Femtosecond phacoemulsification: The business and the medicine

Current Opinion in Ophthalmology

Volumn 23, Issue 1, 2012, Pages 33-39

  Uy, Harvey S ^a,b,d   Edwards, Keith ^c   Curtis, Nick ^c  

^a Asian Eye Institute   (Philippines)

^b UNIVERSITY OF THE PHILIPPINES MANILA   (Philippines)

^c LensAR Inc   (United States)

^d Rockwell Center   (Philippines)

Author keywords

Femtosecond laser; Laser capsulotomy; Laser lens fragmentation; Limbal relaxing incision; Phacoemulsification

Indexed keywords

ACCURACY; ANTERIOR LENS CAPSULE; CAPSULOTOMY; CONTINUOUS CIRCULAR CAPSULORRHEXIS; FEMTOSECOND LASER; HEALTH CARE COST; HUMAN; LENS IMPLANT; MARKETING; OPERATION DURATION; PHACOEMULSIFICATION; PREOPERATIVE EVALUATION; PRIORITY JOURNAL; REVIEW; SURGICAL TECHNIQUE; TEMPERATURE; TOPICAL ANESTHESIA; ULTRASOUND; LENS CAPSULE; LOW LEVEL LASER THERAPY; METHODOLOGY; RISK ASSESSMENT;

HUMANS; LASER THERAPY; LENS CAPSULE, CRYSTALLINE; PHACOEMULSIFICATION; RISK ASSESSMENT;

EID: 84856603394     PISSN: 10408738     EISSN: 15317021     Source Type: Journal    
DOI: 10.1097/ICU.0b013e32834cd622     Document Type: Review

References (42)

