Controversies in Femtosecond Laser-Assisted Cataract Surgery
Controversies in Femtosecond Laser-Assisted Cataract Surgery
There are 4 femtosecond laser cataract surgery platforms currently available: Catalys, LenSx, LensAR (LensAR Inc.), and Victus. Elements of these platforms continue to evolve as more experience and feedback is incorporated into the software. Key differences in these platforms at the time of this publication are summarized in Table 1.
There are 2 types of patient interfaces for the femtosecond laser, contact (applanating) or noncontact (fluid-filled interface); each offers advantages and disadvantages. In general, applanating interfaces create a larger increase in intraocular pressure (IOP) during the procedure, higher rates of subconjunctival hemorrhage, and a narrower field of view compared with the noncontact interface. The IOP increase in noncontact interface was estimated by Schultz et al to be 15.6±2.5 mm Hg preoperatively to 25.9±5 mm Hg during the laser procedure. There is also variation among the platforms in the size of the patient interface at the orbit. Contact interfaces are generally smaller and will fit a smaller orbit better. Earlier versions of the curved contact interface suffered from corneal folds and incomplete capsulotomies beneath these folds, but this limitation has been improved with recent updates to the technology.
Additional differences in platform include the presence of a bed that is fixed to the laser versus a platform that allows a mobile bed or stretcher to be used with the laser as well as the imaging modality of the anterior segment [optical coherence tomography (OCT) vs. non-OCT] and whether or not the patient's head must be secured to the stretcher.
Platforms Available
There are 4 femtosecond laser cataract surgery platforms currently available: Catalys, LenSx, LensAR (LensAR Inc.), and Victus. Elements of these platforms continue to evolve as more experience and feedback is incorporated into the software. Key differences in these platforms at the time of this publication are summarized in Table 1.
There are 2 types of patient interfaces for the femtosecond laser, contact (applanating) or noncontact (fluid-filled interface); each offers advantages and disadvantages. In general, applanating interfaces create a larger increase in intraocular pressure (IOP) during the procedure, higher rates of subconjunctival hemorrhage, and a narrower field of view compared with the noncontact interface. The IOP increase in noncontact interface was estimated by Schultz et al to be 15.6±2.5 mm Hg preoperatively to 25.9±5 mm Hg during the laser procedure. There is also variation among the platforms in the size of the patient interface at the orbit. Contact interfaces are generally smaller and will fit a smaller orbit better. Earlier versions of the curved contact interface suffered from corneal folds and incomplete capsulotomies beneath these folds, but this limitation has been improved with recent updates to the technology.
Additional differences in platform include the presence of a bed that is fixed to the laser versus a platform that allows a mobile bed or stretcher to be used with the laser as well as the imaging modality of the anterior segment [optical coherence tomography (OCT) vs. non-OCT] and whether or not the patient's head must be secured to the stretcher.
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