New era seen for cataract

Heidelberg, Germany-Application of a proprietary femtosecond laser (LenSx, LenSx Lasers/Alcon Laboratories) to perform lens liquefaction, capsulorhexis, and corneal incisions is safe, effective, and offers potential advantages that suggest this technology will usher in a new era in cataract surgery, according to information presented by Michael C. Knorz, MD.

The procedures were performed using integrated real-time optical coherence tomography to position laser application and involved an average laser treatment time of about 35 seconds. Dr. Knorz said the laser was highly effective in producing nuclear liquefaction and for reproducibly creating the capsulorhexis and corneal incisions.

He described how the femtosecond laser was used first to liquefy the lens, then to create the capsulorhexis, and finally for the corneal incisions.

"This is the sequence of how the three steps are done," Dr. Knorz said. "The laser goes from in to out, the reverse of our traditional method."

Once the patient was moved into the operating room, the corneal incisions were easily opened with a spatula. Then viscoelastic was injected into the anterior chamber, and the dissected capsule could be extracted using a simple forceps. After hydrodissection, the liquefied nuclear material flowed forward and could be removed by simple irrigation/aspiration. However, in eyes with very dense nuclei, the femtosecond laser was used to fragment the lens in a "divide-and- conquer" technique.

"Liquefaction of the lens with the laser is currently possible when operating on cataracts with up to grade 2 nuclear density," Dr. Knorz said. "Higher-density nuclei were efficiently fragmented with the laser to enable safe and efficient phacoemulsification. In the future, optimization of the laser should improve its effectiveness for liquefying harder nuclei."