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First Author: C.Moraru ROMANIA
Co Author(s): O. Moraru I. Iliescu
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To investigate the efficacy, safety and advantages vs. disadvantages of the use of the femtosecond laser in cataract surgery in a patient with white cataract and a 4+ nucleus case presentation.
Oculus Eye Clinic Bucharest, Romania
This is a retrospective analyses of a case report. The surgical management of this white cataract with a 4+ nucleus consisted of a femto-assisted phacoemulsification using the LenSx® femtolaser (Alcon) and INFINITI ® Vision System (Alcon). We used the femtolaser to perform a central 5 mm capsulorrhexis, the nucleotomy (two perpendicular cross grooves and an additional 2 mm diameter round groove to divide the nucleus), the main incision and two aditional side-port incisions. The nucleus was then phacoemulsified with ultrasound (US) energy (Infiniti Vision System) and the IOL was implanted in the bag. This case was performed in my first 10 femto-assisted cataract surgeries. One month after the surgery we evaluated the visual acuity (VA), position and centration of the IOL and configuration of the capsulorrhexis.
Despite difficult visualisation due to white cortex (no Tripan blu could be used to visualise the anterior capsule), capsulorrhexis was complete, perfectly centered and of desired diameter. The nucleotomy was done and the complete separation of the nucleus pieces could be achieved with the chopper. The phacoemulsification was fast and with no complications. The first postoperative day the eye did not show any sign of inflammation or corneal edema and the IOL was well centered. At 1 month follow-up, the uncorrected distance visual acuity was 20/20, with perfect in the bag IOL centration, under a round, circular, centered capsulorrhexis.
The very good visual outcome beginning with the first postoperative day in this case shows great efficacy and safety of the femto-assisted cataract surgery even in eyes with white cataracts and hard nuclei. We feel as an advantage the use of the femtolaser to create a better, round and centered capsulorrhexis and to divide the hard nucleus, thus decreasing the ultrasound energy needed for facoemulsification. The disadvantage of the femtolaser in white cataracts comes from the fact that we cannot use dye to visualize the anterior capsule which can be a risk, due to poor visualization, in case of an incomplete capsulorhexis or important residual capsular bridges.