EyeWorld Asia-Pacific June 2014 Issue

15 June 2014 EWAP FEAturE Femtosecond laser-assisted cataract surgery complications by Erin L. Boyle EyeWorld Editor Most complications occur in the preop and intraop stages of the laser- assisted procedure O ne of the advantages of the femtosecond laser-assisted cataract surgery procedure is that it has a safety profile similar to manual cataract surgery, but when prepping for the procedure and during it, physicians should be aware of issues that can arise. “At the beginning of the femtolaser cataract surgeries, the most frequent complications were docking problems due to loose conjunctiva and conjunctival redness due to higher suction force. Partial capsulotomy and more central corneal wound location occurred more than expected,” said Zoltan Z. Nagy, MD , professor of ophthalmology, Semmelweis University, Budapest, Hungary. Dr. Nagy, the first clinician to use the laser for cataract surgery, said that most of the issues have been or are being resolved with improvements in technology. He uses the LenSx laser (Alcon, Fort Worth, Texas, U.S.). “With the invention of the SoftFit patient interface [PI] with the LenSx, most of the problems have been solved because the pressure went down, there was no corneal folds, capsulotomy became freefloating in 97% [of cases], and the surgical field increased by 12.5%. As the corneal wound reached the limbal area, surgically induced astigmatism became much smaller,” he said. Robert J. Cionni, MD , medical director, The Eye Institute of Utah, and adjunct clinical professor, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, U.S., also uses the LenSx machine. “Fortunately, complications have been very few since the AT A GLANCE • New and improved technology continues to reduce femtosecond laser-assisted cataract surgery complications. • Complications occur mainly preop and intraop. • Take care when docking a patient’s eyes before the procedure, stopping to redock if the eye is not centered. • Watch for incomplete anterior capsulotomies. A 100% complete capsulotomy made with the LenSx laser and SoftFit PI Verion toric alignment tool with LenSx capsulotomy and LuxOR Z-Vue microscope Source: Robert J. Cionni, MD introduction of the LenSx SoftFit PI,” he said. “[There are] only what I would call ‘mild annoyances.’ Capsulotomies are now much more pristine and in nearly 100% of cases, complete or free-floating.” “The only other common complication, or better stated ‘side effect,’ is mild subconjunctival hemorrhage that dissipates fairly quickly after the procedure,” Dr. Cionni said. William W. Culbertson, MD , professor of ophthalmology, director of the cornea and refractive surgery services, and the Lou Higgins Chair of Ophthalmology, Bascom Palmer Eye Institute, Miami, Fla., U.S., uses the Catalys laser (OptiMedica/ Abbott Medical Optics, Santa Ana, Calif., U.S.). “I encountered complications in our clinical trial when we were using a curved interface, especially with the capsulotomy, and incomplete cutting, but the companies have improved the machines and made it so that it’s much more predictable,” he said. He said the complications profile for femtosecond laser- assisted cataract surgery is running the usual course of the “natural history of a new device,” with physicians learning how to use the machines for the best possible outcomes over time. “I was around for early phacoback in the mid-70s, and there were a ton of potential complications with that; as people used it and the machines improved, it’s changed the continued on page 19