Photofragmentation technique minimizes endothelial cell loss
SAN DIEGO — Use of a nanosecond laser during cataract surgery causes minimal intraocular trauma and imparts very low energy into the eye, Gangolf Sauder, MD, said at the American Society of Cataract and Refractive Surgery annual meeting.
Using the Cetus nanosecond laser (A.R.C. Laser), Sauder and colleagues compared the technique with phacoemulsification in a randomized prospective study of 72 patients and found the “greatest possible endothelial protection” and fast visual rehabilitation with the nanolaser platform.
In the study technique, a nanosecond pulsed Nd:YAG laser strikes an angled titanium plate, creating a photofragmented microplasm that surrounds an angulated instrument that simultaneously aspirates the resultant particles through an open hole, Sauder said. The nanolaser can be connected with phacoemulsification machines that are outfitted with a pneumatic vitrectomy port.
Main study outcomes were endothelial cell density, energy emitted in the eye, corneal pachymetry on the first postop day and speed of visual rehabilitation. No intraoperative or postoperative complications such as capsular rupture, iris defect, corneal trauma or endophthalmitis were reported in the nanolaser group. One patient with cystoid macular edema was reported in the control group.
After 1 year, endothelial cell loss was 2.1% in the nanolaser group and 7.2% in the phaco group.
“The ease and the speed of visual rehabilitation” within the first hour after surgery was much faster in the nanolaser group, and at day 1, corneal pachymetry favored the nanolaser group but results were not statistically significant, according to Sauder.
“What’s obvious when you look at the working principles and physics of the nanolaser is that the energy emitted in the eye is very low compared to the phaco, and you will not find a surgical technique where you can remove the cataract with less energy than the nanolaser,” Sauder said. – by Patricia Nale, ELS
Sauder G. Evolution and current limits in nanolaser photofragmentation cataract surgery. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.
Disclosure: Sauder reports no relevant financial disclosures.