Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery

Lens Fragmentation with Picosecond Laser Pulses After Artificial Cataract Induction with Microwaves

Objectives: In this work we demonstrate the first laboratory study results of lens fragmentation with low-energy picosecond ultrashort laser pulses after artificial induction of cataract with microwave radiation on an ex vivo animal model. Background: This method will be evaluated with regard to the further development of lens fragmentation with novel ultrashort picosecond laser systems instead of ultrasonic phacoemulsification or the significantly more complex femtosecond laser fragmentation. Methods: As samples we used postmortem porcine eyes. The lenses were dissected and then irradiated in a microwave oven for artificial cataract induction. Subsequent computer-driven lens fragmentation was performed with a 12 ps, 1064 nm pulsed laser source with 100 µJ pulse energy, and 10 kHz pulse repetition rate. Results: Both the artificial cataract induction and the lens fragmentation were demonstrated. When inducing cataract, different degrees/stages of opaqueness and hardness could be achieved with different irradiation times and methods. The fragmentation with 12 ps pulses led to good results with regard to ablation depth and rate, especially for the softer lenses. Conclusions: As could be shown, low-energy picosecond ultrashort laser pulses are feasible for cataractous lens fragmentation on an ex vivo animal model with artificial cataract induction. Thus, this technique may influence future cataract surgeries by possibly being an alternative or extension to state-of-the-art methods. This will be evaluated with further tests and studies.

Update on Femtosecond Laser-Assisted Cataract Surgery: A Review

The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.