Steps in Femtosecond Laser Cataract Surgery
Although the steps for each laser platform differ, they all need pupillary dilatation and topical anesthesia, followed by applanation of the cornea with a docking system that includes a contact lens with a circumferential suction skirt dispersing pressure evenly on the cornea. The docking system minimally misshapes anatomy while increasing intraocular pressure (IOP), although reportedly less IOP increase than seen in FSL refractive surgery. According to Friedman et al., the OptiMedica platform has a liquid optics user interface which increases IOP by 15 mmHg and avoids corneal folds.
Other platforms have actually not defined a degree of IOP boost. When docking is total, anterior segment imaging is then carried out. LenSx and OptiMedica make use of Fourier-domain optical coherence tomography (FD-OCT), while LensAR utilizes Scheimpflug imaging innovation. This step is needed to find physiological landmarks for laser pattern mapping. It is also vital that certain borders are mapped, consisting of the iris and the posterior surface of the lens. The posterior surface area of the lens must be determined in order to avoid puncture of the posterior capsule. Preprogrammed corneal lacerations for temporal injury, paracentesis, and any optional limbal-relaxing lacerations (LRIs) can be changed at this indicate surgeon choice. The pattern is then centered and the laser is triggered.
Making use of the OptiMedica and LenSx systems, laser-assisted capsulotomy is carried out, followed by lens fragmentation. This sequence is warranted since lens fragmentation triggers release of gas bubbles, which can misshape the anatomy and influence capsulotomy planning. If a corneal incision is created, it is the last step prior to the client is moved to the operating room. The stability of the anterior chamber is not disrupted prior to the client is sterile, as this initial incision does not permeate the posterior corneal surface. Once in the sterile field, any partial-thickness corneal cuts are then completed with a microsurgical blade.Clients then go through removal of the anterior capsulotomy, followed by conventional phacoemulsification.
While there have been reasonably few studies showing the energy of FSL in all steps of cataract surgery, there have been multiple publications detailing FSL use in the separate steps of cataract surgery We will initially evaluate the researches on laser-assisted laceration, capsulorhexis, and lens fragmentation separately, followed by studies showing clinical results.
Regarding capsulorhexis, we hope to understand if the improved centration results seen with laser-derived capsulotomy will reveal long-lasting superiority for visual outcomes and rates of posterior capsular opacification. This is a crucial question because positioning of the IOL is the most significant contributor to visual mistake after cataract surgery.Lasik eye surgery
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