Femtosecond Laser Cataract Surgery (Femto-Phaco)

WHAT IS A FEMTOSECOND LASER?

The femtosecond laser is used nowadays in corneal refractive surgery to correct refractive defects: myopia, hypermetropia and astigmatism. Thanks to this technique, the entire operation can be performed by laser without the need to make manual incisions  in the cornea.

For the same reason, this laser has recently been incorporated, under the name Femto-phaco, as an aid in cataract surgery, to mechanise parts of the surgery which the surgeon used to perform manually.  It is designed to enable personalised cataract surgery and achieve an optimum result with Premium lenses.  In addition, thanks to OCT (Optical Coherence Tomography) which is also used, high resolution images can be seen of the anterior part of the eye in real time throughout all phases of the procedure.

 

Diagram of the Femtosecond (Femto-phaco) laser models Victus by Bausch&Lomb and LenSx by Alcon.
Diagram of the Femtosecond (Femto-phaco) laser models Victus by Bausch&Lomb and LenSx by Alcon.

AT WHAT POINT IS FEMTO-PHACO USED DURING CATARACT SURGERY?

Femto-phaco constitutes a major development in cataract surgery. Its arrival brings an end to several steps which were previously performed manually.  The difference between this surgery and the traditional method is the mechanisation of first phase, which contains the most critical steps and is where greatest precision is required.

  • Incisions: it is possible to program the type, size and exact position of the incisions in advance. In the past, as this was performed manually, there was the possibility of causing induced astigmatism.  With this method, the risk is reduced to a bare minimum.
  • Capsulorhexis: this is one of the most important steps as it determines the centring of the intraocular lens, which is of vital importance especially for Premium lenses. Up until now this was done using forceps and the surgeon had to take special precaution, as its size or centring could be varied manually.  This step involves removal of the anterior part of the crystalline lens capsule. With the femtosecond laser, capsulorhexis can be performed very precisely to achieve optimum centring, as well as being able to program the diameter.
  • Fragmentation of the nucleus: it is now possible to mechanically break up the nucleus into small pieces, selecting exactly how it should be done, depending on the hardness and type of cataract the patient has. The laser makes it possible to break the nucleus up into smaller pieces so that these can be removed by suction more easily. For this reason gentler ultrasound is used, thereby reducing the risk of affecting the eye’s other structures.

Once these three steps have been performed, the surgery continues according to the traditional method, removing the cataract by suction and then implanting the intraocular lens.

Diagram of the Femtosecond (femto-phaco) Laser Models Lensar by Topcon and Catalys by OptiMedica.

WHAT ARE THE ADVANTAGES OF FEMTOSECOND (FEMTO-PHACO)?

  • Precise incision in the cornea without a blade
  • High stability of the eye thanks to the perfect cut
  • Very precise opening of the anterior lens capsule (capsulorhexis)
  • Fragmentation of the lens with significantly reduced ultrasound energy
  • Measurable procedure
  • Greatly improved quality of vision thanks to the exact positioning of the artificial lens (directly related to an optical result in Premium lenses)
  • Possibility of correcting astigmatism at the same time through programmed incisions