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Speaker: Features of femtosecond laser preferred in challenging cataract cases
Patients with Fuchs' dystrophy or mature cataracts benefit from reduced dissipated energy.
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Faster capsulotomy, less nuclear manipulation and less energy expenditure in femtosecond laser-assisted cataract surgery are all features that enhance surgical results when faced with challenging cataracts, according to a speaker.
In a presentation at OSN New York 2015, Kendall E. Donaldson, MD, MS, demonstrated the use of femtosecond laser-assisted cataract surgery in a variety of demanding cases. In white cataracts, for example, the procedure “can really be of great utility,” she said. A fast capsulotomy — between 0.7 seconds and 1.5 seconds with the Catalys laser (Abbott Medical Optics) — can prevent the complication of the Argentinian flag sign altogether in these cases, she said.
Minimized nuclear manipulation
In pseudoexfoliation syndrome, material builds up on the anterior lens capsule and changes the integrity of the capsular bag, making it less stable, and changes the integrity of the lens, making it more friable, Donaldson said.
To avoid stressing the zonules with excess nuclear manipulation, she uses the laser for both the capsulotomy and the lens fragmentation in these cases.
In pseudoexfoliation syndrome, patients may also have small pupils, which present a challenge with the femtosecond laser. But placement of a Malyugin ring through the main incision dilates the pupil, Donaldson said, and she can remove the lens fragments thereafter.
“We’re fortunate at Bascom Palmer to have two of our femtosecond lasers in the OR where we can place a Malyugin ring and then perform the laser portion of the procedure under sterile conditions in the presence of the Malyugin ring,” Donaldson subsequently told Ocular Surgery News. “In this way, even patients with small pupils may be candidates for the femtosecond laser pretreatment if this may benefit them.”
The laser is also “a great tool” in cases of traumatic cataracts with zonular dialysis, she said, when less nuclear manipulation leads to better results.
“For any reason, one reason or another, whether it’s a traumatic cataract or [pseudoexfoliation], cases with loose zonules can be facilitated, and you have less nuclear manipulation in these patients if you use the femtosecond laser,” Donaldson said in the presentation.
Energy reduction
“I love the laser with mature cataracts,” Donaldson said, because it reduces the amount of energy used as well as phaco time in these cases.
“At Bascom Palmer, we found a 42% decrease in cumulative dissipated energy using either the LenSx (Alcon) or Catalys laser in comparison with traditional cataract surgery,” she said. Similar results having been duplicated on all laser platforms.
In Fuchs’ dystrophy, patients with vulnerable endothelium can also benefit from less energy being put in the eye, resulting in a more atraumatic case, she said.
Several studies have looked at endothelial cell count reduction with traditional cataract surgery compared with femtosecond cataract surgery. Endothelial cell loss is correlated with nucleus density, anterior chamber depth and cataract surgery technique, including proximity to the endothelium, length of procedure, fluid use and amount of energy used, she said.
“We haven’t really been able to translate the conservation of energy to preservation of endothelial cells yet; however, small nonrandomized studies have shown promising results,” Donaldson said. – by Kate Sherrer
- Reference:
- Donaldson KE. Femtosecond cataract surgery in eyes with challenging cataracts. Presented at: OSN New York 2015. Oct. 23-25, 2015; New York. http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B47b75a54-eacd-4bab-af77-01dce48de8e3%7D/video-femtosecond-cataract-surgery-in-eyes-with-challenging-cataracts
- For more information:
- Kendall E. Donaldson, MD, MS, can be reached at Bascom Palmer Eye Institute, 900 NW 17th St., Miami, FL 33136; email: kdonaldson@med.miami.edu.
Disclosure: Donaldson reports she is a consultant for Alcon, Allergan and Abbott Medical Optics.