Broad inclusion criteria for femtosecond

San Francisco-New data suggest that it may be time to stop worrying about broad inclusion criteria when evaluating patients with cataracts for potential femtosecond laser surgery.

A retrospective review of more than 800 consecutive cases found that the technology provides high precision in the treatment of challenging cases with broad inclusion criteria, said H. Burkhard Dick, MD, professor and chairman of ophthalmology, director of the University Eye Clinic Bochum in Bochum, Germany.

“Femtosecond laser refractive cataract surgery has great safety, especially in complex cases,” Dr. Dick said.

He presented data on 850 cases. The patient population included capsulotomy, lens fragmentation, cataract, and/or arcuate incisions, all documented by video. Surgeries were performed using a proprietary laser system (Catalys Precision Laser System, OptiMedica).

All of the patients were evaluated for comorbidities, capsulotomy precision, intraoperative complications, and postoperative complications. Patients were evaluated prospectively to assess effective phacoemulsification time (EPT) during lens removal. All cataracts were graded by slit lamp using the LOCS III scale.

The patient population was diverse and included glaucoma (53), mature cataracts (31), Fuchs’ dystrophy (5), cornea guttata (55), pseudoexfoliation (38), intraoperative floppy iris syndrome (62), small pupils (40), post-vitrectomy (15), anticoagulation (91), and scars (12).

“We found that the liquid optic interface works on all patients, including pediatric cases,” Dr. Dick said.

Nearly all of the capsulotomies, 99%, were free. There were conjunctival alterations, mainly in eyes that were undergoing anticoagulation therapy. No phacoemulsification was used at all in 40% of surgeries. When a suction ring was used, IOP rose by a mean of 10 mm Hg. Compared with standard procedures, Dr. Dick said, EPT was reduced by 96% across all grades of cataract, including significant reductions in even the most difficult grades.

Data also showed a trend for less need and use of ultrasound with experience, he noted. Surgical time was similar with or without ultrasound, between 4.5 and 6 minutes.

“My patients certainly have comorbidities,” Dr. Dick said, “but they can benefit very well from the safety of laser refractive cataract surgery. When we are doing cataract surgery, safety first!”