Femtosecond laser-assisted cataract surgery: Update and perspectives

Abstract

Cataract surgery is among the most frequently performed surgical procedures worldwide and has a tremendous impact on patients' quality of life. Phacoemulsification (PCS) is accepted as a standard of care; its technique has continuously evolved and already achieved good anatomical, visual, and refractive outcomes. Lasers in ophthalmology are widely used in clinical practice, femtosecond lasers (FSLs) for corneal surgery in particular. It was natural to assess the usefulness of FSL in cataract surgery as this technology was within reach. Indeed, precise and reproducible cuttings provided by FSL platforms could improve standardization of care and limit the risk associated with the human element in surgery and provide a step toward robot-assisted surgery. After docking and planning the procedure, femtosecond lasers are used to perform corneal incisions, capsulorhexis, lens fragmentation, and arcuate incisions in an automated manner. A well-constructed corneal incision is primordial as it offers safety during the procedure, self-seals afterward, and influences the refractive outcome. Capsulorhexis size, centration, and resistance to shearing influence the surgery, intraocular lens (IOL) centration and stability, and posterior capsular opacification formation. Lens fragmentation is where most of the energy is delivered into the eye, and its amount influences endothelial cell damage and potential damage to other ocular structures. The arcuate incisions offer an additional opportunity to influence postoperative astigmatism. Femtosecond laser-assisted cataract surgery (FLACS) has been a topic of research in many studies and clinical trials that attempted to assess its potential benefits and cost-effectiveness over PCS and is the subject of this mini-review.

Exploring anterion capsular contraction syndrome in cataract surgery: insights into pathogenesis, clinical course, influencing factors, and intervention approaches

“…With the advancement of technology, the utilization of femtosecond laser technology in cataract surgery has allowed for a less invasive and safer approach, minimizing injury to the zonules. This technique has been widely adopted to effectively and safely enlarge the capsulorhexis ( 112 ). Further research is needed to investigate whether a femtosecond laser can offer advantages over existing treatment methods in intervening ACCS ( Figure 5 ).…”

Application of femtosecond laser in anterior segment surgery

“…[ 1 ] However, FLACS may provide a lower risk profile for patients with dense cataracts, traumatic cataracts, Fuchs’ dystrophy, low endothelial cell count, and in some pediatric cases. [ 2 ]…”