Throughout my 20 years of experience in ophthalmic surgery, nothing has impressed me more than my introduction to the concept of the femtosecond laser for ophthalmic use. I will never forget the first time I learned of this prospect—it was at the American Society of Cataract and Refractive Surgery (ASCRS) meeting in 2000. An investigative tool at the time, the prototype IntraLase femtosecond laser (now Abbott Medical Optics Inc.) had potential applications in corneal and possibly anterior segment surgery.
It took only a few years to witness bladeless LASIK become a mainstay in refractive surgery globally. Although we all know that you can perform very good LASIK with a mechanical microkeratome, 6 years of experience with laser-only LASIK surgery, initially with the IntraLase and currently with the FS200 (Alcon Laboratories, Inc.), has convinced me that I will never go back to a bladed microkeratome. The high reproducibility and accurate flap parameters, regardless of corneal astigmatism, thickness, and diameter, as well as patient age, are signature features with almost all femtosecond laser systems. Similarly, after 6 months of experience in laser cataract surgery with the LenSx femtosecond laser (Alcon Laboratories, Inc.), I am starting to see some of the advantages of this technology, especially in high-risk and pseudoexfoliation cases, compared with manual cataract surgery. One of my recent cases is featured at eyetube.net/?v=dehir.
This month, CRST Europe’s cover stories feature a global perspective from a team of well-known cataract surgeons, offering varied points of view on the application of the femtosecond laser in cataract surgery. Following the approval of the LenSx in the United States and in Europe, several other excellent and promising laser devices for cataract surgery are now available, all of which are discussed in this issue. As you will see in each surgeon’s article, the learning curves have been relatively short. There are some intrinsic restrictions in performing laser cataract surgery, however, such as achieving adequate pupil dilatation, avoiding lens fragmentation close to the posterior capsule (as this may risk posterior capsular rupture prior to entering the eye), performing careful hydrodissection (as there will be air within the capsular bag from the femtosecond-assisted lens fragmentation), and dealing with annoying pupil constriction after the femtosecond laser treatment has been applied. Additionally, application of laser cataract surgery may necessitate an updated technique for lens fragment removal.
Most of the early adopters of this technology agree that, even at this early point, the femtosecond laser has established itself as a far more accurate tool than manual cataract surgery in regard to wound creation, impeccable positioning and construction of the capsulorrhexis, and significant reduction or elimination of phacoemulsification time by allowing prefragmentation of the lens.
Of course, the procedure is still in its infancy. It is now up to the ultimate surgical machine, which is nothing other than ourselves, the surgeons. Over time, we will devise and advance new femtosecond cataract techniques, new instruments, and possibly further upgrades of these technologies to make cataract surgery an even safer and easier procedure.