The femtosecond laser in everyday clinical use

We have been using the Femtec femtosecond laser at the Hospital for Refractive and Ophthalmosurgery in Duisburg, Germany since July 2004 and we can now look back on nearly two years of practical experience. We have not ceased to be fascinated by the broad diversity of possible applications for the device and we continue to see promising results in patients other than those receiving LASIK surgery. Yet, we believe that we have only scraped the surface of the possible uses of this exciting technology.

The femtosecond laser, which has both CE certification and FDA approval, is an infrared laser that works at a wavelength of 1,052 nm. It emits ultrashort laser pulses with a diameter of 0.001 mm at one-billionth of a second (10^-15 sec). With the laser, tissue can be cut very precisely and with practically no heat development. The laser pulses develop their energy at a depth inside the cornea, which is exactly defined in advance. Each laser pulse creates a mini-gas bubble that separates the tissue (photodisruption). Three-dimensional, high-precision laser cuts can then be made within the cornea by means of thousands of computer-positioned laser pulses. In ophthalmosurgery, the laser is used primarily for cuts in the interior of the cornea, for example, for flap preparation prior to LASIK, or for preparation of corneal tunnels for intracorneal ring segment (ICRS) implantation.

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Progressive keratoconus?

Implantation of ICRS supported by femtosecond laser technology offers a new option in the treatment of progressive keratoconus with a clear central cornea because the laser can be used for exact preparation of the implantation tunnel. The advantages of the femtosecond laser over mechanical techniques are related to the intrastromal cuts, which can be made from inside to outside, the risk of infection is clearly reduced in every procedure, centric or eccentric fixation of the tunnel can be selected and the curvature of the cornea remains intact throughout the procedure. The patented patient interface ensures minimal flattening of the cornea to about 35 D.