Femtosecond laser-assisted cataract surgery, technology, outcome, future directions and modern applications

Femtosecond-Laser Assisted Surgery of the Eye: Overview and Impact of the Low-Energy Concept

This article provides an overview of both established and innovative applications of femtosecond (fs)-laser-assisted surgical techniques in ophthalmology. Fs-laser technology is unique because it allows cutting tissue at very high precision inside the eye. Fs lasers are mainly used for surgery of the human cornea and lens. New areas of application in ophthalmology are on the horizon. The latest improvement is the high pulse frequency, low-energy concept; by enlarging the numerical aperture of the focusing optics, the pulse energy threshold for optical breakdown decreases, and cutting with practically no side effects is enabled.

Evaluation of the effectiveness of combined femtosecond laser-assisted cataract surgery and femtosecond laser astigmatic keratotomy in improving post-operative visual outcomes

Background

To determine postoperative refractive and visual outcomes and astigmatic changes after femtosecond laser astigmatic keratotomy in femtosecond laser-assisted cataract surgery (FLACS).

Methods

This was a prospective interventional case series. Patients with age-related cataract and corneal astigmatism (1.0–3.0D) were treated with FLACS and femtosecond laser astigmatic keratotomy (FSAK). All patients underwent examinations before and 3 months after surgery; visual acuity, subjective and objective refraction, and corneal astigmatism were evaluated and recorded for all patients by using an OPD-Scan III topographer. Vector analysis of astigmatic changes was performed by using the Alpins vector method.

Results

Twenty-five patients were included in the study. Postoperatively, refractive and corneal astigmatism were both reduced significantly (P < 0.05), concurrent with improved uncorrected distance visual acuity and corrected distance visual acuity. The rate of spectacle use was significantly reduced at 3 months postoperatively (P = 0.001). The mean magnitude of the target-induced astigmatism vector (1.40 ± 0.37D) was slightly higher than the mean magnitude of the surgically induced astigmatism vector (1.22 ± 0.46D). The magnitude of error (− 0.18 ± 0.36D), as well as the correction index (0.88 ± 0.29), demonstrated slight undercorrection. The angle of error was 0.85 ± 13.69°, which was close to zero.

Conclusions

Combined femtosecond laser-assisted cataract surgery and astigmatic keratotomy may be an effective approach to manage preoperative astigmatism in cataract surgery, although slight undercorrection may exist during short-term follow-up.

Trial registration

ChiCTR-TRC-14004977