Surgical skills remain important with use of femto laser

The authors of this letter to the editor emphasize the continued importance of surgical skills despite the use of the femtosecond laser to perform cataract surgery.

They discuss a study that reported on a corneal perforation that occurred during intrastromal astigmatic keratectomy as part of femtosecond laser–assisted cataract surgery, and provide an excellent explanation of how these perforations can occur and can be prevented. They advise ophthalmologists to remember that they are surgeons while the machine is not, and it is important to avoid both human and mechanical mistakes at every step of an operation.

They note that OCT-guided arcuate incisions have the potential to correct astigmatism but have not been investigated in prospective clinical trials. Regardless, they say that the surgeon is responsible and must have the skill and knowledge to act quickly if the system is not performing as it should.

They caution that all OCT images should be examined carefully. In particular, attention should be paid to good image quality and proper detection of anatomical structures.