Facilitation of Difficult Cataract Surgery With Femtosecond Cataract Laser
Narrative Responses:
Purpose
Femtosecond laser assisted cataract surgery (FLACS) has been criticized as being unhelpful and more expensive and time consuming than conventional cataract surgery. Proponents have maintained that FLACS gives better results, especially in difficult cases. This study was undertaken to determine if FLACS truly facilitates otherwise difficult cataract surgery.
Methods
Cataract surgical cases (n=32) that were expected to be difficult were identified and assigned to have FLACS by a single surgeon (WWC) using the AMO Catalys femtosecond cataract laser. These included hypermature, white, black, posterior polar, traumatic and spherophakic cataracts, cataracts with pseudoexfoliation, and/or loose zonules, and cataracts in eyes with Fuchs’ Corneal Dystrophy. Phacoemusification times and dissipated energy was recorded. Video of each case was reviewed to rate the ease of removal and the occurrence of complications. The FLACS surgeries were compared to the known complications and complication rates associated with conventional surgeries.
Results
In this prospective series of 32 potentially “difficult “cases, no complications were recorded. The FLACS surgeries required fewer manipulations and lower ultrasound energy than even conventional surgery in routine cases. Visual acuities after one month were as good (mean 20/20) as the acuities found in routine, non-difficult cases (mean 20/20). No ultrasound energy was necessary to remove the cataract in 2/3rds (22) of eyes.
Conclusion
We concluded that FLACS was beneficial in difficult cataract cases and was worth the extra time and expense to ensure as good an outcome as would be expected in routine, non-difficult cases. FLACS made “difficult cases “routine”.