This article is more than 5 years old. Information may no longer be current.
Surgeon: Nanosecond laser provides safe cataract surgery at lower cost than femto
The procedure is performed through laser impulses and completely emulsifies and aspirates the lens.
Click Here to Manage Email Alerts
The nanosecond laser may provide an affordable, safe and effective alternative method for cataract surgery, with advantages over both standard phacoemulsification and femtosecond laser-assisted surgery, according to one specialist.
“A minimal level of energy is applied to the eye. There is no thermal alteration in the anterior chamber, no mechanical or thermal side effects,” Jérôme C. Vryghem, MD, said. “It should be the method of choice when maximal endothelial protection is required, such as in Fuchs’ dystrophy or after corneal transplantation.”
The laser creates a plasma-induced emulsification of the cataract. Unlike the femtosecond laser, which can only induce tissue separation, this laser completely dissolves and aspirates the lens.
“It delivers energy comparable to a grenade, but in a very small area of 2 µm to 3 µm. We have more than 50 times less energy distributed in the eye during cataract surgery compared to phaco surgery,” Vryghem said.
The currently available system, the Cetus, produced by the German company A.R.C., is a 50 cm × 50 cm × 20 cm box that can be connected to any phaco system and is triggered by the air impulse of the vitrectomy mode. Laser energy is transferred to the probe by a quartz fiber optic. Aspiration is done through the probe and irrigation through a sleeve or a separate handpiece in case of bimanual surgery.
Other users of this laser, such as Gangolf Sauder, MD, and Ivan Tanev, MD, demonstrated that the impact on tissue is significantly less traumatic as compared with phaco, as shown by corneal pachymetry and retinal OCT at day 1, endothelial cell count and time for visual rehabilitation.
Personal experience
“I myself treated 141 eyes of 74 patients who were prepared to pay for the supplement, and in 81% of them I implanted a trifocal IOL, a PhysIOL FineVision,” Vryghem said at the 2016 European Society of Cataract and Refractive Surgeons meeting in Copenhagen.
He used a bimanual microincision phaco chop technique, with a sleeveless laser probe and a separate handpiece for irrigation.
“With no sleeve, your incision needs to perfectly match the instruments. I performed two incisions of 1.4 mm. Sometimes it was slightly difficult to insert the laser probe,” he said.
Unlike with ultrasound, there is no aspiration supplied by the laser, only by the phaco machine, and the fragments need to be pushed forward toward the laser probe.
This surgery has a learning curve, along which Vryghem had eight posterior capsule ruptures.
“Five of them were in the first 2 months I used the laser. When there is a good anterior chamber depth and cataract from mild to moderate, there is no problem, but with hard grade 3 nuclear cataracts, I had postoperative edema more than expected,” he said.
In the good cases, postoperatively, eyes were calm, there was less wound leakage, visual recovery occurred faster, and results were highly predictable. Cell loss was 6.9% at 6 months postop, slightly higher than in previous case series.
Eighty-nine percent of the patients were satisfied with the procedure, and 73% of the patients were completely spectacle-independent, due to the implantation of a trifocal IOL. The others used spectacles for less than 10% of the time to read very small print, knit, sew or do computer work.
Vryghem’s current indications for nanosecond laser surgery are all cases of refractive lens exchange and cataract when density is no more than grade 3.
Affordable technology, easy to integrate
Vryghem said that he purchased this laser essentially for marketing reasons because patients like and want laser procedures and because of the competitive environment created by the femtosecond laser in cataract surgery. He is personally not an advocate of femto. He is not convinced about the advantages of the femtosecond laser because the initial purchase cost of the laser and then the cost of disposables and maintenance are too high.
“With the nanosecond laser, I have all the advantages of laser at a much more affordable price. It costs €65,000 to €70,000, and the disposables are €60 for one eye,” he said.
In addition, it is easily integrated in everyone’s practice because the laser is small and directly connected to the phaco system.
“Do you really need it? I’d say no, but if you want laser cataract surgery, with the nanosecond laser you have real laser cataract surgery, with less energy distribution in the eye and at least an affordable tool,” he said.
A European study will soon be starting, he said, involving 10 centers. – by Michela Cimberle
- For more information:
- Jérôme C. Vryghem, MD, can be reached at Brussels Eye Doctors, 12-16 Boulevard St-Michel, 1150 Brussels, Belgium; email: info@vryghem.be.
Disclosure: Vryghem reports no relevant financial disclosures.