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Innovations | Mar 2016

The Value of LACS in Eyes With Shallow Anterior Chambers

The use of femtosecond laser technology eliminates many worries in these cases.

Lasers have been an important part of ophthalmic practice almost since the time of their invention, and indications for their use only keeps growing. Although there has been some controversy over the value of laser-assisted cataract surgery (LACS) in general practice, we have found that the use of a femtosecond laser can be valuable in certain specific situations. One of these is most certainly in eyes with shallow anterior chambers.


• The biggest advantage of using femtosecond laser technology in eyes with shallow anterior chambers may be that the dependence on phaco energy to chop and emulsify the cataract nucleus is greatly reduced.

• The use of femtosecond laser technology in a shallow anterior chamber can eliminate the surgeon’s fear of running into additional trouble in an already challenging situation.

To understand the value of LACS in these cases, it is important to understand the difficulties that shallow chambers pose to a surgeon without the benefit of femtosecond laser technology. Let us imagine a routine day for a surgeon doing cataract surgery in an eye with a shallow chamber, first without this technology, then with it. These two scenarios are detailed on page 48 in Surgery in a Shallow Anterior Chamber, Two Ways.


There are a few situations in which surgeons may find the use of femtosecond laser technology in cataract surgery more challenging. These include white cataracts, subluxated cataracts, eyes with small pupils, and eyes with hazy corneas. Additionally, there can be a learning curve with this technology in certain situations. With regard to pupil dilatation, some surgeons have proposed changes to address poorly dilating pupils: for example, applying a Malyugin Ring (MicroSurgical Technology) prior to commencement of the laser. In white cataracts, some users have begun setting safer controls, such as a depth limit to the posterior part of the cataract so that the laser does not pass too deep. As surgeons amass more experience with the technology, there are sure to be other innovative approaches suggested.

LACS is helping surgeons achieve more reproducible results. At the same time, it makes procedures easier by eliminating the fear of running into trouble in challenging situations such as a shallow anterior chamber. n

Amar Agarwal, MS, FRCS, FRCOphth
• Professor and Head, Dr. Agarwal’s Eye Hospital and Eye Research Centre, Chennai, India
• Financial disclosure: None

Ashvin Agarwal, MS
• Senior Consultant, Dr. Agarwal’s Eye Hospital and Eye Research Centre, Chennai, India
• Financial disclosure: None