Femtosecond laser-assisted cataract surgery successful in initial pediatric cases
The initial pediatric cases of femtosecond laser-assisted cataract surgery demonstrated that the technology has great potential in young patients, according to one surgeon.
“Infants and children are the real winners of the femto technology,” H. Burkhard Dick, MD, OSN Europe Edition Associate Editor, told Ocular Surgery News. “Capsulotomy, the most challenging step of pediatric cataract surgery, becomes safe, much easier and reproducible.”
H. Burkhard Dick
The femtosecond laser was used in pediatric eyes only for capsulotomy, anterior and posterior. The soft nucleus needs only aspiration, and there is no real advantage in creating the incision with the laser rather than manually, Dick said.
“Capsulotomy comes out just perfect . Everyone who has experience with pediatric cataract surgery knows how unpredictable the rhexis diameter is and how often it runs out in the periphery because of the extreme elasticity of the capsule. With the laser, you have to target it a little bit smaller to obtain the size you want, but this is about the only problem,” he said.
Posterior capsulotomy, perfectly coinciding in size and position with the anterior capsulotomy, is performed after puncturing the capsule and injecting an ophthalmic viscosurgical device to push back the anterior hyaloid.
“Thanks to the 3-D spectral-domain OCT integrated in the Catalys laser (OptiMedica), you can nicely detect the posterior capsule,” Dick said. “You don’t need to perform vitrectomy, which is an advantage particularly if you want to implant the bag-in-the-lens.”
Dick has so far performed the procedure in 15 pediatric patients, of whom the youngest was 2 weeks old. Surgery was successful in all cases, with no complications.