Turning Femtosecond Capsulorhexis Into ''Iris Tattooing''.

In our practice we use femtosecond laser technology to perform routine cataract surgery (FLACS) and apply premium lenses, for the treatment of cataract and/or presbyopia. We have done so far more than 1000 eyes with FLACS mostly for multifocal or edof lenses, in patients within the age of 50-70 years old.  Last month, we had an unexpected minimal complication that we would like to report. 

We use two laser platforms: Catalys (J&J) and Victus (B&L). Both platforms perform well during cataract surgery. We can perform capsulorhexis, lens fragmentation, astigmatic keratotomies and corneal incisions.  With Catalys, all the above surgical steps are being programmed and performed in one single docking and pedal step, while with Victus, two dockings and two pedal steps are needed. 

The patient was a 68-year-old woman that was undergoing a bilateral cataract surgery for edof lenses. Victus laser platform had been using for the surgery. Capsulorhexis was set to 5,5mm. During the first step for capsulorhexis creation, there was a pupil constriction. The result was the laser to hit the iris and not the front capsule. Fortunately, the heat effect was minimal and there were no complications on iris function. Of course, the procedure was interrupted. The surgery continued manually in the second surgery room. In similar cases with Catalys, there is an auto pupil detection system that keeps the laser 1mm inner the pupil zone.

Not all machines have the safety feature to recognize the pupil constriction and automatically adjust the size of the capsulorhexis. So, caution must be given for the patients to be well dilated before surgery with FLACS and high awareness during the cut is needed.