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Complicated cases bring out the best in femtosecond laser cataract surgery
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BARCELONA — While most surgeons are still using femtosecond laser-assisted cataract surgery only in standard cases, in which no significant difference from classic phaco has yet been demonstrated, the true advantages are in a wide range of complicated cases, according to José L. Güell, MD.
At a symposium on femtosecond laser cataract during the European Society of Cataract and Refractive Surgeons meeting, he showed examples of several situations in which laser makes the difference for the surgeon and the eye he or she is operating on.
José L. Güell
In eyes with a shallow anterior chamber, and especially with positive vitreous pressure, the risk of capsulorrhexis failure and indirect endothelial trauma is high, Güell said.
“The laser makes life easier for the surgeon. Despite the positive pressure, the rhexis is performed in a safe, controlled manner,” he said.
Another group of eyes that may benefit from the laser are those with white cataracts, with or without a small pupil.
“In these cases, there is a risk of capsulorrhexis failure and secondary excessive manipulation in the anterior chamber. If you presume that there will be not too much liquid cortex, the laser is safer,” Güell said.
In congenital and juvenile cataracts, the laser can better deal with the high elasticity of the capsule for both anterior and posterior capsulorrhexis. It holds advantages also with subluxated lenses and combined vitreoretinal surgery because it avoids zonular traction and secures IOL stability.
“Finally, I would recommend it for post-traumatic cataract, capsular fibrosis, in presence of corneal or intraocular opacities, and after keratoplasty to avoid manipulations in the anterior chamber and endothelial trauma,” Güell said. – by Michela Cimberle
Disclosure: Güell is a consultant for Alcon and Carl Zeiss Meditec.