Laser's Precision and Simplicity Could Revolutionize Cataract Surgery

Two new studies add to the growing body of evidence that a new   approach to Cataract surgery may be safer and more efficient than   today's standard procedure. The new approach, using a special   femtosecond laser, is FDA-approved, but not yet widely available in the   United States. It's one of the hottest topics this week at the 115th Annual Meeting of the American Academy of Ophthalmology.

Research reported Oct. 23 by William W. Culbertson, MD, of the Bascom   Palmer Eye Institute at the University of Miami School of Medicine, and   by Mark Packer, MD, of Oregon Health and Sciences University, confirms   several advantages of laser Cataract surgery.

Laser Lens Fragmentation Boost Safety by Reducing Need for Ultrasound

Dr. Culbertson's team studied how pre-treating Cataracts with the   femtosecond laser affected the level of ultrasound energy needed to   soften the Cataracts. This emulsification is performed so that the   Cataracts can be easily suctioned out. Surgeons want to use the lowest   possible level of ultrasound energy, since in a small percentage of   patients it is associated with slower recovery of good vision after   surgery and/or problems with the cornea, which is the clear outer layer   of the eye. Ideally, in appropriate cases, ultrasound use would be   eliminated altogether.

In Dr. Culbertson's prospective, randomized study, 29 patients had   laser Cataract surgery with a femtosecond laser in one eye and the   standard Cataract procedure, called phacoemulsification, in the other.   Laser surgery included: a laser capsulotomy, which is a circular   incision in the lens capsule, followed by laser lens fragmentation, then   ultrasound emulsification and aspiration. Lens fragmentation involved   using the laser to split the lens into sections and then soften it by   etching cross-hatch patterns on its surface. Standard surgery included a   manual incision, followed by ultrasound emulsification and aspiration.   After Cataract removal by either method, intraocular lenses were   inserted into eyes to replace the natural lens and provide appropriate   vision correction for each patient.

The use of ultrasound energy use was reduced by 45 percent in the   laser pre-treated eyes compared with the eyes that received the standard   cataract surgery procedure. Also, surgical manipulation of the eye was   reduced by 45 percent in eyes that received laser pre-treatment as   compared to manual standard surgery. This study involved the most common   types of cataracts, those graded 1- 4. Dr. Culbertson notes that these   findings may not apply to higher grade cataracts.

"In clinical practice, surgeons would expect safer, faster cataract   surgery when laser pre-treatment is performed before cataract removal,"   said Dr. Culbertson. "The combination of precision and simplification   that is possible with the femtosecond laser represents a major advance   for this surgery."

Laser Lens Fragmentation Protects Corneal Endothelial Cells

Dr. Packer's team at the Oregon Health and Sciences University in   Portland, Oregon, assessed the safety of laser cataract surgery in terms   of loss of corneal endothelial cells, as measured after cataract   surgery. Measuring endothelial cell loss is one of the most important   ways to assess the safety of new cataract surgery techniques and   technology. These cells preserve the cornea's clarity, and since they   don't regenerate, they must last a lifetime. Dr. Packer's study found   that when laser lens fragmentation was used in 225 eyes, there was no   loss of endothelial cells, while the 63 eyes that received standard   treatment had cell loss of one to seven percent.

"Our finding, that laser lens fragmentation appears to protect   corneal endothelial cells, represents a significant benefit of this new   surgery," said Dr. Packer. "This procedure is safer than standard   cataract treatment and is likely to mean better vision and fewer eye   health concerns for cataract patients, over the long term."

Earlier studies of femtosecond laser cataract surgery found other   benefits. The laser allows the surgeon to make smaller, more precise   incisions and to perform improved capsulotomies, which is the removal of   part of the lens capsule that make intraocular lens (IOL) placement   more secure. This reduces the chance that an IOL will later become   displaced. Also, laser cataract surgery appears to improve results in   patients who opt for advanced technology IOLs, plus corrective corneal   incisions, to achieve good all-distance vision.

Femtosecond lasers have been used by ophthalmologists for years in   refractive surgery such as LASIK, in-corneal transplants, and in other   procedures. In 2009, a new type of femtosecond laser that could reach   deep enough into the eye to be used in cataract removal was approved by   the FDA. In addition to Dr. Culbertson's and Dr. Packer's presentations,   key sessions on the topic at the Academy's 2011 Annual Meeting include a   special session in the Sunday afternoon program, Spotlight on   Femtosecond-Assisted Cataract Surgery: The Tough Questions, Femtosecond   Laser Cataract Surgery: the Future,a video presentation,and two new   instruction courses. 

http://www.sciencedaily.com/releases/2011/10/111023135653.htm

Story Source:

  The above story is reprinted from materials provided by American Academy of Ophthalmology.

  Note: Materials may be edited for content and length. For further information, please contact the source cited above