MR Jafarinasab MD Labbafinejad Medical Center

www.iranophthalex.com

Introduction

 Cataract surgery is one of the most frequently performed surgeries in the world today, enabling millions of people to regain eyesight lost because of cataracts.

 Modern cataract surgery is safe, effective and highly predictable .

 Surgical tools and techniques are constantly evolving to make the procedure even better.

Complications of Traditional PE

Cataract surgery complications are still10x that of LASIK LASIK (

Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Objectives:

1.

Increase safety 2.

Improve precision 3.

Automate undependable components

Contemporary Cataract Surgery

Steps:

 Incision  Capsulorhexis  Phacoemulsification  IOL Insertion  Relaxing Incisions (Astigmatism)

Cataract Incisions :

 

Wound construction is critical in modern cataract surgery because it is the BASIC step



A poorly constructed wound will make subsequent steps more

 

difficult and increase the risk of complications.



A well-constructed wound is the first step in successful surgery for both the surgeon and the patient.

Potential Problems in manual Capsulorhexis



Small



Large



Eccentric



Irregular

FS Laser-assisted vs Manual Capsulorhexis

FS Laser-assisted vs Manual Capsulorhexis

Femtosecond Laser-Assisted Lens Fragmentation & Softening

Femtosecond Laser-Assisted Lens Fragmentation & Softening

Relaxing Incision for Astigmatism:

Historical Background



2008: First surgery performed by Zoltan Nagy in Budapest using Alcon Lensx Laser



2009: Alcon Lensx became first laser to receive FDA approval for Cataract surgery



2010: First surgery performed in United States performed by Stephen Slade

FS laser cataract surgery procedure



Stages of

FS laser cataract surgery procedure

 1-Planning  2-Engagement (Docking)  3-Visualization and customization  4-Treatment

Docking (Engagement

)

  

Prior to delivery of the laser, a patient’s eye must be stabilized relative to the optical system of the laser. In refractive surgery, this is achieved with a curved or flat plate that pulls the eye into a suction ring, distorting the globe In FLACS another option is liquid interface

Visualization and customization



The image guidance system is a critical part of laser cataract surgery as it determines the location and dimension of ocular structures



It is critical that the posterior surface of the lens ( Posterior Capsule ) be detected in order to maintain a safety zone and prevent cuts in the posterior capsule

Visualization and customization



LenSx and OptiMedica use FD-OCT for three dimensional, high-resolution viewing of ocular structures.



LensAR uses a three-dimensional confocal structured illumination- scanning transmitte very similar to Scheimpflug technology .



Additionally, the lens density can be valuated

FS Laser-assisted Cataract Surgery Imaging and Registration:

OCT Technique (Optimedica) Scheimpflug Technique (LensAR)

Treatment

1. Lensx _ animation 2. lens_aspiration_ii 3. lens_fragmentation_ii 4.

anterior_capsulotomy

FS Laser-Assisted Cataract Surgery: The Future:



Sub Bowman’s Relaxing Incisions



Complex Cataract Incisions



Customized Capsulorhexis



Posterior Capsulotomy



Capsulorhexis Integrating with IOLs - “Capsule in the Lens” - Toric IOL Orientation



IOL Power Adjustment



Lens Refilling Surgery

FS Laser-assisted Cataract Surgery: Advantages and Disadvantages:

• • •

Advantages:

Improved safety Increased precision Enhanced reproducibility • •

Disadvantages:

Increased Cost Added time

Conclusion:

 William J. Link, Ph.D., Newport Beach, Calif.,       when a new technology is introduced, "there's always this beautiful, awkward, disruptive time where we try to sort it out and debate, and then it will be refined with data and experience." Dr. Link platform.

believes that in the future, cataract surgery will be dramatically different because of the advent of the femtosecond " For that to happen, it has to work economically , It has to be good for the patient, it has to be good for the practice, it has to be good for the company.