• Cataract/Anterior Segment

    This prospective study found that, compared to traditional phaco, femtosecond laser cataract surgery results in a significantly high rate of anterior capsule tears beyond the initial learning curve expected with the technology.

    Subjects included 1,626 patients undergoing femtosecond laser-assisted cataract surgery or phacoemulsification.

    There was a significantly increased rate of anterior capsule tears in the femtosecond group (1.87 percent vs. 0.12 percent). In seven cases, the anterior capsule tear extended to the posterior capsule.

    Because all cases had occurred in complete capsulotomy, the integrity of the anterior capsule was questioned in the femtosecond group. Subsequent scanning electron microscopy sampling showed irregularity at the capsule margin, as well as multiple apparently misplaced laser pits in normal parts of the tissue. Aberrant pits were approximately 2 to 4 μm apart and occurred at a range of 10 to 100 μm radially from the capsule edge.

    The authors write that although femtosecond laser technology may be safer in some surgeons' hands, this is not necessarily true for all surgeons and certainly depends on the benchmark against which one is measuring. They also cannot rule out individual variations in the performance of each laser platform. Deficiencies in laser output energy or disruptions to the optical path of laser pulses may affect the quality and consistency of resultant biological photodisruption resulting from laser-induced optical breakdown.

    They conclude that with demonstrated improvement in surgery outcomes, the small risk of complications may be acceptable. However, further studies are required to evaluate which surgical techniques, laser platforms, surgeons and patients may benefit from the technology. Patients should be aware that they belong to a learning cohort for the surgeon's initial cases, and surgeons need to take care when implementing this technology into their practice.