I was one of the first surgeons in Europe to start performing LCS on a routine basis, because I believed it was a better way to do the surgery.
For example, a perfectly cut and centred capsulotomy gives a better chance of achieving the IOL’s optimal effective lens position after implantation. Pristine sideport, main, and arcuate incisions offer a means to address astigmatism at the time of surgery and reduce surgically induced astigmatism.
I was also intrigued by the possibility of using the laser to fragment the lens and thereby reduce ultrasound power while potentially lowering the time spent performing intraocular manoeuvres.
As to whether the LCS lived up to my expectations, the short answer is yes. In fact, in my hands, LCS is an upgrade over manual techniques for several reasons.
Although my LCS cases did take a little longer while I was getting used to the new way of operating and figuring out the platform, in the long term, LCS actually improved my surgical efficiency. There is no difference in the time taken for the procedure with LCS (from suction on to wound closure) compared with manual,1 and no difference in cortex removal time.2 The overall procedure time is equivalent to manual because ophthalmic viscosurgical device (OVD) use can be minimised or elimated1 and the need for ultrasound to emulsify the lens is significantly reduced.3
My hunch about the intrastromal incisions also proved correct. Histology studies indicate that laser-cut incisions are precise and accurate, with no apparent damage to the cornea.4 LCS is associated with faster visual rehabilitation, less deviation from the refractive target and earlier postoperative refractive stability than manual surgery.5
Performing LCS may increase prostaglandin levels in the eye, which could induce miosis,6 particularly when cutting the anterior capsulotomy.7
To counteract this and maintain mydriasis, it is highly recommended to use a non-steroidal anti-inflammatory drug three times on the day of surgery.7
However, this is a relatively minor concern, especially considering that LCS does not induce any additional endothelial cell loss8 and can reduce postoperative inflammation compared with manual surgery.9