we have four platforms to choose from,” Lisa Arbisser, MD, said at OSN New York 2014. “Our journey is on a continuum of perfection in cataract surgery, and I think that it is not the giant leap but it has the potential to get there.”

According to Arbisser, a central dimple-down maneuver can be used for consistent continuous femtosecond laser capsulotomy removal. Capsulotomy removal with a femtosecond laser is not approved by the U.S. Food and Drug Administration and is an off-label use.

“If there is a tiny little tag or adhesion that we are not aware of, we can dimple down in the center and [the dimple-down maneuver] will pull toward the center,” Arbisser said.

There are different ways surgeons can reduce ultrasound in femtosecond laser cataract surgery: fragmentation parameters, tip design, ultrasound and fluidics parameters, and active second instrument “stuffing,” Arbisser said.

“I am a very low ultrasound usage surgeon because the purpose of applying the ultrasound is just to gain hold to apply mechanical forces and then to assist aspiration in flow. Even without changing my fluidics and my size of my tip, as long as we are active with the second hand for stuffing, very often we can do 2 to 3+ nuclei rather handily,” Arbisser said.

The future of femtosecond laser-assisted cataract surgery has the potential for true standardization, custom astigmatism, sterile redocking, posterior capsulotomy and new lens design, Arbisser said.

Disclosure: Arbisser is a consultant for Bausch + Lomb, speaker for Alcon, and speaker and consultant for AMO.