Femtosecond Laser Cataract Surgery

samar
17 Sep, 2024
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An Overview to Femtosecond Laser Cataract Surgery

Femtosecond Laser Cataract Surgery Training Course is designed to provide comprehensive
and contemporary instruction on femtosecond lasers in cataract surgery.
The first day will start with an introduction to femtosecond lasers and the critical importance
of cataract surgery training.

Importance of Femtosecond Laser Cataract Surgery

First and foremost, we must understand that the human eye is significantly more complex
than what we perceive it to be.
The simplicity that we see when we look into someone’s eyes does not reflect
the true nature of the multiple layers of complexities that define our sense of sight.

Because the eye is such a vital sensory organ in our body, any form of surgery,
especially surgeries that involve the removal and implantation of substances within the eye cavity,
should not be taken lightly.
This is why patients choosing to undertake cataract surgery are sometimes offered
the option to employ the use of femtosecond lasers over traditional surgical techniques.

The reason is simple – femtosecond lasers offer a level of consistency, reliability,
and safety that is significantly higher than traditional hand-manipulated surgical tools.

The amount of control offered by femtosecond lasers’ ability to pulse at speeds of a quadrillionth
of a second is simply not possible to achieve through a surgeon’s hand,
no matter how steady the surgeon’s hand may be.

To maintain this high standard of safety and to ensure that surgeons remain efficient
and effective in the use of this advanced technology, structured training programs such as this course
will cover every single aspect of the processes from preoperatively, intraoperatively to postoperatively.

Objectives of the Femtosecond Laser Cataract Surgery Training Course

Firstly, the course aims to provide a foundation for understanding cutting-edge technology
and the principles behind femtosecond laser surgery.
The course begins with an introduction that includes an overview of femtosecond lasers
and emphasizes the importance of cataract surgery training.

The course aims to introduce trainees to femtosecond laser-assisted lens and cataract surgery,
including the advantages, disadvantages, and clinical pearls in challenging cases

By the end of this course, our trainees should have the prerequisite knowledge base
and technical skills needed to transition into practicing, teaching,
and advancing the field of laser refractive cataract surgery.

Lastly, as the preoperative setups and intraoperative operation steps in femtosecond cataract
surgery involve hands-on actions and visual-spatial reasoning skills,
a successful learning of the surgical technique can significantly boost the confidence
and independence of the trainees in adapting to new technological advancements in eye surgery.

Fundamentals of Femtosecond Laser Cataract Surgery

1- Femtosecond Laser Technology

The laser used in the surgery is an infrared laser that emits ultra-short pulses of energy,
which can disrupt the molecular bonds in the tissue, creating the precise tissue cutting necessary for cataract surgery.

Also, the ability of femtosecond technology to create predictable, clean,
and efficient anterior capsulotomies – in addition to its benefits in lens fragmentation,
corneal wound creation, and astigmatic keratotomies – has driven its integration into cataract surgery.

2- Anatomy of the Eye

Surgeons need to have a more detailed understanding of the eye when undertaking cataract surgery,
as the surgery involves the removal of the opaque,

natural lens and its replacement with a synthetic intraocular lens.

3- Preoperative Assessment

– The preoperative assessment allows the surgeon to gather all the necessary information
to prepare for a cataract procedure. A detailed medical and ophthalmic history is obtained
to identify any conditions affecting the surgical outcome.

– The patient’s expectations should be explored and discussed,
particularly as lens options now include the possibility of correcting presbyopia or astigmatism.

– A full ocular examination, including objective and subjective refractions and visual acuities,
should be performed.
Intraocular lens calculations are often performed at the preoperative stage and use measurements
of corneal curvature and axial length of the eye, which are usually obtained using non-contact methods.

– The biometry data gathered is used to choose an appropriate power of intraocular lens for the individual patient.

4- Patient Selection Criteria

The patients who receive the best benefits from a femtosecond laser for cataract surgery
are those with astigmatism or individuals receiving astigmatism-correcting lenses.
A femtosecond laser can help the physician create incisions in the cornea to correct this visually debilitating condition.

Additionally, femtosecond laser surgery helps the precise construction of incisions needed
for patients who elect to receive presbyopia-correcting intraocular lenses

Surgical Techniques in Femtosecond Laser Cataract Surgery

From the experts in this course, students not only learn the general steps of the surgery – making
an incision and fixating the eye with a toric marker, using an axis marker,
an axis marker being utilized to mark the target position of the main incision and one or two
paracenteses about the main incision, making a perfectly circular capsulotomy, etc.,
but also learn many advanced techniques, and get the chance to see how the surgeons
are dealing with different difficulties.

1- Capsulotomy and Lens Fragmentation

In femtosecond laser cataract surgery, the first step is to create the capsulotomy,
with the femtosecond laser, you can create a circular or round shape that is much
more reproducible and centered on the visual axis.

The laser is programmed to size the capsulotomy to the surgeon’s specifications,
including diameter and location.

Once the capsulotomy is performed, the next step is to perform lens fragmentation.
The femtosecond laser can be used to soften and divide the cataract into smaller sections.
This step requires a significant amount of laser energy, and it can potentially lengthen the operation time,
depending on the density of the cataract.
However, it makes the removal process easier and requires less energy delivery into the eye,
which may mean less overall energy to the ocular tissues.

2- Corneal Incisions and Wound Construction

Corneal incisions are a critical step in cataract surgery, as they allow the surgeon
to access the cataract for removal.

Traditional cataract surgery requires the use of handheld metal or diamond blades to make these incisions,
but with femtosecond laser technology, we can make these incisions with a laser instead.

Many studies have demonstrated the superiority of femtosecond laser-constructed corneal incisions,
showing that they result in more precise and more predictable wounds as well as less corneal edema,
which is the swelling of the cornea due to fluid accumulation.

3- Astigmatism Management and Intraocular Lens Implantation

The next focus in astigmatism management is intraocular lens implantation.
This involves removing the eye’s natural lens once it has been fragmented and replacing it with an artificial lens.

Several different types of artificial lenses can be used in cataract surgery, ranging from fixed focus
mono-focal lenses which means patients typically need to wear glasses for reading or close work,
to the newer, more expensive multifocal or accommodating lenses that aim to correct presbyopia.

Hands-on Training and Case Studies

Real-life case studies are a vital part of the learning process and anecdotally be highly successful.

The foundation of the hands-on training is a series of practical skill development exercises using model eyes.
A curriculum at MoAcademy is designed to teach the basic and advanced steps of the procedure.

Simulation Exercises and Practical Skills Development

The Femtosecond Laser Cataract Surgery Training Course aims to provide training in both
the application of the femtosecond laser and in the subsequent phacoemulsification
and intraocular lens implantation phases.
This technology allows trainees to acquire skills in a controlled environment without risk to patient safety.
It also provides an opportunity for deliberate practice with detailed feedback,
which has been consistently shown to improve skill acquisition and transfer.
Several studies have validated the effectiveness of simulation training for cataract surgery.

Troubleshooting and Problem-solving in Femtosecond Laser Cataract Surgery

Upon completion of didactic instruction and practice utilizing simulation work,
trainees must be educated on difficulty avoidance, problem recognition,
and management of femtosecond cataract surgery steps.
This will enable a smooth transition to performing the procedure in a live operating room environment.
To maximize the benefits of femtosecond cataract surgery and minimize potential problems
the surgical steps can be analyzed in a systematic fashion

For each step of femtosecond laser cataract surgery we identify potential pitfalls,
teach the trainee how to recognize that a problem or complication has occurred,
and provide guidance on strategies to manage and correct the problem.