Use of Femtosecond Laser-Assisted Cataract Surgery in Complex Cases
Narrative Responses:
Purpose
To evaluate the utility of femtosecond laser assisted cataract surgery in complex cases.
Methods
Retrospective chart review of 15 patients, with a mean age of 58 years (range 27 to 81 years), who underwent LenSx femtosecond laser (Alcon) assisted complex cataract surgery between 2012 and 2013. Ten patients had a dense white cataract, 3 patients had a dense brunescent nuclear cataract, 1 patient had a central anterior capsular scar, and 1 patient had pseudoexfoliation syndrome and marked phacodonesis. The main outcome measures were complications with the anterior capsulotomy, other surgical complications, and post-operative best corrected visual acuity.
Results
Twelve of 15 patients had a pre-operative visual acuity of count fingers or worse (range 20/60 to light perception). A successful complete capsulotomy was achieved in 14 of 15 cases. Suction loss occurred in one case resulting in an incomplete capsulotomy. Lens fragmentation was attempted on two cases. A posterior capsular tear occurred during one of these cases on a brunescent lens. Two additional cases were complicated by a posterior capsular tear. Overall, all patients had a better post-operative best corrected visual acuity compared with pre-operative acuity, with 83% of patients with sufficient follow-up achieving vision of 20/40 or better.
Conclusion
The femtosecond laser is an effective tool for creating an anterior capsulotomy in challenging cases. The safety and utility of lens fragmentation using the femtosecond laser in complex cases, particularly dense lenses, is yet to be determined.