OSN round table, part 2: How to become a better femtosecond laser cataract surgeon

Same surgeon for femto and phaco?

At the European Society of Cataract and Refractive Surgeons meeting, Ocular Surgery News gathered an international panel of experts to discuss their experiences with femtosecond laser-assisted cataract surgery, with the objective of improving the procedure. The second part of that wide-ranging discussion, moderated by William B. Trattler, MD, is featured in this issue of OSN.

William B. Trattler, MD: The femtosecond laser portion of the cataract procedure is relatively fast. Most surgeons perform femtosecond laser on their own patients in a procedure room or in the operating theater. However, higher volume surgeons can consider working with another surgeon, where one surgeon performs the femto procedure and a second surgeon performs the intraocular portion of the procedure. Over the past few months, I have had the opportunity to work with my father, who is also an ophthalmologist. He performs the femto portion of the procedure in one room, and I am able to perform the intraocular portion of the procedure, flipping between two rooms. We work together as a team.

There is a learning curve when the surgeon does not perform the femtosecond laser portion of the procedure. For example, we treated a patient who had previously undergone laser thermal keratoplasty (LTK) for hyperopia, which left small round opacities in the cornea paracentrally. Following the femto portion of the procedure, I evaluated the eye under the microscope. I identified an area both within the nucleus as well as within the capsule that was untreated. It was directly underneath one of the LTK treatment opacities. It looked like Pac-Man took a bite out of the normal circle of the nuclear frag pattern and capsulotomy. Thankfully, I identified the situation before starting the intraocular portion of the case. I was able to use capsular dye to easily visualize the area of the capsulotomy that was incomplete. The point is that if you are not doing the actual laser surgery, you need to pay attention when starting your portion of the procedure to confirm that the laser procedure was completed as expected.

Click here to read the full cover story published in Ocular Surgery News U.S. Edition, December 25, 2014.