Femtosecond Laser–Assisted Cataract Surgery in Challenging Cases
To evaluate role of femto-laser assisted cataract surgery in challenging situations.
One-thousand eyes were taken up for femto-phaco-emulsification using the LenSx Femto-second laser. Complicated cases such as phacomorphic glaucoma, cataract after retinal detachment surgery, poorly dilating pupils, hard cataracts, cataracts in patients with previous RK, fibrotic cataracts were also taken up for femto-cataract surgery. Intra-operative parameters including total phaco-time, capsulorhexis formation, incision ease and post-operative parameters including UCVA, BCVA, surgical induced astigmatism and endothelial cell loss were monitored.
UCVA of >20/30 was seen in 96 % eyes and 20/20 in 90% eyes. In complicated cases such as intumescent cataracts, phacomorphic glaucoma and fibrotic cataracts, rhexis formation was found easier and smoother compared to routine phaco-emulsification. Poorly dilating pupils were treated with smaller rhexis upto 4mm. In patients with previous RK scars, incisions were planned so as to lie in between previous RK marks. Hard cataracts were emulsified using the matrix grid pattern. With the upgraded software, free floating capsulorhexis, smoother incisions and reduced laser and surgical time was noted even in complicated cases.
Femto-second laser offers better safety and precision in management of complicated cases and is a useful tool to improve surgical and visual outcomes especially in such situations.