Cataract surgeons are buzzing about femtosecond laser cataract surgery, a new technology aimed at helping surgeons achieve better results with toric and multifocal IOLs.

Traditional cataract surgery is already pretty successful, but the lasers deliver a benefit that's difficult to achieve with traditional techniques. They can create a perfectly round, perfectly centered opening in the front of the bag that holds the cataractous lens. That's especially important for some specialty IOLs. When the capsulorhexis (the name for the opening in the anterior portion of the capsular bag) is too small, it can interfere with the performance of multifocal lenses like the Bausch & Lomb Crystalens and the Alcon Restor. When it's too large, it can cause any intraocular lens to tilt and push forward, particularly troublesome for toric and multifocal lenses.

The lasers, which work external to the eye, with no need for sterile condition, also can make stepped clear corneal incisions, paracentesis incisions and relaxing incisions, and can at least partially emulsify the crystalline lens. Phacoemulsification and aspiration are still necessary, but the lasers supposedly make it possible to remove the cataractous lens much more gently, helping to preserve the other structures inside the eye.

The laser treatments will probably be applied outside of the OR, then the patient will be wheeled into the OR for the completion of the procedure, says a spokesperson for OptiMedica, one of 3 companies making lasers.

Currently only 1 company, LenSx of Aliso Viejo, Calif., holds FDA approval to market a femtosecond laser; the LensX laser is approved for capsulorhexis and incisions, but not yet for emulsification of the lens. An American surgeon, Steven Slade, MD, performed the first femtosecond cataract surgeries at the Slade-Baker Vision Center in Houston last month, says company spokeswoman Trudy Larkin. She says LenSx lasers will be for sale in October; she declined to disclose pricing, but she says the lasers will be available on a for-purchase or a fee-per-case basis.

In addition to LenSx and OptiMedica, 1 other company, LensAR of Winter Park, Fla., also displayed a femtosecond cataract laser at the American Society of Cataract and Refractive Surgeons in Boston last week.

Outpatient Surgery Magazine staff

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