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Session Title: Femtolaser Cataract Surgery
Session Date/Time: Tuesday 08/10/2013 | 14:00-16:15
Paper Time: 15:41
Venue: Auditorium (First Floor)
First Author: : S.Anisimova RUSSIA
Co Author(s): : S. Anisimov I. Novak K. Polyakova N. Anisimova
It is well known that the advent and further development of phacoemulsification turned cataract surgery in less traumatic and more precise procedure with decreased number of different complications. But in cases with complicated cataracts the risk of surgery is still higher than in common cases. These are cases when cataract is combined with high myopia, lens subluxation, pseudoexfoliative syndrome, glaucoma. Intraocular manipulations of even experienced surgeon in such eyes can lead to posterior capsula rupture and other different complications. Performance of the most risky steps of cataract surgery - capsulorhexis and facofragmentation with femtosecond laser open new horizons in treatment of this difficult patients. The purpose of this work was to evaluate the effectiveness and safety of femtosecond laser assisted cataract surgery (FLACS) using Victus femtolaser platform on patients with complicated cataracts.
Eye center «East Sight recovery»
82 eyes of 42 patients 64 to 85 years of age with complicated cataracts have been operated using FLACS method since July 2012. Cataract was combined with the following pathology: glaucoma (29 eyes), lens subluxation and pseudoexfoliative syndrome (12 eyes), myopia of high degree (41 eyes). The following examinations were performed before the surgery: vision acuity check, tonometry, biomicroscopy, A-scan, IOL-master and perimetry, optic nerve OCT and ORA in cases of glaucoma. In all cases FLACS consisted from femtosecond laser assisted capsulorhexis and lens fragmentation were performed using Victus femtolaser platform (Technolas PV), then followed by phacoemulsification and IOL implantation. In 11 cases of all eyes with cataract combined with glaucoma non-perforating deep sclerotomy was performed between femtolaser step and phacoemulsification. The femtosecond laser parameters were chosen in dependance of nuclear density. The most part of all patients (80 eyes) had 3-4 cataract grade, and in 2 cases - 2 grade. In cases with lens subluxation intracapsular ring was implanted. All procedures were performed in outpatient conditions with topical anesthesia. In postoperative period all patients received antibiotic and corticosteroid drops. The long-term observation period was 6 months.
Vision acuity (VA), tonometry, the number of complications, ultrasound parameters and intraocular surgery time were evaluated. There were no «bridges» during femtocapsulorhexis, and no posterior capsula ruptures or other complications during phacoemulsification. Before operation VA ranged from pr.certa to 0.2 and average IOP was 30.6 mm Hg After the surgery VA parameters were as follows: 0.5; 0.6; 0.7 respectively 1 day, 1 week and 1 month after the surgery and kept stable till all observation period. IOP dynamics was as follows: 1 day - 30.2 mm Hg, 1 week- 21.7, 1 month - 15.04 mm Hg. In 7 cases (cataract combined with far advanced glaucoma) patients used hypotensive medications for IOP compensation. The parameters of ultrasound used during the surgery were in average 17.8 % (power), 0.67 (phacoemulsification time) and 0.1 (ultrasound time).
The accuracy and predictability of femtosecond laser can help to perform the most dangerous steps of cataract surgery, capsulorhexis and lens fragmentation, with minimum risk. Also it helps to reduce the time when the instruments are inside the eye, thus additionally decreasing the risk of complications especially in cases of complicated cataracts. The results of our study show that FLACS in cases of complicated cataracts is save and effective. More over one can consider these cases to be indication for performing surgery with femtosecond laser assistance because of its more safety comparing with manual surgery.
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