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Salgado RMPC, Torres PFAAS, Marinho AAP. Update on Femtosecond Laser-Assisted Cataract Surgery: A Review. Clin Ophthalmol 2024; 18:459-472. [PMID: 38375440 PMCID: PMC10875176 DOI: 10.2147/opth.s453040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
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.
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Affiliation(s)
- Ramiro M P C Salgado
- Departamento de Oftalmologia do Hospital da Arrábida, Hospital de Santo António, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Paulo F A A S Torres
- Departamento de Oftalmologia do Hospital da Prelada, Universidade do Porto, Porto, Portugal
| | - Antonio A P Marinho
- Departamento de Oftalmologia do Hospital da Luz Arrábida, Universidade do Porto, Porto, Portugal
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Slezak F, Thumann G, Kropp M, Cvejic Z, De Clerck EEB, Bravetti GE, Guber I, Pajic B. Comparison of Conventional and Femtosecond Laser-Assisted Cataract Surgery Regarding Macula Behavior and Thickness. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040639. [PMID: 37109597 PMCID: PMC10145739 DOI: 10.3390/medicina59040639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/05/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023]
Abstract
Background: The aim of the study was to compare macular thickness behavior and clinical outcomes after femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification conventional surgery (PCS). Methods: Macular Optical Coherence Tomography OCT was analyzed in 42 patients preoperatively, 1 day, 12 days, 4 weeks and 6 weeks postoperatively according to the 9-field Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Clinical findings were collected in both the FLACS group and the PCS group. Results: There was no significant difference in macular thickness between the FLACS and PCS groups (p > 0.05). However, from postoperative day 12 onwards, there was a significant increase in macular thickness observed in both groups (p < 0.001). In the FLACS group, a significant increase in visual acuity was observed on the first postoperative day, as compared to the PCS group (p = 0.006). Conclusions: The use of a low-energy high-frequency femtosecond laser has potentially no effect on postoperative macular thickness. In the FLACS group, visual rehabilitation was significantly faster as compared to the PCS group. No complications occurred intraoperatively in either group.
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Affiliation(s)
- Filip Slezak
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
| | - Gabriele Thumann
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Martina Kropp
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Zeljka Cvejic
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
| | - Eline Elodie Barbara De Clerck
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Giorgio Enrico Bravetti
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Ivo Guber
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Bojan Pajic
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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The creation of a corneal incision with a femtosecond laser. OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov109082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: The cutting action of a femtosecond laser (FS-laser) on the corneal tissue is performed using a photodestructive effect. FS-laser technology is used in many different areas of corneal surgery, and studying this effect is an actual issue.
AIM: To evaluate the surface of the corneal incision created by a FS-laser (experimental study).
MATERIALS AND METHODS: 20 porcine eyes were divided into two groups (FS-laser and keratome). The corneal tissue surface in the area of contact between two lips of the incision was visualized by electron microscopy.
RESULTS: In all cases, we received a full-thickness incisions through the cornea. Images obtained by electron microscopy showed regular surface, no signs of thermal or mechanical damage to the corneal structure.
CONCLUSIONS: The FS-laser is used as a microscopic scalpel in surgery. The precision cutting process is performed by mechanical forces generated by photodestruction by expanding cavitation bubbles.
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Chang L, Zhang L, Cheng Z, Zhang N, Wang C, Wang Y, Liu W. Effectiveness of collagen cross-linking induced by two-photon absorption properties of a femtosecond laser in ex vivo human corneal stroma. BIOMEDICAL OPTICS EXPRESS 2022; 13:5067-5081. [PMID: 36187250 PMCID: PMC9484424 DOI: 10.1364/boe.468593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
This study aimed to investigate the effectiveness of two-photon induced collagen cross-linking (CXL) using femtosecond lasers in human corneal stroma. An 800-nm femtosecond laser optical path for CXL was established. Corneal samples that received two-photon induced CXL and ultraviolet-A (UVA) CXL underwent uniaxial stretching experiments, proteolytic resistance assays and observation of collagen fiber structure changes. Two-photon induced CXL can achieve corneal stiffening effects comparable to UVA CXL and showed better advantages at low strains. The cornea after two-photon induced CXL exhibited high enzymatic resistance and tight collagen fiber arrangement. Two-photon induced CXL promises to be a new option for keratoconus.
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Affiliation(s)
- Le Chang
- Clinical College of Ophthalmology, Tianjin Medical University, No. 22 Meteorological Terrace Road, Heping District, Tianjin 300070, China
| | - Lin Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, No. 22 Meteorological Terrace Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, No. 4 Gansu Road, Heping District, Tianjin 300020, China
| | - Zhenzhou Cheng
- Institute of Modern Optics, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin 300071, China
- Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, No. 94 Weijin Road, Nankai District, Tianjin 300071, China
| | - Nan Zhang
- Institute of Modern Optics, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin 300071, China
- Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, No. 94 Weijin Road, Nankai District, Tianjin 300071, China
| | - Congzheng Wang
- Department of Mechanics, School of Mechanical Engineering, Tianjin University, No. 92 Weijin Road, Nankai District, Tianjin 300072, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, No. 22 Meteorological Terrace Road, Heping District, Tianjin 300070, China
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Nankai University, No. 4 Gansu Road, Heping District, Tianjin 300020, China
| | - Weiwei Liu
- Institute of Modern Optics, Nankai University, No. 94 Weijin Road, Nankai District, Tianjin 300071, China
- Tianjin Key Laboratory of Micro-scale Optical Information Science and Technology, No. 94 Weijin Road, Nankai District, Tianjin 300071, China
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