Cataract Surgery and Lasers

There are several different types of ophthalmic lasers used to treat various different eye conditions, and one that is relatively new to ophthalmology is the femtosecond laser. This laser was first used in eye surgery for the creation of the flap in LASIK surgery, which is a thin layer of superficial corneal tissue that must be cut and lifted prior to the application of a laser sculpting treatment to the tissue underneath it. The laser sculpting process reshapes the cornea in order to induce a change in the refractive power of the eye. Historically, the LASIK flap has been created with a mechanical device, but can now also be created with the femtosecond laser. This laser has recently been used to perform several of the steps in cataract surgery. The procedure is called femtosecond laser-assisted cataract surgery (FLAC) and can be used to:

create limbal relaxing incisions (correction for astigmatism)

create the corneal incision (the main surgical incision)

create the capsulorrhexis (an opening in the anterior capsule that allows forremoval of the cataract from the capsular bag)

soften the cataract if it is dense

break the cataract into smaller pieces prior to phacoemulsification

However, the cataract must still be removed with conventional ultrasound and aspiration; there is no laser technology in existence today that can completely remove a cataract. The use of femtosecond laser-assisted cataract surgery is mainly targeted at improving refractive outcomes after cataract surgery (decreasing the need for glasses by improving uncorrected vision after cataract surgery).

Another type of laser, called a YAG laser, is sometimes used to create an opening in the posterior capsule after patients have undergone cataract surgery. This is because the posterior capsule can become cloudy over time after removal of a cataract, and, as with a cataract, clouding of the posterior capsule can lead to blurry vision. However, this laser application is not part of the cataract procedure and is only necessary in approximately a third of patients who undergo cataract removal.

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