"prechopped" nucleus is easier to fragment and easier to
segment, and it uses less energy and time than if it were done
manually.
As we gain more experience with the LenSx Laser, we are
coming to realize its utility in complicated and difficult cases.
I recently saw a patient who had a dislocated, cataractous lens
resulting from a traumatic injury. The LenSx Laser allowed me
to perform a capsulorhexis much more easily than I would
have been able to do manually. Being able to perform the
capsulorhexis exactly in the portion of the lens that I wanted
and to make it exactly the size that I wanted allowed me to
use capsular retraction hooks more effectively and without
the concern of these tearing out. It was done more easily and
accurately with the femtosecond laser.
Similarly, I used the LenSx Laser in another case where
the patient had an intumescent, white lens that clinically
appeared to have significant intralenticular pressure. I was
concerned that this case could be complicated, producing an
Argentinian flag sign. This phenomenon is well-known and is
a concern because of the high intralenticular pressure. When
the capsule is punctured after having applied trypan blue to
enhance capsular visibility (even in the presence of viscoelastic
and a pressurized chamber), the capsule can tear out, creating
a central white band (the white lens) with a blue band on
either side resembling the Argentina flag. This is not a concern
with a femtosecond laser, however. A perfect capsulorhexis can
be performed without having it tear out because the pressure
inside the eye is maintained and constant. This significantly
improves the safety margin in these type of cases.
Recent advancements have made femtosecond laser
technology even more exciting. When you think about it,
phacoemulsification has been around for 30 or 40 years.
Femtosecond laser technology has only been around for 4 or
5 years, and it is amazing that it can perform the steps of the
procedure more precisely than manual techniques.
Most surgeons who perform these steps manually believe
that they can be better, more consistent, more accurate, more
precise, and more reliable with femtosecond technology. Why
isn't everyone using it? A big question is the economics of the
technology. We are finding that this can be overcome and that
discussing the use of the femtosecond laser with patients is
not as difficult as we once thought.
We continue to see remarkable improvements in the
upgrades of the instruments. There have been numerous
upgrades to the current LenSx Laser system since its inception,
and each one has made a powerful impact on the improve-
ment of the procedure. I expect that this technology will
continue to evolve and as a result provide the opportunity to
enhance our practices and our patient outcomes.
Reference
1. Kranitz K, Mihaltz K, Sandor GL, Takacs A, Knorz MC, Nagy ZZ. Intraocular
lens tilt and decentration measured by Scheimpflug camera following manual
or femtosecond laser-created continuous circular capsulotomy. J Refract Surg.
2012;28(4):259–263.
Stephen Lane, MD
Dr. Lane is in practice in St. Paul,
Minn. He can be contacted at
sslane@associatedeyecare.com.
7
The LenSx Laser shown with the Verion Digital Marker
