In the world of modern technology, an everyday progress is not the news anymore. That’s also the case with ophthalmology, a medical discipline that’s adopting new technologies faster than any other medical field.
Even when it comes to cataract surgery, ophthalmologists think that more can and should be done with only one goal in mind-to have a satisfied patient. It is clear that the visual acuity as a surgical result plays an important role, but it looses on its importance if an unsatisfied patients leaves our clinic.
As surgeons, we have to make a precise definition of patient’s needs and expectations when it comes to the postoperative visual acuity. Only after that we will be able to assess our capabilities in order to achieve them. With technological booming in the cataract field, today’s possibilities are much greater not only with new IOL designs and Excimer laser correction of residual refractive error, but the laser assisted cataract surgery (LACS) as well.
Growing use of LACS
There has been an increasing amount of interest in LACS, with evidence in the peer-review literature as well. In 2005 there was only one published article on laser cataract surgery, while in 2013 this number reached 88. The data of all these studies showed that the LACS can improve surgical result, especially with capsulorexis and IOL centration, limbar relaxing incisions and lens fragmentation.
Capsulorexis centration is crucial to ensuring excellent postoperative visual outcomes. As a reminder, capsulorexis is an opening in the anterior part of the lens-anterior lens capsule, while the rest of the fragments of the lens are situated in the capsular bag.
Last scientific publications have shown that the capsulorexis centration is much better done by laser than manually by a surgeon, while it supports good IOL stability withing the capsular bag. Truthfully, there is still a lot of debate among surgeons on whether the adequate IOL centration in the capsular bag alone will bring the patient to the excellent postoperative outcome.
Limbal relaxing incisions
In patients with astigmatism, or uneven curvature of the cornea, there are ways of correcting it during or after the cataract surgery. Nowadays, patients are offered toric intraocular lenses, Excimer laser surgery after the cataract surgery, or limbal relaxing incisions (LRI).
During the laser cataract surgery, computer software can be adjusted to the LRI module, so the laser performs incisions at the same time while it does capsulorexis and lens fragmentation. The surgeon can than manually adjust not only the position of the incisions, but their dept as well for each patient separately, which makes this procedure much more personalized.
The studies on this subject have articulated that the precision and outcome of the laser LRIs is 20-30% more efficient than done manually.
Another great feature of the LACS is the fragmentation of the lens/cataract. In fact, in standard phacoemulsification surgery the cataract is dissolved by ultrasound waves which divide clouded lens into smaller particles later aspirated by the phaco probe. Harder cataracts demand more ultrasound power that often leads to the corneal edema and slower postoperative recovery.
In some cases laser lens fragmentation of the cataract lets the surgeon extract the particles without any additional phaco energy. This way the postoperative recovery is reduced to hours, not days.
A few deficiencies of the laser-assisted cataract surgery
As with any other technological improvement, the laser-assisted cataract surgery has its pitfalls. First of all, this is still a very expensive, and for many, elusive technology that rises the price of the surgery significantly.
Furthermore, the time of surgery is extended, which makes even bigger anxiety in patients already stressed out by the surgery itself. This can lead to the increase of intraoperative complications.
Finally, this type of surgery cannot be technically performed in many patients, mainly in those with smaller eyeballs, deeper orbits, hard blepharospasm, etc.
Bojan Kozomara (Banjaluka, 30. decembra 1978) je doktor medicine, specijalista oftamologije i direktor specijalne oftalmološke bolnice Svjetlost Banja Luka.
U svom rodnom gradu završio je Gimnaziju i Medicinski fakultet, a 2009. godine specijalizovao se za oblast oftamologije. 2016. godine postao je magistar medicinskih nauka iz oblasti oftamologije, a svoju profesiju usavršio je na Klinici za očne bolesti, VMA Beograd, Srbija, te na Klinici Oculistica Universita „Careggi“, u Firenci, Italija. Nakon završene specijalizacije u Italiji, odlučio se vratiti u rodnu Banjaluku i tu pokrenuti privatnu kliniku, koja će za vrlo kratko vrijeme postati popularna i prepoznatljiva u regionu, ali i svijetu.