Elsevier

Ophthalmology

Volume 119, Issue 5, May 2012, Pages 891-899
Ophthalmology

Original article
Early Experience with the Femtosecond Laser for Cataract Surgery

https://doi.org/10.1016/j.ophtha.2011.12.025Get rights and content

Objective

To describe the intraoperative complications and to evaluate the learning curve with femtosecond laser cataract surgery.

Design

Prospective, consecutive cohort study.

Participants

The first 200 eyes undergoing femtosecond laser cataract surgery and refractive lens exchange in a single center.

Methods

The initial 200 eyes undergoing cataract surgery between April 2011 and June 2011 by 6 surgeons were included in the study. The cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the femtosecond laser. The procedure was completed by phacoemulsification and insertion of an intraocular lens. Data were collected about patient demographics, preoperative investigations and intraoperative complications. The cases were divided into 4 groups—group 1 included the first 50 cases, group 2 included cases 51 through 100, group 3 included cases 101 through 150, and group 4 included cases 151 through 200—and were analyzed.

Main Outcome Measures

Intraoperative complication rates.

Results

The mean age of patients included was 69.2±9.8 years. Of the 200 eyes, 74.5% underwent a complete procedure of laser capsulotomy, lens fragmentation, and corneal incisions. Five eyes had suction breaks during the laser procedure that led to the remainder of the laser procedure being aborted. Twenty-one (10.5%) eyes showed the presence of small anterior capsular tags. The number of eyes with free-floating capsulotomies was 35 (17.5%). The other complications during the study were anterior radial tears (n = 8; 4%), posterior capsular ruptures (n = 7; 3.5%), and dropped nucleus (n = 4; 2%). A significant difference was noted among the sequential groups with respect to the number of docking attempts (P<0.001), miosis after the laser procedure (P<0.001), and free-floating capsulotomies (P<0.001), suggesting an improving learning curve. The surgeons with prior experience with femtosecond lasers had fewer complications in the first 100 cases (P<0.001). No difference in complications was observed after the initial 100 cases.

Conclusions

In this case series, there was a clear learning curve associated with the use of femtosecond lasers for cataract surgery. Adjustment to surgical technique and prior experience with a femtosecond laser seemed to flatten the learning curve.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients and Methods

This prospective study included the initial 200 consecutive femtosecond laser cataract surgeries, refractive lens exchange surgeries, or both performed at the Vision Eye Institute by 7 surgeons (M.L., G.S., T.V.R., Colin Chan, David Ng, Simon Chen, and Mark Jacobs) between April 2011 and June 2011. Three surgeons ((M.L., G.S., Colin Chan) had prior extensive experience with the use of the femtosecond laser in LASIK. The study conformed to the tenets of the Declaration of Helsinki. Ethics

Results

The initial 200 consecutive eyes were included in the study. The mean age of the patients was 69.2±9.8 years. Table 1 lists the baseline characteristics of patients included in the study.

Of the 200 eyes, the laser procedure was completed successfully with respect to capsulotomy, lens fragmentation, and primary corneal and secondary corneal incisions in 153 eyes. None of the cases underwent arcuate keratotomy. In 9 eyes, the laser procedure included capsulotomy and lens segmentation without the

Discussion

The ultrashort-pulse femtosecond lasers have been developed to increase the precision of and to minimize the collateral tissue damage in ocular surgery. Because power is a function of energy and time, the use of shorter pulses decreases the energy output and hence leads to better preservation of ocular structures. Recent experimental and human studies have reported the applicability of femtosecond lasers in cataract surgery.17, 18 Phacoemulsification surgery remains the standard for cataract

Acknowledgment

The authors thank Drs. Colin Chan, Simon Chen, Mark Jacobs, and David Ng for performing surgery and allowing the access to patient data for those undergoing cataract surgery.

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    Manuscript no. 2011-1254.

    Financial Disclosure(s): The author(s) have made the following disclosure(s):

    Michael Lawless - Consultant - Alcon LenSx USA

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