1. Kelman CD. Phaco-emulsification and aspiration. A new technique of cataract removal. A preliminary report. Am J Ophthalmol 1967; 64:23-35.
2. Fishkind W, Bakewell B, Donnenfeld ED, et al. Comparative clinical trial of ultrasound phacoemulsification with and without the WhiteStar system. J Cataract Refract Surg 2006; 32:45-49. (Pubitemid 43330047)
3. Vasavada AR, Raj SM, Patel U, et al. Comparison of torsional and microburst longitudinal phacoemulsification: A prospective, randomized, masked clinical trial. Ophthalmic Surg Lasers Imaging 2010; 41:109-114.
4. Zeng M, Liu X, Liu Y, et al. Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol 2008; 92:1092-1096.
5. Georgescu D, Kuo AF, Kinard KI, Olson RJ. A fluidics comparison of Alcon Infiniti, Bausch & Lomb Stellaris, and Advanced Medical Optics Signature phacoemulsification machines. Am J Ophthalmol 2008; 145:1014-1017.
6. Hoffman RS, Fine IH, Packer M. New phacoemulsification technology. Curr Opin Ophthalmol 2005; 16:38-43. (Pubitemid 40379442)
7. Busic M, Kastelan S. Pseudoexfoliation syndrome and cataract surgery by phacoemulsification. Coll Antropol 2005; 29 (Suppl 1):163-166. (Pubitemid 41265125)
8. Bourne RR, Minassian DC, Dart JK, et al. Effect of cataract surgery on the corneal endothelium: Modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology 2004; 111:679-685. (Pubitemid 38435335)
9. Davison JA. Comparison of ultrasonic energy expenditures and corneal endothelial cell density reductions during modulated and nonmodulated phacoemulsification. Ophthalmic Surg Lasers Imaging 2007; 38:209-218. (Pubitemid 46953788)
10. Lundstrom M, Behndig A, Montan P, et al. Capsule complication during cataract surgery: Background, study design, and required additional care. Swedish Capsule Rupture Study Group report 1. J Cataract Refract Surg 2009; 35:1679-1687.
11. Clark A, Ng JQ, Morlet N, et al. Quality of life after postoperative endophthalmitis. Clin Exp Ophthalmol 2008; 36:526-531.
12. Reepolmaha S, Limtrakarn W, Uthaisang-Tanechpongtamb W, Dechaumphai P. Fluid temperature at the corneal endothelium during phacoemulsification: Comparison of an ophthalmic viscosurgical device and balanced salt solution using the finite element method. Ophthalmic Res 2010; 43:173-178.
13. Binder PS, Sternberg H, Wickman MG, Worthen DM. Corneal endothelial damage associated with phacoemulsification. Am J Ophthalmol 1976; 82:48-54.
14. Kim EK, Cristol SM, Geroski DH, et al. Corneal endothelial damage by air bubbles during phacoemulsification. Arch Ophthalmol 1997; 115:81-88. (Pubitemid 27034936)
15. Geffen N, Topaz M, Kredy-Farhan L, et al. Phacoemulsification-induced injury in corneal endothelial cells mediated by apoptosis: In vitro model. J Cataract Refract Surg 2008; 34:2146-2152.
16. Nemet AY, Assia EI, Meyerstein D, et al. Protective effect of free-radical scavengers on corneal endothelial damage in phacoemulsification. J Cataract Refract Surg 2007; 33:310-315. (Pubitemid 46188504)
17. Takahashi H. Free radical development in phacoemulsification cataract surgery. J Nippon Med Sch 2005; 72:4-12. (Pubitemid 41379452)
18. Dodick JM, Christiansen J. Experimental studies on the development and propagation of shock waves created by the interaction of short Nd:YAG laser pulses with a titanium target. Possible implications for Nd:YAG laser phacolysis of the cataractous human lens. J Cataract Refract Surg 1991; 17:794-797.
19. Dodick JM, Lally JM, Sperber LT. Lasers in cataract surgery. Curr Opin Ophthalmol 1993; 4:107-109. (Pubitemid 23058408)
20. Kanellopoulos AJ, Dodick JM, Brauweiler P, Alzner E. Dodick photolysis for cataract surgery: Early experience with the Q-switched neodymium:YAG laser in 100 consecutive patients. Ophthalmology 1999; 106:2197-2202. (Pubitemid 30194246)
21. Kanellopoulos AJ. Laser cataract surgery: A prospective clinical evaluation of 1000 consecutive laser cataract procedures using the Dodick photolysis Nd:YAG system. Ophthalmology 2001; 108:649-654. (Pubitemid 32238455)
22. Lin ZD, Feng B, Cheng B, Zou YP. The preliminary study of photolysis for cataract surgery. Zhonghua Yan Ke Za Zhi 2003; 39:601-604.
23. Hoh H, Fischer E. Pilot study on erbium laser phacoemulsification. Ophthalmology 2000; 107:1053-1061.
24. Mian SI, Shtein RM. Femtosecond laser-assisted corneal surgery. Curr Opin Ophthalmol 2007; 18:295-299. (Pubitemid 46955295)
25. Toropygin SG, Krause M, Riemann I, et al. In vitro femtosecond laser-assisted nanosurgery of porcine posterior capsule. J Cataract Refract Surg 2008; 34:2128-2132.
26. Touboul D, Salin F, Mortemousque B, et al. Tissular and mechanical effects observed with an experimental femtosecond laser microkeratome for corneal refractive surgery. J Fr Ophtalmol 2005; 28:274-284. (Pubitemid 40476962)
