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What is Femtosecond laser-assisted cataract surgery?

The Femtosecond laser started to be applied to cataract surgery ten years ago now.  

It is a high frequency laser that cuts the tissue and we use it in cataract surgery to perform capsulorhexis, which is the circular opening in the anterior capsule of the crystalline lens to access it and aspirate its content.

Phacofragmentation or a section of the crystalline lens—which is sometimes hard, meaning it breaks into pieces or fragments, for example in little triangles—can also be performed.

In addition, it enables linear and circular cuts to be made. It can also cut entry corneal incisions to facilitate the use of instruments. The cataract itself is not operated on with a laser, the surgeon uses their hands. 

The laser makes the entry cuts and sections the opacified crystalline lens and the capsule. It is a high precision scalpel, which has some benefits. 

The energy of the laser can be placed exactly on the precise point with the exact intensity. The cuts it makes are somewhat more precise than those made by the human hand. 

When is this technique indicated?

This technique is indicated in any type of cataract surgery although it still has not been proven to be much more efficacious than manual surgery. 

It is true that in certain circumstances in which intraocular manoeuvres are difficult to perform such as narrow chambers, the Femtosecond laser may make them easier or reduce the risk of intraoperative complications.

How is it performed?

There are two steps in Femtosecond laser-assisted cataract surgery. First, the laser is applied. All the incisions are programmed on the Femtosecond laser software. 

The patient lies back on the bed and the laser is placed closed to the eye using a suction pad, a suction cone, that immobilises the eye. The laser treatment usually lasts between 2 and 4 minutes maximum.  

The surgeons can modify the incisions, size, depth and diameter of the capsulorhexis during the procedure by making small modifications on the software. Once all the incisions have been made with the laser, the patient moves to the theatre where the second phase is performed, which is entry into the anterior chamber, the aspiration of the crystalline lens and the intraocular lens implant, which the surgeon must perform with their hands.  

Results

Visual recovery is equivalent to the manual cataract operation. In published studies, it seems that the lens accuracy slightly increases as does the postoperative refractive result, but there still aren't any conclusive studies that lead us to advise all patients to have Femtosecond laser-assisted surgery.  

It may be a safer type of surgery, but it is a slightly slower procedure and its benefits compared to manual surgery remain to be seen.

Professionals who perform this treatment

Frequently asked questions

  • It is a high frequency and highly accurate laser that cuts the tissue and is used in ophthalmology in cornea surgery (refractive surgery and cornea transplants) and in cataract surgery. In cataract procedures, it enables us to make all the incisions required to extract the cataract and implant the intraocular lens. They make a corneal incision, a circular-shaped cut in the anterior capsule of the crystalline lens and cut it into small fragments, which makes it easier for the surgeon to aspirate subsequently.

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