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