FemtoCataract Surgery - Is this the Future?

• 1. 1 FEMTOCATARACT SURGERY - IS THIS THE FUTURE? Dr Diana Semmonds North Shore Medical Centre 66 Pacific Hwy St Leonards

2. Manual Cataract Surgery Today Ophthalmic surgeon uses instruments to create a opening in the lens capsule (capsulorhexis) that is as circular as possible The surgeon then breaks up the clouded lens with surgical instruments and ultrasound energy An artificial intraocular lens (IOL) is then placed in the eye. 3. Potential Limitations of Traditional Cataract Surgery 6 4. WHY LASER CATARACT SURGERY? 5. Advantages Accurate capsulorhexis size, shape and centration Precise incisions to tens of microns Reduction in phako power and time Numerous unique fragmentation pattern options allow for treatment customization Arcuate incisions 6. Manual vs. Femtocataract Surgery 1 month postop Manual Surgery Femtocat Surgery MK-00251 Rev A 7. More predictable outcomes More predictable shape ? Better outcomes Catalys Clinical Results: Capsulotomy Shape Manual Capsulorhexis Catalys Capsulotomy MK-00251 Rev AImages courtesy of OptiMedica Corp. 8. OR microscope view MK-00185 Rev B MK-00251 Rev AImages courtesy of OptiMedica 9. Femtosecond laser Femtosec laser causes tissue disruption with its near-infrared scanning pulse focused to 3um with an accuracy of 1um The focused laser energy generates plasma which expands, causing a shock wave, cavitation and bubble formation The bubble expands and collapses causing separation of the tissue 10. Manual Arcuate Incisions Manually executed by tracing corneal marks with handheld diamond knife Inconsistent depth control Unpredictable effect as is imprecise 19 11. Laser Arcuate Incisions Image-guided surgical planning with 3D visualization: Real time corneal thickness Computer programmed incisions - % depth - incision length and position - 3D visualization of incision placement 20 12. PROCEDURE OVERVIEW 13. Technique Performed under LA with speculum Mydriasis Patient looks at fixation lights Laser is docked 14. Patient Experience Clinical Workup No major changes to standard procedure Things to note: How well patient dilates Is patient able to keep still during procedure 15. Patient Experience During procedure Docking: Slight pressure from vacuum pressure of interface (no pain or loss of vision) During laser: A kaleidoscope of lights as the procedure occurs Immediate to One-Day Post-op Same regimen as existing practices Visual recovery may be faster because of reduced ultrasound energy Patient may notice slight haemorrhaging on the conjunctiva 16. Contraindications Femtocat is contraindicated in patients with corneal ring and/or inlay implant(s) In patients with severe corneal opacities, corneal abnormalities, significant corneal edema or diminished aqueous clarity that obscures OCT imaging of the anterior lens capsule Technical difficulties-small pupil, deep orbit, very shallow AC, dementia, tremor ? Paediatrics 17. Potential Advantages Accurate capsulorhexis size, shape, centration-may allow for better positioning of MF and TIOLs Precise incisions to tens of microns -astig, infection, iris prolapse Reduction in phako power and time less endothelial cell loss, decreased risk of corneal oedema Numerous unique fragmentation pattern options allow for treatment customization Arcuate incisions 18. Disadvantages Technology- country/third world Expensive machine -set up cost Only does part of the operation Takes longer No evidence ?better outcome 19. Is it the future?