Stability a benefit of laser surgery

November 1, 2012

Surgeon evaluates use of laser refractive cataract surgery technique in complicated cases

A new laser refractive cataract surgery technique seems to be safe and effective when used to treat patients with complicated preexisting conditions. Gerd U. Auffarth, MD, PhD, discussed his experience with the femtosecond laser platform (Victus, Bausch + Lomb and Technolas Perfect Vision) at the annual meeting of the American Society of Cataract and Refractive Surgery.

The platform (previously called the Technolas 520F laser when it was used to create LASIK flaps) has been used to perform Intracor procedures to treat presbyopia and keratoplasty. This laser platform is currently the only one used to perform cataract and refractive procedures, according to Prof. Auffarth (chairman, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany).

The laser also includes an online optical coherence tomography capability to provide accurate positioning intraoperatively. Prof. Auffarth demonstrated that it provides a safety zone of about 1000 µm away from the posterior capsule when performing fragmentation.

In a single-surgeon, single-centre study, Prof. Auffarth and colleagues assessed how the laser platform works in more complicated cases - such as those with brown/black cataracts, pseudoexfoliation syndrome, lentodonesis and white cataracts. In cases of lentodonesis, Prof. Auffarth noted, if the capsulorhexis can be performed without touching the eye, the diaphragm might be much more stable.

"That [stability] is necessary in cases with lentodonesis or in eyes with pseudoexfoliation," he said.

Prof. Auffarth and his colleagues evaluated the surgeries and outcomes in seven eyes of six patients (mean age, 67 years; range, 65 to 83) that were complicated by brown/black cataracts, pseudoexfoliation syndrome, lentodonesis, zonular atrophy, and white cataracts.

One patient, the first to undergo the femtosecond rhexis procedure in Germany, was a 66-year-old woman with a black cataract and pseudoexfoliation syndrome. The patient had a preoperative uncorrected distance visual acuity of 0.2 and corrected distance visual acuity of 0.05 in the left eye. The respective values 3 weeks postoperatively were 0.8 and 1. No complications developed intraoperatively.

Surgical assessment

"My impression was that the entire procedure was much easier," Prof. Auffarth said. "Normally, in such cases the entire lens spins back and forth. In this case, the environment was very stable and the patient achieved good uncorrected and corrected visual acuity levels."

In another case, a 65-year-old man had bilateral corticonuclear cataracts; the left eye was amblyopic. The patient underwent bilateral implantation of posterior chamber toric IOLs without complications. Preoperatively, the corrected distance visual acuity in the right eye was 0.5 and in the left eye 0.25. Postoperatively, the uncorrected distance visual acuities, respectively, were 0.8 and 0.32 in the amblyopic eye.

The laser platform can use different fragmentation patterns, such as the cross-pattern, the 'pizza' cut that uses six radial cuts and quadrant cuts.

"Laser refractive cataract surgery can be applied in complicated cases," Prof. Auffarth concluded. "Cases of pseudoexfoliation and lentodonesis can benefit from this technology. The lens diaphragm remains more stable during the phacoemulsification. Safety is enhanced during this procedure. Several fragmentation patterns are available, but others should be tested. In the long run, there could be numerous indications, such as in paediatric cases, in which the capsulorhexis is always problematic."

Special contributor Professor Gerd U. Auffarth, MD, PhD, is chairman, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany. He may be reached by Email: gerd.auffarth@med.uniheidelberg.de

Prof. Auffarth reported that he receives travel grants and lecture honoraria from Bausch + Lomb and Technolas Perfect Vision, as well as research funding from Technolas Perfect Vision.