Femtosecond Laser-Assisted Cataract Surgery (FLACS)
MR Jafarinasab MDLabbafinejad Medical Center
www.iranophthalex.com
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.
Introduction
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:IncisionCapsulorhexisPhacoemulsificationIOL InsertionRelaxing 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
SmallLargeEccentricIrregular
FS Laser-assisted vs ManualCapsulorhexis
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 procedure1-Planning2-Engagement (Docking)3-Visualization and customization4-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 SurgeryImaging and Registration:
OCT Technique (Optimedica)
Scheimpflug Technique (LensAR)
Treatment
1. Lensx _ animation2. lens_aspiration_ii3. lens_fragmentation_ii4. anterior_capsulotomy
FS Laser-Assisted Cataract Surgery:The Future:
Sub Bowman’s Relaxing IncisionsComplex Cataract IncisionsCustomized CapsulorhexisPosterior CapsulotomyCapsulorhexis 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 believes that in the future, cataract surgery will be dramatically different because of the advent of the femtosecond platform.
"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.
Thank you