Femtosecond Laser-Assisted Cataract Surgery

Educational Objectives

The goal of this program is to improve diagnosis and treatment of ophthalmologic disorders. After hearing and assimilating this program, the clinician will be better able to:

1. Select appropriate patients for undergoing cataract surgery using a femtosecond laser.

Summary

Overview: high power and low energy of femtosecond laser (FSL) reduce collateral damage; FSL works by photodisruption

Cataract surgery: complications include opacification of posterior capsule, cystoid macular edema, retinal detachment, and malposition of intraocular lens (IOL)

Patient selection: pupil must dilate to ≥5 mm; contraindications to FSL include significant corneal opacity, advanced glaucoma, bleb, valve, uncooperative or anxious patient, pterygium, severe neck or back problems, and sometimes corneal inlays

Technique: wound construction not necessary; capsulorhexis rounder and more predictable; removal of adherent cortex most difficult step; FSL produces stronger capsulorhexis then manual method; useful for patients with mature cataracts, Marfan syndrome, zonular defects, and pseudoexfoliation; less use of ophthalmic viscoelastic device and trypan blue required; surgery may be done through small pupil using Malyugin ring; unclear whether better circularity improves vision; phacoemulsification and operative time shorter; patients have less corneal swelling

Complications: include damage to cornea and anterior capsule, loss of suction, grid pattern on cornea, conjunctival hemorrhage, and incomplete capsulotomy; damage to iris and rupture of posterior capsule rare

Surgical pearls: patient should be comfortable, scleral show consistent, and cornea premarked; patient should be told that darkness normal after suction applied; fragmentation may be adjusted depending on anatomy

Costs: higher but may be worthwhile; FSL useful for patients receiving premium IOLs such as ReSTOR

Readings

Abell RG et al: Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 cases at a single center. J Cataract Refract Surg 2015 Jan;41(1):47-52; Bartlett JD, Miller KM: The economics of femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol 2016 Jan;27(1):76-81; Day AC et al: Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev 2016 Jul 8;7:CD010735; Ittner EA et al: Necrotising herpetic retinopathies: a review and progressive outer retinal necrosis case report. Clin Exp Optom 2016 Jan;99(1):24-9; Kanellopoulos AJ, Asimellis G: Standard manual capsulorhexis / ultrasound phacoemulsification compared to femtosecond laser-assisted capsulorhexis and lens fragmentation in clear cornea small incision cataract surgery. Eye Vis (Lond) 2016 Jul 29;3:20; Schultz T, Dick HB: Suction loss during femtosecond laser-assisted cataract surgery. J Cataract Refract Surg 2014 Mar;40(3):493-5.

Disclosures

For this program, members of the faculty and planning committee reported nothing to disclose.

Acknowledgements

Dr. Negahban was recorded at Ophthalmology Update and Haimovici Lecture, presented by Boston University School of Medicine and held April 1-2, 2016, in Boston, MA. For information about courses sponsored by Boston University, visit www.bumc.bu.edu. The Audio Digest Foundation thanks the speakers and sponsors for their cooperation in the production of this program.

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Audio Digest Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation. Audio Digest Foundation designates this activity for 0 CE contact hours.

Lecture ID:

OP550102

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.