27. Frey RW, Edwards K, Naranjo Tackman R, Villar Kuri J, Quezada N, Bunch T, Bott S. Changes in CDE With laser lens fragmentation compared with standard phacoemulsification cataract surgery. Invest Ophthalmol Vis Sci 2010; 51: A434 E-Abstract 5418. This study demonstrates that LLF can significantly decrease the amount of phacoemulsification energy needed for removal of the crystalline lens. This suggests that LLF can reduce surgical complications attributable to excessive ultrasonic energy such as corneal decompensation.
28. Nagy Z, Takacs A, Filkorn T, Sarayba M. Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Cataract Refract Surg 2009; 25:1053-1060. This study is one of the first to demonstrate the feasibility and safety of femtosecond cataract surgery.
29. Assia E, Apple DJ, Tsai JC, Morgan RC. Mechanism of radial tear formation and extension after anterior capsulotomy. Ophthalmology 1991; 98:432-437.
30. Hollick EJ, Spalton DJ, Meacock WR. The effect of capsulorrhexis size on posterior capsular opacification: One-year results of a randomized prospective trial. Am J Ophthalmol 1999; 128:271-279. (Pubitemid 29413221)
31. Peng Q, Apple DJ, Visessook N, Werner L, et al. Surgical prevention of posterior capsular opacification. Part 2: Enhancement of cortical cleanup by focusing on hydrodissection. J Cataract Refract Surg 2000; 26:188-197. (Pubitemid 30097397)
32. Aasuri MK, Kompella VB, Majji AB. Risk factors for and management of dropped nucleus during phacoemulsification. J Cataract Refract Surg 2001; 27:1428-1432. (Pubitemid 32889322)
33. Tackman RN, Kuri JV, Nichamin LD, Edwards K. Anterior capsulotomy with an ultrashort-pulse laser. J Cataract Refrac Surg 2011; 37:819-824. This study demonstrates that laser capsulotomy results in more consistently sized and shaped capsule buttons that are subjectively easier to remove. This suggests that laser capsulotomy may facilitate capsulorrhexis in complicated eyes.
34. Friedman NJ, Palanker DV, Schuele G, Andersen D, et al. Femtosecond laser capsulotomy. J Cataract Refract Surg 2011; 37:1189-1198. This study demonstrates that laser anterior capsulotomies are superior to manual capsulorrhexis in terms of precision, consistency and strength.
35. Kranitz K, Takacs A, Mihaltz K, et al. Femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis parameters and their effects on intraocular lens centration. J Refract Surg 2011; 27:558-563. This study demonstrates that laser capsulotomy results in reduction of horizontal IOL decentration which may lead to stable and improved refractive outcomes when using advanced technology IOLs.
36. Nagy ZZ, Kranitz K, Takacs AL, et al. Comparison of intraocular lens decentration parameters after femtosecond and manual capsulotomies. J Refract Surg 2011; 27:565-569. This study demonstrated that femtosecond lasers create more regularly shaped, sized and centered capsulotomy buttons resulting in better IOL overlap. These results suggest that better refractive stability can be achieve using laser capsulotomies.
37. Uy HS, Hill W, Edwards KH. Refractive results after laser anterior capsulotomy. Association for Research in Vision and Ophthalmology Annual Meeting. A4695 Poster #D634. Fort Lauderdale, FL; 2011. www.arvo.org These results demonstrate that laser anterior capsulotomy can translate to improved refractive results that are closer to intended refractive target.
38. Batlle JF, Feliz R, Culbertson WW. OCT-guided femtosecond laser cataract surgery: Precision and efficacy. Association for Research in Vision and Ophthalmology Annual Meeting. A4694 Poster #D633. Fort Lauderdale, FL; 2011. www.arvo.org These results reveal that femtosecond lasers significantly reduce the amount of phacoemulsification energy needed for removal of cataracts of different grades.
39. Edwards K, Uy HS, Schneider S. The effect of laser lens fragmentation on use of ultrasound energy in cataract surgery. Association for Research in Vision and Ophthalmology Annual Meeting. A4710 Poster #D768. Fort Lauderdale, FL; 2011. www.arvo.org This paper demonstrated that significant reductions in utilized phacoemulsification energy can be achieved with the application of femtosecond LLF.
40. Edwards KH, Frey RW, Tackman RN, et al. Clinical outcomes following laser cataract surgery. Invest Ophthalmol Vis Sci 2010; 51:E-Abstract 5394. This study involving 60 eyes that underwent laser cataract surgery reported absence of adverse outcomes following laser cataract surgery. There were no differences in postoperative intraocular pressures and corneal thickness compared with conventionally treated eyes.
41. Dalton M. Bringing new technologies into the fold. Laser assisted cataract surgery. EyeWorld 2011; 16:30-31. This article provides survey results from 1047 ophthalmologist regarding their opinions and concerns about adoption of femtosecond cataract surgery.
42. Passut J. Rules on how to charge for femto procedure get muddied, some say. EyeWorld 2011; 16:36-38. This article discusses different opinions rendered by leading cataract surgeons and regulatory experts on the financial issues of femtosecond cataract surgery including Medicare laws.