Controversies in Femtosecond Laser-Assisted Cataract Surgery
At the time of this publication, optimal candidates for LCS include patients with clear corneas, some degree of corneal astigmatism that can be treated with an astigmatic correcting corneal incision, patients electing to have a premium intraocular lens (IOL) implanted, and patients who can lie still for at least 5 minutes while the laser treatment is performed.
Certain patient characteristics may increase the likelihood of encountering difficulty in using the femtosecond laser in cataract surgery, and should be considered during patient selection. These include:
Patient Selection
At the time of this publication, optimal candidates for LCS include patients with clear corneas, some degree of corneal astigmatism that can be treated with an astigmatic correcting corneal incision, patients electing to have a premium intraocular lens (IOL) implanted, and patients who can lie still for at least 5 minutes while the laser treatment is performed.
Certain patient characteristics may increase the likelihood of encountering difficulty in using the femtosecond laser in cataract surgery, and should be considered during patient selection. These include:
Poor dilation: patients who do not dilate well may not be good candidates for femtosecond-assisted cataract surgery because of the risk that the capsulorhexis laser treatment could cause collateral damage to iris structures.
Presence of corneal opacities or irregularities: corneal opacities may reduce transmission of laser light and thus patients with significant opacities may be suboptimal femtosecond laser candidates.
Glaucoma: with certain platforms, patients with advanced glaucoma run the risk of incurring further compromise of optic nerve function from the substantial increase in IOP with applanation and suction.
Positioning challenges: kyphosis/scoliosis, small interpalpebral fissures are all features that may complicate docking.
Nystagmus: during the applanation step of the procedure, suction is applied to the eye. If the patient moves, suction may be lost and therefore patients who suffer from nystagmus may be suboptimal candidates for laser-assisted cataract surgery.
Patient cooperation and comfort: although uncooperative or overly anxious patients can make any cataract surgery challenging, use of the femtosecond laser in cataract surgery requires the patient to remain still for the imaging, docking, and laser application so assessing the patient's ability to remain still must be considered in the preoperative evaluation of the potential femtosecond-assisted cataract surgery patient. A peribulbar or retrobulbar block can induce chemosis, also making suction difficult.
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