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Femtosecond laser-assistant phacoemulsification in challenging cases

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Session Details

Session Title: Femto Cataract II

Session Date/Time: Monday 15/09/2014 | 14:30-16:30

Paper Time: 16:04

Venue: Boulevard B

First Author: : I.Novak RUSSIA

Co Author(s): :    S. Anisimova   S. Anisimov   K. Polyakova        

Abstract Details


During last years the phacoemulsification technique, first proposed by Kelman in 1967, has significantly improved and became much safer and effective. It is considered to be a'golden standard' of cataract surgery. Inspite of this, some steps of this procedure have not changed almost since very beginning. For example, the quality of capsulorhexis still depends on skill and experience of the surgeon. High expositions of ultrasound energy can lead to different complications, and one plane manual clear corneal incisions have more risk of intraocular infections. These facts are especially important in cases of lens subluxation, pseudoexfoliation syndrome, hard cataracts, coexisting glaucoma. In these challenging cases surgeons often face with a greater risk of complications. The first publications of femtosecond lasers use in cataract surgery showed that intraocular working time and ultrasound power reduce, and the strength on lens zonular decreases. The multiplane femtolaser corneal incisions contribute to block liquid flow in and out of the eye. The purpose of our work was to compare clinical results during operation and in postoperation period in femtoassisted and traditional phacoemulsufication in challenging cases of complicated cataracts.


Eye center 'East sight recovery'


Two group of patients underwent cataract surgery those with pseudoexfoliation syndrome or with glaucoma after previously performed glaucoma surgery or with lens subluxation of 1-2 degree. In Group I (92 patients, 125 eyes) standard phacoemulsification was performed. In Group II (105 patients, 120 eyes) femtoassisted phacoemulsification was performed. Lens density was evaluated according Buratto classification. Patients of both groups had the same preoperative examinations and preparations. In Group I intracapsular rings were implanted in 31 cases, and in Group II - in 20 cases. Femtosecond laser step included capsulotomy, lens fragmentation and corneal incisions. Subjective and objective eye structural and functional data was evaluated in 1,3, 7 days and 1 month.


The femtosecond laser performs precise strong edge capsulorhexis with high accuracy according to parameters assigned. There were no cases of bridges and anterior capsula was easily removed with phaco tip. Gas bubbles formation during femtofragmentation provided nucleus pneumodissection, so there was no need in additional hydrodissection. The ultrasound power and total intraocular operation time was lower in Group II. This helps to decrease the force impacting on lens zonula during the surgery which is very important in challenging cases of cataracts. In manual group of surgery capsula wrapping towards IOL was observed in 35 % according to ultrasound biomicroscopy performed postoperatively. In femto group IOL was placed in more central position and stabilized. There were no cases of macular edema in both groups postoperatively.


The comparative analysis of two groups showed that femtosecond laser assistance is a safe and effective procedure which have advantages especially in cases of complicated cataracts. It helps to perform precise circular capsulorheŅ…is, reduce overall and ultrasound operation time, and totally reduce the strength of forces impacting on lens zonula.

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