Femtosecond (fs) laser, used in ophthalmology, operates at a wavelength of 1053nm and offers precise tissue disruption with minimal collateral damage compared to yag lasers. It is utilized in procedures such as femtolasik, cataract surgery, and keratoplasty, providing optimal safety and less complication risks such as flap issues. Despite its advantages, the high cost limits its use to indicated cases.

1. BY
Dr. Amr Mounir
Lecturer of ophthalmology
Sohag university

2. Femtosecond (FS) laser is an infrared laser with a
wavelength of 1053nm.
Works by producing photodisruption or photoionization
of the optically transparent tissue such as the cornea.
FS laser has pulse duration in the femtosecond range
(10-15 second)

3. Femtosecond laser differ significantly from Yag Laser in
the amount of collateral damage they cause. Nd:YAG
laser has a pulse duration in the nanosecond range (10-9
second) where as FS laser has pulse duration in the
femtosecond range (10-15 second).

6. Uses:
- Femtolasik
- Femtosecond cataract surgery
- Femtokeratoplasty
- Femtosecond laser in keratoconus

12. Optimal safety
No flap related complications e.g.: free cap, button
holes, incomplete cuts
- Thinner flap:
Uniform thin flaps with no liability of complications
Thin flaps leads to large stromal bed with less liability
for ectasia
- Precise depth

14. Flap Design
Large flap diameter : in HMT, in custom
ablation
Hinge : superior or nasal if there is cylinder,
hinge size

16. femtosecond laser
Flap: Planner Flap
>>>less
complications---
Less Dry Eye
M2 flap : Meniscus
flap

17. Flap edge :
femtosecond laser can
create a corneal flap that
has edges that enable the
flap to fit more securely
in place, (inverted Side
cut) > 90 degree “
beveled edge”
Better Biomechanics
M2 flap : 40: 70 degree

19. less IOP elevation
Femtosuction elevates IOP to about 18:25 mm.hg
Suction ring in conventional Lasik elevates IOP to about
70: 80 mm.hg
Better in High myopia

20. Flap striae (wrinkles in the flap)
Diffuse lamellar keratitis, DLK (inflammation under the
flap)
Epithelial ingrowth

21. What are the real problems we face in
Femtolasik ???

22. - Lengthy procedure especially in inexpert hand.

23. - Subconjunctival hemorrhage

24. - Technology problems

27. When to do
Femto
Lasik?????

28. 1- Normal steep cornea : No risk of button hole

29. 2. Flat cornea: No risk of free cap

30. 3- High Myopia :
- Controlled depth 90 um (Precise depth)
- Less effect in the posterior segment

31. When large flap diameter is needed :
in HMT,
in custom ablation

33. - Femtolasik is a relatively new procedure with many
advantages.
- Most important advantages include optimal safety,
with less complications, flap design ability and less
effect in the posterior segment.
- Our most Femtolasik problem is that it is an expensive
technique so we preserve it for indicated cases.