Aao media briefing laser assisted cataract surgery october 25 2009 san francisco ca
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AAO Media Briefing Laser Assisted Cataract Surgery October 25, 2009 San Francisco, CA William W. Culbertson, MD Professor of Ophthalmology Bascom Palmer Eye Institute – Miami, Florida Interests: Cataract and Refractive Surgery (LASIK) Financial Relationships:

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AAO Media BriefingLaser Assisted Cataract SurgeryOctober 25, 2009San Francisco, CA


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William W. Culbertson, MD

  • Professor of Ophthalmology

  • Bascom Palmer Eye Institute – Miami, Florida

  • Interests: Cataract and Refractive Surgery (LASIK)

  • Financial Relationships:

    - Optimedica (Santa Clara, CA): Consultant

    - Abbott Medical Optics (Santa Ana, CA): Consultant

    - Carl ZeissMeditec (Dublin, CA): Consultant

    - Alcon (Fort Worth, TX): Speaker


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Contemporary Cataract Surgery

Steps:

  • Incision

  • Capsulorhexis

  • Phacoemulsification

  • IOL Insertion

  • Relaxing Incisions (Astigmatism)

Eyemaginations

Cartoon of Cataract surgery

1 Minute (runs with video below)

Video of Cataract Surgery 1.0 minute


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Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Leaking wound and endophthalmitis


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Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)


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Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Corneal Phaco Burn

Phaco burn picture


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Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Decentered Multifocal IOL

Decentered IOL


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Potential Problems in Contemporary Cataract Surgery:

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Decentered Multifocal IOL

Decentered IOL


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Potential Problems in Contemporary Cataract Surgery:

Pre-op LRIs

Steps:

Incision

Capsulorhexis

Phacoemulsification

IOL Centration

Relaxing Incisions (Astigmatism)

Post-op LRIs



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History of “Laser Cataract Surgery”

  • YAG laser lens softening

  • Dodick laser

  • Phoenix Laser


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Femtosecond Laser in Ophthalmology

  • Corneal Surgery

    Lasik flaps

    Corneal transplants

    (Corneal relaxing incisions)

    (Cataract surgery incisions)

  • Companies doing corneal surgery with fs laser:

    AMO (Intralase)

    Technolas (FEMTEC Perfect Vision)

    Zeimer (LDV)

    Zeiss (Visumax)


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Femtosecond Laser Photodisruption

  • Plasma expansion

  • Shock wave pressure

  • Cavitation bubble creation

  • Decreased pulse duration reduces photodisruption threshold and secondary effects allowing closer placement of pulses

Initial

Beam

Cavitation

Bubble


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Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Three American Companies:

LensAR (Winter Park, FL)

LenSx (Aliso Viejo, CA)

Optimedica (Santa Clara, CA)


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Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Objectives:

  • Increase safety

  • Improve precision

  • Automate undependable components


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Femtosecond Laser-Assisted Cataract Surgery (FLACS)

Laser Assisted Steps:

  • Imaging of the front of the eye

  • Cataract incision

  • Capsulorhexis (anterior capsulotomy)

  • Cataract (lens nucleus) segmentation and softening

  • Limbal relaxing incisions


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FS Laser-assisted Cataract SurgeryImaging and Registration:

OCT Technique (Optimedica)

Scheimpflug Technique (LensAR)


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Cataract Incision:

(Optimedica)


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FS Laser-assisted Cataract Surgery:Cataract Incision:

(Optimedica)


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FS Laser-Assisted Cataract Surgery:Cataract Incision:

Cartoon of incision

Video of incision


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Capsulorhexis:

(Optimedica)


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Capsulorhexis:

(LensAR)


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Capsulorhexis Edge: SEM

500X

50X




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Limbal Relaxing Incisions:


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FS Laser-assisted Cataract Surgery:Advantagesand Disadvantages:

  • Advantages:

  • Improved safety

  • Increased precision

  • Enhanced reproducibility

  • Disadvantages:

  • Increased Cost

  • Added time


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Conclusion:

Femtosecond laser assisted cataract surgery is a promising improvement on standard contemporary phacoemulsification cataract surgery.


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FS Laser-Assisted Cataract Surgery:The Future:

  • Sub Bowman’s Relaxing Incisions

  • Complex Cataract Incisions

  • Customized Capsulorhexis

  • Capsulorhexis Integrating with IOLs

    - “Capsule in the Lens”

    - Toric IOL Orientation

  • Lens Refilling Surgery