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Femto-assisted cataract surgery on Victus femtosecond laser platform: first clinical results in Russia
Session Title: Femtolaser Cataract Surgery
Session Date/Time: Tuesday 08/10/2013 | 14:00-16:15
Paper Time: 14:43
Venue: Auditorium (First Floor)
First Author: : S.Anisimova RUSSIA
Co Author(s): : S. Anisimov I. Novak K. Polyakova
Since their first use in ophthalmology, femtolasers appeared to show promising results because of their accuracy and predictability. The first clinical results of femto-assisted cataract procedure using different femtosecond laser platforms verified that femtolaser-assisted cataract surgery (FLACS) could be considered to be one of he most outstanding advance in this field of ophthalmology during the last decades. Femtosecond laser makes some of the most risky steps of cataract surgery more safe and precise.
The purpose of this work was to study the clinical experience of cataract surgery when the first steps of the procedure, capsulorhexis and lens fragmentation are performed using Victus femtolaser platform, then followed by phacoemulsification and IOL implantation. The effectiveness and safety of the procedure were evaluated.
Eye center "East Sight recovery", Moscow, Russia
Since July 2012, 210 FLACS procedures with IOL implantation have been performed on patients 73,5 ± 6,4 years of age with grade 1-2 cataracts (18 eyes) and grade 3-4 cataracts (192 eyes). The results of ophthalmology examinations before the surgery were as follows: vision acuity from pr. certa to 0.4; IOP 18-25 mm Hg. Axial length was 21.74-31.08 mm. In 11 eyes FLACS was combined with non-perforating deep sclerotomy (NPDS). Phacoemulsification was performed in all cases with first steps of the surgery (capsulorhexis and lens fragmentation) using Victus femtosecond laser platform. Capsulorhexis parameters were as follows: diameter 5000- 5200 µm , the energy - 5700-6000 nJ. In lens fragmentation step two main algorithms were used- radial (pizza) cuts with 6-8 cuts and fragmentation energy of 8000 nJ, and radial- circular cuts with 4 radial and 4 circular cuts and energy of 7500 nJ. Phacoemulsification was performed with Stellaris PC (Bausch & Lomb). The IOL implanted were AcryStyle, AcrySof IQ and Toric, EnVista and ReSTOR. All procedures were performed in outpatient conditions with topical anesthesia with antibiotics and corticosteroids topicaly in average 3-4 weeks after operation.
The long-term observation period was 6 months.
In 2 cases we failed to perform femtolaser steps because of poor patient communication (1 case) and problems to lie supine (1 case). In 1 case we didn"t perform femtolaser lens fragmentation because of "milk" cataract. There were no complications detected during or after the surgery. Best corrected vision acuity (BCVA) and tonometry were checked 1 day, 1 week, 1 month and 6 months after the surgery. The difference between the target refraction and postoperation refraction was estimated. Also the ultrasound used during phacoemulsification was calculated.
1 day after the surgery BCVA was 0,562±0,231, 1 week after operation it was 0,728±0,207, 1 month - 0,851±0,242 and remained stable during all observation period. IOP was 27,367±12,58; 16,485±4,680 and 15,089±3,748 (respectively 1 day, 1 week and 1 month after the operation). As for postop refraction - it differed from target refraction in 0.5 D in 85 % of all cases, and in 0.75-1.0D - in 95%.
The average ultrasound parameters used during phacoemulsification were as follows: power -17.7 percent, total phacoemulsification time - 0.8 min, phaco ultrasound time - 0.12 min
The results of our work showed that FLACS is a safe and effective procedure which is very comfort either for patient or for the surgeon.
Femtosecond laser helps to perform capsulorhexis of precised form, diameter and position that helps to avoid different complications connected with capsular bag position and to achieve target refraction, that is very important when premium IOLs are implanted. Femtosecond laser fragmentation helps to minimize the ultrasound time and power, thus reducing the "intraocular" time of cataract surgery, and decreasing or avoiding complications.