FLACS technology undergoing continuing refinement

Femtosecond laser-assisted cataract surgery (FLACS), though very much promoted as the next big thing,  is still in its infancy  and has some drawbacks. But with time, and  further technological innovations, it seems likely to live up to its promise eventually, said Paul Rosen FRCS, UK. at a clinical research symposium at the XXXII Congress of the  ESCRS.

“I think it's important to point out that it's an evolution. A lot of people expected the FLACS device to be here now, ready to go and and that  it was perfection but it is not, it's very much at the beginning of it's journey,” Dr Rosen said.

He noted that in the types of cataracts surgeons most commonly encounter, phacofragmentation FLACS can reduce effective phaco time to a minimum, sometimes to zero. In fact Bausch and Lomb have already designed a 20-gauge aspiration hand-piece  for removal of laser-fragmented lenses.

However, the reduction in ultrasound input has to be weighed against the input of laser energy, which carries its own risks, such as bubble formation, which can lead to capsular rupture.

Moreover, FLACS also leads to an increased inflammatory response, as demonstrated by a study conducted by Burkhard Dick MD which showed an increased level of prostaglandins in ocular fluid following FLACS.

 On the other hand, there is also research showing that compared to conventional ultrasound phacofragmentation, FLACS can reduce endothelial cell loss by nearly 40 per cent.

Dr Rosen added that further reduction of the hazards associated with phacofragmentation may be achieved through refinement of the laser pulse frequency, beam structure and spot size, and grid size and the imaging systems used to guide the laser pulses.