Initial experience with laser cataract surgery

Evolution of the technique

Kelman introduced phacoemulsification in 1967 but it wasn't until the curvilinear capsulorrhexis became an integral part that it evolved into the preferred cataract surgery technique. The history of phacoemulsification parallels the introduction of femtosecond laserassisted cataract surgery and highlights the fact that the decision 'when' to adopt any new technology is often difficult In the first instance, for example, we wished to establish that the technique was safe and at least as good as the already excellent results we were achieving with smallincision phacoemulsification.

We published the results of our initial experience in the first 200 eyes undergoing LCS at our centre.¹ This multi-surgeon ethics committee approved study identified a number of potential problems and suggested changes to the laser delivery strategy. In the 12 months following installation of the device in April 2011, we have completed over 1500 procedures. The software is under constant evolution and has had several upgrades during this period. Our aim was to understand the techniques better and further improve patient and surgeon satisfaction rates. This was the first prospective study to identify the key issues involved in integrating femtosecond laser cataract surgery into routine clinical practice.

First study

First 200 consecutive eyes operated by six surgeons at our centre were divided into four groups (Group 1–4) comprising 50 eyes each. Exclusion criteria included poor papillary dilation or posterior synechiae as such cases are unsuitable for LCS.

Docking

Initial cohort had an increased number of docking attempts that became less frequent with experience. Patient positioning and the surgeon's verbal communication with the patient are important in docking the 'patient interface' onto the subject's eye. Small palpebral apertures should be noted during preoperative evaluation of patients undergoing LCS. A patient interface with a smaller footprint is being planned for release. Suction breaks occurred in 5 cases (2.5%). These cases proceeded uneventfully with standard cataract surgery.