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Surgeon gives pearls on how to start with femtosecond laser-assisted phaco

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MILAN — As technology improves, femtosecond laser-assisted phacoemulsification is more and more approximating perfection.

“At first my question was whether I should get started with it at all, and now I think it is a spectacular technology and definitely the way to go,” Henry D. Perry, MD, said at the OSN Italy meeting.

His first recommendation to those who are about to start with femtosecond cataract surgery is to practice docking several times because this is the main difference the procedure has from standard cataract surgery; it is also a prerequisite for successful outcomes.

Second, it is important to learn how to set the parameters of the machine.

“A very helpful aspect of several machines, such as the Visx and the Catalys (both Johnson & Johnson Vision), which I have both used, is that they have built-in correction, so you cannot exceed the normal limitations,” Perry said.

Because he is also a corneal surgeon, Perry gained experience with the technology more than 20 years ago by doing arcuate keratotomy for the correction of astigmatism after keratoplasty.

“It is not a bad idea to start with patients who need arcuate incisions for astigmatism and after several cases perform your first capsulotomy. Choose a nice, easy case for your first time, such as an eye with large pupil and a very cooperative patient,” he said.

Femtosecond-assisted phacoemulsification has a learning curve, but improvement comes fast, leading also to increased opportunities.

“When we started we had four surgeons, and in our first 22 cases we had some problems: dropped nucleus in two cases, incomplete capsulorrhexis in four cases, vitreous loss in four cases. Now we are 11 surgeons and have performed 4,800 cases with only a few incomplete capsulorrhexis and two cases of dropped nucleus,” Perry said. – by Michela Cimberle

Reference:

Perry HD. How to get started with femtosecond laser cataract surgery painlessly. Presented at: OSN Italy meeting; May 18-19, 2018; Milan.

Disclosure: Perry reports he is a consultant or grant recipient for Allergan, Alcon, AMO, Bausch + Lomb, BlephEx, NovaBay and Omeros.