Cataract Surgery Using VICTUS. Femtosecond Laser. Buket AYOGLU, MD.
Istanbul Surgery Hospital. Istanbul-Turkey. TM. No financial interest in the
materials ...
TM
Cataract Surgery Using VICTUS Femtosecond Laser Buket AYOGLU, MD Istanbul Surgery Hospital Istanbul-Turkey No financial interest in the materials presented herein.
Laser Refractive Cataract Surgery (LRCS) Laser cataract surgery is one of the most hot topics of refractive surgery and has generated a great deal of interest among surgeons around the world. A cataract surgeon desires: -Less surgically induced astigmatism -Less surgical trauma - Less fluid use - Good sealing corneal wound - Fast visual recovery
TM
VICTUS Femtosecond Laser Technolas Perfect Vision We have been working FS since 2004 starting with FEMTEC TPV520 FS VICTUS FS Applications in single platform for refractive and therapeutic procedures AK
Femto Flap
ICRS
INTRACOR
VICTUS FS • • • •
Diode-pumped solid laser Pulse duration 500fs Wavelength 1033-1055nm Pulse frequency 80kHz up to 320 kHZ Capsulotomy
Lens fragmentation
Cataract Applications • • • •
Incisions Capsulotomy Lens Fragmentation Arcuate Incisions, LRI
L R I
Sec. incision
L R I
Prim. incision
Curved Patient Interface
Intelligent Pressure Control in • Intelligent Pressure Sensors Designed to Reduce Pressure on the Cornea and Deformation which would affect accuracy of online OCT Lateral Force (in X/Y):
IPS Display
Real-Time OCT – treatment planning – Absolute control for the surgeon during the treatment due to live OCT and camera images
OCT imaging is performed continuously during the procedure to improve surgical precision
Lens Fragmentation Patterns ring cuts
radial cuts quadrant cuts
Lens Fragmentation Patterns
LRCS – surgeon screen
LRCS – Alignment, xy centering
Orange: Pupil rim Green: Safety zone
Mark pupil with 3 mouse clicks, orange ellipse appears Pattern is aligned on pupil center
LRCS – Alignment, anterior lens marking
Red: Anterior Capsule Yellow: Safety Zone
Mark anterior capsule with 3 mouse clicks, red line appears Yellow line indicates the anterior safety zone
LRCS – Alignment, posterior lens marking
Red: Anterior Capsule Yellow: Safety Zone Mark posterior capsule with 3 mouse clicks, red line appears Yellow line indicates the anterior safety zone Lens Frag treatment zone is shown
• The surgery begins with docking and planning Docking is easy and accurate
Internal real-time OCT image guided Computer controlled Capsulotomy and lens fragmantation customizable
Stroger capsulotomy Dr. Auffarth
First Patients • • • • • • • • • •
12 patients 13 eyes Mean age : 63,6 ± 13 (44-80 y) First 2 patients with soft cataract, with low-vision Others nuclear cataract grade +2-3 In 2 eyes miosis occured in the OR, extra diluated adrenalin used No infection No vitreus loss No laser related complications No posterior capsule rupture Clear corneas on the next day Less inflammation
Lens Fragmentation 4 quadrant fragmantation
Less phaco time 0,16 ± 0,25 sec. Lower phaco power (less corneal burn, less endothelial cell loss) Less risk of posterior capsule rupture
CASE EXAMPLE
PIZZA CUTS 8 quadrants
NL , 79 y, Female
Pre-op OS : UCVA= 0,2 BCVA= 0,6 RFX= +1,50 (90-0,75) Cataract Grade 3 Post-op 1st day: UCVA= 0,8 BCVA= 1,0 RFX= -0,25 (105-0,25)
Effective Faco time is approximately 16 seconds
Advantages of Laser Refractive Cataract Surgery (LRCS) • Creation of a well-centered capsulotomy • Creation of a precisely sized capsulotomy • Without shock waves or thermal side effects ,minimizes damage to surrounding ocular tissues (zonules, capsular bag)
Capsulotomy Diameter Accuracy Anterior Capsulotomy Diameter Circularity Centration
IOL Position IOL Overlap/PCO development IOL Centration (premium IOLs) Less stress on the zonules
Data: Dr KP Reddy, Hyderabad, India
Circularity of Capsulotomy Better Circularity with Femto-Rhexis: 1.0 = Perfect Circle Data shows the circularity (e= Ømin/ Ømax) following the laserassisted and manual procedure
Data: Dr KP Reddy, Hyderabad, India
creating a tunnel incision • Precise tunnel creation resulting in: • A more stable wound • Better control during the surgery • More stable fluid dynamics • Less influx • Fast healing • Less risk of endophthalmitis
Arcuate Incisions • Image guided control for precision surgery • Perform AK or LRI • Predictability of correction
Other advantages of FS laser • The learning curve of cataract surgery for new surgeons will be much faster • Reduces manual maneuvers • AK cuts for correction of astigmatism can be applied in the same session, • Better outcome for multifocal IOL´s, specially toric IOL’s
Disadvantages of FS laser • LRCS is not possible in small pupils Pupil diameter has to be at least 5mm, better 6mm. • LRCS not possible in opaque corneas , milky white cataracts Light is absorbed by the opacity • LRCS not possible in advanced glaucoma IOP increase, especially if the cataract surgery is combined with AK cuts. •
Increased Cost
•
Added time to move the patient from laser room to OR room
Summary • Femto-cataract is an easy, reliable and safe procedure to perform capsulotomy and lens fragmentation • Comparison between femto and manual capsulotomy shows:
– Higher predictability in capsulotomy diameter – Better circularity – Better centration • Lens fragmentation may reduce required phaco power • Arcuate incisions can compensate for induced cylinder and reduce corneal astigmatism
THANK YOU…
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