Surgeon offers pearls to transition from standard to femtosecond laser-assisted cataract surgery
MILAN — When switching to femtosecond laser-assisted cataract surgery, cataract surgeons should break old habits and adapt their technique to the specific requirements of the new technology, according to one specialist.
Patient selection is the first crucial step, Simonetta Morselli, MD, said at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology. Patients should have a clear, regular cornea, a sufficiently large pupil that dilates well and has no synechiae, a smooth anterior capsule and a cataract that is not too dense.
In removing the tissue after laser capsulotomy, surgeons should check to see whether bridges are present.
“The circular rhexis movement will help with releasing the bridges without tearing the capsule,” she said.
Hydrodissection requires an entirely different approach than in standard cataract surgery.
“A little extra time, care and patience are needed in the [femtosecond laser-assisted] procedure. The laser often generates gas bubbles that get trapped behind the lens and should be moved forward before hydrodissection starts. [Balanced salt solution] penetrates into the fracture lines, and it may be difficult to rotate the nucleus. Strangely enough, hydrodelamination is easier,” Morselli said.
Depending on nucleus hardness, fragmentation may or may not be complete; therefore, surgeons should evaluate whether additional ultrasound or simply aspiration is needed. The dual linear mode is essential to allow separate control of vacuum and phaco power, according to Morselli. Removal of the epinucleus requires special attention because parts of it remain transparent and are difficult to visualize due to the decreased hydration.
“You must be prepared to go through a new learning curve, but the better IOL centration, faster rehabilitation and enhanced visual outcomes, particularly if you use premium IOLs, are definitely worth the effort,” Morselli said.
Disclosure: Morselli has no relevant financial disclosures.