Femtosecond lasers are being touted as the next great leap forward in cataract surgery but, as with any radical change to our practices, many questions remain: Does this technology truly improve cataract surgery? Is the refractive accuracy better? Is the safety profile significantly elevated compared to existing technologies? Are there additional complications or issues with using this laser?

1. 1
FEMTOCATARACT SURGERY - IS THIS
THE FUTURE?
Dr Diana Semmonds
North Shore Medical Centre
66 Pacific Hwy
St Leonards

2. Manual Cataract Surgery Today
 Ophthalmic surgeon uses instruments to create
a opening in the lens capsule (capsulorhexis)
that is as circular as possible
 The surgeon then breaks up the clouded lens
with surgical instruments and ultrasound
energy
 An artificial intraocular lens (IOL) is then placed
in the eye.

3. Potential Limitations of Traditional
Cataract Surgery
6

4. WHY LASER CATARACT
SURGERY?

5. Advantages
 Accurate capsulorhexis
size, shape and
centration
 Precise incisions to
tens of microns
 Reduction in phako
power and time
 Numerous unique
fragmentation pattern
options allow for
treatment
customization
 Arcuate incisions

6. Manual vs. Femtocataract Surgery – 1 month
postop
Manual Surgery Femtocat Surgery
MK-00251 Rev A

7. More predictable outcomes
More predictable shape
? Better outcomes
Catalys Clinical Results:
Capsulotomy Shape
Manual Capsulorhexis
Catalys Capsulotomy
MK-00251 Rev AImages courtesy of OptiMedica Corp.

8. OR microscope view
MK-00185 Rev B MK-00251 Rev AImages courtesy of OptiMedica

9. Femtosecond laser
 Femtosec laser causes tissue disruption
with its near-infrared scanning pulse
focused to 3um with an accuracy of 1um
 The focused laser energy generates
plasma which expands, causing a shock
wave, cavitation and bubble formation
 The bubble expands and collapses causing
separation of the tissue

10. Manual Arcuate Incisions
 Manually executed
by “tracing”
corneal marks with
handheld diamond
knife
 Inconsistent depth
control
 Unpredictable
effect as is
imprecise
19

11. Laser Arcuate Incisions
Image-guided surgical
planning with 3D
visualization:
 Real time corneal
thickness
 Computer programmed
incisions
- % depth
- incision length and position
- 3D visualization of incision
placement
20

12. PROCEDURE OVERVIEW

13. Technique
 Performed under LA with speculum
 Mydriasis
 Patient looks at fixation lights
 Laser is docked

14. Patient Experience
 Clinical Workup
 No major changes to standard procedure
 Things to note:
 How well patient dilates
 Is patient able to keep still during procedure

15. Patient Experience
 During procedure
 Docking: Slight pressure from vacuum
pressure of interface (no pain or loss of vision)
 During laser: A kaleidoscope of lights as the
procedure occurs
 Immediate to One-Day Post-op
 Same regimen as existing practices
 Visual recovery may be faster because of
reduced ultrasound energy
 Patient may notice slight haemorrhaging on
the conjunctiva

16. Contraindications
 Femtocat is contraindicated in patients with
corneal ring and/or inlay implant(s)
 In patients with severe corneal opacities,
corneal abnormalities, significant corneal
edema or diminished aqueous clarity that
obscures OCT imaging of the anterior lens
capsule
 Technical difficulties-small pupil, deep orbit,
very shallow AC, dementia, tremor
 ? Paediatrics

17. Potential Advantages
 Accurate capsulorhexis size, shape,
centration-may allow for better positioning
of MF and TIOLs
 Precise incisions to tens of microns -astig,
infection, iris prolapse
 Reduction in phako power and time –less
endothelial cell loss, decreased risk of
corneal oedema
 Numerous unique fragmentation pattern
options allow for treatment customization
 Arcuate incisions

18. Disadvantages
 Technology- country/third world
 Expensive –machine
-set up cost
 Only does part of the operation
 Takes longer
 No evidence
 ?better outcome

19. Is it the future?