gms | German Medical Science

Purpose: Femtosecond laser-assisted cataract surgery has attracted much attention in the past 4 years. The possibility to operate precisely and contact-free on the eye in an imaging-based procedure as well as to perform a clear corneal incision, corneal astigmatic corrections, a capsulotomy and lens fragmentation has become feasible due to combination of the imaging technologies with the laser technologies.

Methods: The first femtosecond laser to appear on the market was the so-called LensEx laser (Alcon), which shows the anterior segment of the eye by means of a high-resolution OCT. Worldwide, the highest number of applications and experiences were with the LensEx. Further systems that are also based on OCT-imaging include the Victus laser (Bausch & Lomb), the Catalys (AMO) and the LDV8 (Ziemer). The LensAr (Lensar) is the only system not based on OCT but on Scheimpflug basis.

Results: After initial problems during the “learning phase” of the LensEx or of the user, standard treatment regimens have prevailed. The Victus-Laser, the Catalys as well as the LDV8 differ in coupling modalities (interface-technology). Though, they all share in common having a liquid-Interface, which more or less presses on the cornea, however with a minimum impact on the natural curvature of the cornea. The LensAR generates a number of cross-sectional images of the anterior segment of the eye and thereby creates a 3D-reconstruction of the anterior segment. Apart from that, the application procedure of the LensAR doesn’t differ from the other devices.

Conclusion: Different examinations showed that the quality and reproducibility of capsulotomies with femtosecond lasers is outstanding. The pre-fragmentation of the lens leads to a marked reduction of the ultrasound energy to be used. Better visual acuity results are not evident in the perfromed studies so far.