The latest development in modern cataract surgery is the femtosecond laser used in femtosecond laser-assisted cataract surgery (FLACS). This laser can precisely separate tissue under computer control without causing thermal damage to adjacent tissue.

Femto cataract surgery with this new technology is done in two steps, one by the laser and one manually by the surgeon. The femtosecond laser can perform the opening of the lens capsule (capsulotomy), the division of the lens (lens fragmentation) and corneal incisions. The laser can also be used to make arcuate incisions to correct astigmatism. The surgeon then aspirates the pre-fragmented lens using low-level ultrasonic energy and implants the intraocular lens.

 

Surgical Steps Laser Cataract Surgery

The laser can be used for the following surgical steps:

• Corneal incisions
• Opening of the anterior lens capsule (capsulotomy)
• Fragmentation of the lens (lens fragmentation)
• Arcuate incisions to correct corneal astigmatism (AK or limbal relaxing incisions LRI)

Planungsbildschirm eines Femtosekundenlasers bei Laser Grauer Star Operation
Planungsbildschirm Femtokataraktlaser
Pros: + High-precision computer-controlled cuts are made with the laser + Low energy in the eye + Simultaneous correction of minor corneal astigmatism possible + Latest generation of intraocular lenses (Femto-IOLs) can be implanted + Innovative development in cataract surgery Cons: – Prolonged surgery time – Not applicable in all patients (e.g. with small pupils) – Higher surgery costs
The laser works with ultra-short light pulses in the femtosecond range (a femtosecond corresponds to 10-15 seconds = 0.000,000,000,000,001 s) and can generate high energy densities by focusing. Predetermined tissue layers are separated precisely by converting laser energy into mechanical energy (photodisruption) without causing thermal damage to adjacent tissues. A 3D imaging process supports the femtosecond laser-assisted intervention. Using optical coherence tomography (OCT) – high-resolution imaging – the lens and the cornea are imaged in the micrometer range. Based on that, the computer-controlled laser can work precisely.