Caution recommended in femto cataract surgery due to IOP increase

This prospective study found a significant increase in IOP during femtosecond laser-assisted cataract surgery with the Victus platform.

Because the duration of increased IOP was longer than during LASIK and patients were older than most LASIK patients, the authors advise caution when performing femto laser-assisted cataract surgery in patients with ocular conditions vulnerable to IOP fluctuation.

This is a repeat of a discussion from 15 to 20 years ago about LASIK and IOP. No significant impact of the IOP-raising effects of LASIK was ever found. Although the vacuum time in this study is longer than with femtosecond LASIK, it's likely that the findings will be the same Meanwhile, some surgeons will use caution.

The researchers measured IOP in 41 eyes of 35 patients using a handheld portable applanation tonometer (Tono-Pen Avia) during femtosecond laser–assisted cataract surgery with the Victus platform. The mean age of the patients was 70.5 years.

Mean IOP increased significantly when the suction was turned on compared with before docking and suction, and then decreased significantly when the suction was switched off and the suction ring removed. The mean suction duration was 216 ± 15 seconds.

They note that the rise in IOP during cataract surgery in this study was not as high as that reported during LASIK procedures. However, patients undergoing femto laser-assisted cataract surgery are likely to be older than LASIK patients and have a higher risk for retinal nerve fiber damage over the long term.

They recommend careful patient selection, and that patients with ocular conditions that may be vulnerable to acute ocular hypertension or IOP fluctuation—such as  advanced glaucoma, optic atrophy, retinal vascular disease and ischemic optic neuropathy—be made aware that femto laser-assisted cataract surgery is a high-pressure procedure, even though the relevance of the duration of increased IOP remains uncertain.