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8 T here are many steps within the cataract procedure, when performed manually, that contain an inherent level of variability. These steps include capsulotomy, making the primary and secondary inci- sions, and making arcuate incisions in the cornea. Many surgeons have avoided performing similar types of incisions like manual arcuate inci- sions during cataract surgery. Manual arcuate incisions require significant expertise and produce some degree of unpredictability. As a result, manual arcuate incisions are largely avoided by the great majority of cataract surgeons due to concerns about accuracy. The LenSx Laser (Alcon, Fort Worth, Texas) utilizes image-guided surgical planning with 3D visualiza- tion for the surgeon. This enables surgeons to plan and execute the necessary corneal incisions to ad- dress the needs of the patient at the time of cataract surgery with com- puter-controlled arcuate incisions of precise depth, length, and posi- tion. The integrated imaging system ensures incisions of accurate width and tunnel length and geometric shape. My early experiences with the femtosecond laser for refractive cataract surgery demonstrate that the femtosecond laser will provide another layer of precision by creat- ing reproducible arcuate incisions at the desired optical zone. Incorporat- ing femtosecond laser arcuate inci- sions into my armamentarium has given me the confidence to know I'm offering the most advanced technologies on the market today to my patients. Adjust arcuate incisions The surgeon's ability to adjust surgi- cal parameters and thereby titrate the amount of residual tissue attach- ments in the incision enables an- other distinct advantage. Utilizing this feature, the surgeon can adjust the arcuate incision width by using a blunt manual instrument. These kinds of incisions also could be likened to a LASIK flap. The surgeon must lift the flap by hand to make use of the incision. Likewise, until the cataract femtosecond incisions are opened manually, the fenestrations the surgeon has made with the laser have not been realized. A great majority of ophthalmol- ogists aren't doing any type of man- ual arcuate incision during cataract surgery due to fear of cutting deeply into the cornea and risking perfora- tion. Using the femtosecond laser allows any ophthalmologist to perform a quality arcuate incision. Surgeons can be assured that this is being done with the accuracy and precision of a laser that is as good as any surgeon, even one with years of experience. Accuracy and reproducibility My personal belief is that femtosec- ond cataract surgery is a more accu- rate and reproducible way of doing cataract surgery. If I can incorporate that technology into my cataract surgery, I will do so at any opportu- nity. I'm getting better reproducibil- ity with my femtosecond incisions than I ever got with my manual incisions. Using the femtosecond laser to create those incisions is more reproducible, gives me adjustable incisions, and provides a level of accuracy that I cannot consistently achieve manually. Dr. Donnenfeld is a partner at Ophthalmic Consultants of Long Island. Contact information Donnenfeld: eddoph@aol.com EW Chicago 2012 Sunday, April 22, 2012 8 Femtosecond laser arcuate incisions: Delivering accuracy and reproducibility by Eric D. Donnenfeld, M.D. The LenSx Laser Source: Alcon " My early experiences with the femtosecond laser for refractive cataract surgery demonstrate that the femtosecond laser will provide another layer of precision by creating reproducible arcuate incisions at the desired optical zone " Eric Donnenfeld, M.D. Please refer to page 12 for important safety information about the Alcon surgical products described in this supplement. Alcon Sunday supplement_Chicago2012-12pages_Layout 1 4/20/12 4:51 PM Page 8

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