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The Promise of Phaco-less Cataract Surgery

Femtosecond lasers continue to revolutionize the procedure's potential.

Ming Wang, MD, PhD


diseased lens is fragmented FIRST CRACK The diseased lens is fragmented, but not broken up, during the laser portion of the procedure.

Why is there so much disparity in opinions about laser cataract surgery? Surgeons looking for immediate significant benefit will be disappointed. Those with the foresight to consider laser's potential realize it's a revolutionary technology that promises safer cataract surgery with unmatched refractive outcomes. In my opinion, it's time for forward thinking. Adding lasers now will put your facility on the cutting edge of care and position it to meet the future demands of rising patient expectations.

Perfect cuts, every time
The laser's primary clinical benefit is realized during creation of the capsulorhexis — the large circular incision in the anterior lens capsule. Studies have shown the capsulorhexis needs to offer predictive size and a precise diameter, and be perfectly centered in order to improve a patient's post-op vision. Manual techniques result in successful capsulorhexis most of the time, but the human element makes the cuts imperfect, however slight the imperfections might be, which might cause the implanted intraocular lens to shift over time. Creating a perfectly circular, perfectly centered capsulorhexis with a laser, however, results in more predicable refraction with less astigmatism and more precise vision outcomes.

Even a slight improvement in the accuracy of manual techniques is valuable when considered in the context of rising patient expectations. Patients don't want to simply see better after cataracts are removed, they want to see with near-perfect vision, without the aid of glasses.

Small improvement to the creation of the capsulorhexis is nice, but a more important consideration is the laser's current ability to reduce the amount of phacoemulsification power used and its ultimate future ability to remove phaco from the surgical equation altogether, eliminating the leading cause of complications in a relatively safe procedure.

One of the most common, and feared, phaco-related complications is rupturing of the capsular bag, caused by the horizontal or vertical movements of the sharp phaco tip. Corneal edema, inflammation caused by the ultrasonic energy that can result in long-term cornea failure and needed transplantation in some cases, is also a concern.

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