Presentation on theme: "Femtosecond Laser-Assisted Cataract Surgery (FLACS)"— Presentation transcript:
1 Femtosecond Laser-Assisted Cataract Surgery (FLACS) MR Jafarinasab MDLabbafinejad Medical Center
2 IntroductionHaving improved outcomes in the field of refractive surgery, beginning with LASIK flap creation, the femtosecond laser is continuing to make great strides across a range of other anterior segment applications, from transplanting corneas and implanting intrastromal rings to perfecting the capsulotomy and blasting cataracts.
3 IntroductionOne can't talk about new technology without mentioning femtosecond laser cataract surgery.
4 IntroductionCataract surgery is one of the most frequently performed surgeries in the world today, enabling millions of people to regain eyesight lost because of cataracts.Modern cataract surgery is safe, effective and highly predictable .Surgical tools and techniques are constantly evolving to make the procedure even better.
5 Why do we need a Change ?It has been and still is a almost manual that is highly dependent on surgeonOccasionally, even the most experienced surgeoncan get an inconsistent surgical maneuvers.
6 Complications of Traditional PE Cataract surgery complications are still10x that of LASIK LASIK(
7 IntroductionThe next major advance in cataract surgery may be the use of femtosecond lasers to perform some of the steps in the cataract procedure
8 Born of a Workplace Accident The medical use of the femtosecond laser originated more than a decade ago at the University of Michigan in Ann Arbor, in a classic lemons-to-lemonade serendipity:A graduate student in the ultrafast lasers lab had sustained a well-defined laser burn on his retina, according to Shahzad I. Mian, MD, associate professor of ophthalmology and visual sciences at the university. “The examination of this burn by a second-year resident [Ron M. Kurtz, MD] led to collaborative research between the department of ophthalmology and the school of engineering, and ultimately to the original femtosecond medical laser, marketed as IntraLase in 2001.”
9 Femtosecond LaserPhotodisruption The laser’s delivery of power pulsed at high speeds generates microscopic gas bubbles that break bonds between cells in a process known as photodisruption
10 FS Laser Advantages Controllable Laser intensity and Power Precision of PhotodisruptionNot absorbed by clear media; can be focusedLeast amount of shock-wave formationComputer-Controlled delicate incisions
12 Photodisruption5 to 12 MicronsAn expanding bubble of gas & water is created separating the corneal lamellae
13 PhotodisruptionThe bi-products of photodisruption (CO2 & water) are absorbed by the mechanism of the endothelial pump, leaving a resection plane in the cornea
14 PhotodisruptionThousands of laser pulses are connected together in a raster pattern to define a resection plane
15 Photodisruption Gas & water are absorbed or liberated when corneal flap is liftedA resection plane is created
16 PhotodisruptionLaser pulses can be stacked on each other to create a vertical cleavage plane
17 PhotodisruptionLaser pulses can be stacked on each other to create an angled cleavage plane
18 Spot & Line SpacingThe distance from the center of each spot to the one next to & above it can be adjustedDecreasing the distance between spots can ease a smoother lift, but also increase treatment time10µLine SpacingRange 8 -14µ12µ12µSpot Spacing
20 Contemporary Cataract Surgery Steps:IncisionCapsulorhexisPhacoemulsificationIOL InsertionRelaxing Incisions (Astigmatism)
21 Cataract Incisions:Wound construction is critical in modern cataract surgery because it is the BASIC stepA poorly constructed wound willmake subsequent steps moredifficult and increase the risk ofcomplications.A well-constructed wound is the first step in successful surgery for both the surgeon and the patient.
22 Potential Problems in manual Capsulorhexis SmallLargeEccentricIrregular
28 Historical Background 2008: First surgery performed by Zoltan Nagy in Budapest using Alcon Lensx Laser2009: Alcon Lensx became first laser to receive FDA approval for Cataract surgery2010: First surgery performed in United States performed by Stephen Slade
30 FS laser cataract surgery procedure Stages of FS laser cataract surgery procedure1-Planning2-Engagement (Docking)3-Visualization and customization4-Treatment
31 Docking (Engagement) a patient’s eye must be Prior to delivery of the laser,a patient’s eye must bestabilized relative to theoptical system of the laser.In refractive surgery, this isachieved with a curved orflat plate that pulls the eyeinto a suction ring,distorting the globeIn FLACS another option isliquid interface
32 Visualization and customization The image guidance system is a critical part of laser cataract surgery as it determines the location and dimension of ocular structuresIt is critical that the posterior surface of the lens ( Posterior Capsule ) be detected in order to maintain a safety zone and prevent cuts in the posterior capsule
33 Visualization and customization LenSx and OptiMedica use FD-OCT for three-dimensional, high-resolution viewing of ocular structures.LensAR uses a three-dimensional confocalstructured illumination- scanning transmitte very similar to Scheimpflug technology .Additionally, the lens density can be valuated
34 FS Laser-assisted Cataract Surgery Imaging and Registration: OCT Technique (Optimedica) Scheimpflug Technique (LensAR)
37 FS Laser-Assisted Cataract Surgery: The Future: Sub Bowman’s Relaxing IncisionsComplex Cataract IncisionsCustomized CapsulorhexisPosterior CapsulotomyCapsulorhexis Integrating with IOLs- “Capsule in the Lens”- Toric IOL OrientationIOL Power AdjustmentLens Refilling Surgery
38 FS Laser-assisted Cataract Surgery: Advantages and Disadvantages: Improved safetyIncreased precisionEnhanced reproducibilityDisadvantages:Increased CostAdded time
39 Conclusion:John A. Vukich, M.D., Madison, Wis., estimated that laser systems would cost anywhere between $400,000 and $550,000. Service fees are about 10% a year of the purchase price.All systems to date have indicated a per use fee of $350-$450 per eye.Dr. Chang ;. “The challenge is that it is very expensive for a procedure we are already doing very efficiently,”
40 Conclusion: William J. Link, Ph.D., Newport Beach, Calif., when a new technology is introduced, "there's always this beautiful, awkward, disruptive time where we try to sort it out and debate, and then it will be refined with data and experience."Dr. Link believes that in the future, cataract surgery will be dramatically different because of the advent of the femtosecond platform."For that to happen, it has to work economically,It has to be good for the patient,it has to be good for the practice,it has to be good for the company.
41 Conclusion: Practices should consider some basic questions: Is it too early?Is it a safe and reliable procedure?Will it provide a benefit to the practice’s patients?Can your facility afford it?