Two does become one

A remarkable step forward in femtosecond laser technology, was the view of OTEurope's editorial advisory board member, Prof. Gerd Auffarth about the combined cataract and refractive capabilities of CUSTOMLENS from Technolas Perfect Vision.

The new femtosecond laser procedure has been designed to perform anterior capsulotomy, lens fragmentation and corneal incision, as well as astigmatic cuts for related astigmatism correction. This will be available on the company's Femtosecond Workstation, enabling both cataract and refractive surgery to be performed with one single device.

Prof. Auffarth detailed his clinical experiences of performing capsulorhexis and lens fragmentation using the CUSTOMLENS procedure at this year's annual ESCRS meeting in Paris.

Prof. Auffarth expressed that the laser only takes a few seconds and once completed the rhexis is easily removed. Additionally, he remarked that this procedure is very useful for more complicated surgery, for example, Marsden Syndrome where the patient shakes, and could also be considered suitable for children and other difficult situations.

Prof. Auffarth also discussed the different approaches available for lens fragmentation. He mentioned the various ways to cut the lens, including circular or horizontal, and that the surgeon knows the depth of the cuts as well as the distance from the posterior capsule. Additionally, he noted that pre-fragmentation of the nucleus is possible, which means that the final energy needed to remove the lens is lower than previously required and ultrasound is not necessary from the beginning of the procedure. In cases of traumatic cataract where the capsule is moving a little bit it is possible to use the technique so that no damage is caused. "This will especially increase possibilities in cognitive cases," he affirmed.

He used an example of lens fragmentation where he made six cuts in the middle of the lens, then cut horizontally and performed the capsulorhexis to soften the centre of the lens. Also, he stated that with this system it is possible to separate the different layers of the lens, which enables the surgeon to pull it apart and finally remove the lens.

In conclusion Prof. Auffarth said: "This is a very promising addition to an already working and functioning procedure for cataract surgery, the capsulorhexis is very nice, the lens fragmentation is very impressive and the corneal incision in the eye is something that we have as an adjunct to it, which is quite interesting for astigmatic control." He added: "We can offer the patient the premium cataract procedure similar to premium lenses or we can go for complicated situations where we can pre-operate entire internal procedures on the lens before running into trouble. Being able to perform femtosecond laser-assisted cataract surgery with the Technolas system is a remarkable step forward in femtosecond laser technology. I already perform the Intracor procedure with the system, as well as use it to create flaps and for perforating keratoplasty. So, the option to also perform the cataract steps with CUSTOMLENS module is a very exciting development."

The combined cataract and refractive procedure will be commercially available in 2011.