Initial evaluation of a femtosecond laser system in cataract surgery

Purpose To report the early experience and complications during cataract surgery with a noncontact femtosecond laser system. Setting Hong Kong Sanatorium and Hospital, Hong Kong Special Administrative Region, China. Design Retrospective case series. Methods All patients had anterior capsulotomy or combined anterior capsulotomy and lens fragmentation using a noncontact femtosecond laser system (Lensar) before phacoemulsification. Chart and video reviews were performed retrospectively to determine the intraoperative complication rate. Risk factors associated with the complications were also analyzed. Results One hundred seventy eyes were included. Free-floating capsule buttons were found in 151 eyes (88.8%). No suction break occurred in any case. Radial anterior capsule tears occurred in 9 eyes (5.3%); they did not extend to the equator or posterior capsule. One eye (0.6%) had a posterior capsule tear. No capsular block syndrome developed, and no nuclei were dropped during irrigation/aspiration (I/A). Anterior capsule tags and miosis occurred in 4 eyes (2.4%) and 17 eyes (10.0%), respectively. Different severities of subconjunctival hemorrhages developed in 71 (43.8%) of 162 eyes after the laser procedure. The mean surgical time from the beginning to the end of suction was 6.72 minutes ± 4.57 (SD) (range 2 to 28 minutes). Conclusions Cataract surgery with the noncontact femtosecond laser system was safe. No eye lost vision because of complications. Caution should be taken during phacoemulsification and I/A to avoid radial anterior capsule tears and posterior capsule tears. Financial Disclosure Dr. Chang received travel expenses from Abbott Medical Optics, Inc., and Technolas Perfect Vision GmbH and lecture honoraria from Abbott Medical Optics, Inc., Technolas Perfect Vision GmbH, and Alcon Laboratories, Inc. Dr. Chang was a consultant to Abbott Medical Optics, Inc., from 2010 to 2011. No author has a financial or proprietary interest in any material or method mentioned.