Cataract surgery femtosecond laser now doubles as flap-maker

Take-home message: A software upgrade brings flap-making capability to the first commercially available femtosecond laser for cataract surgery.

By Cheryl Guttman Krader; Reviewed by Stephen G. Slade, MD

Houston-With a new software upgrade, the first femtosecond laser for cataract surgery (LenSx Laser, Alcon Laboratories) can now also be used to create corneal flaps in refractive surgical procedures, said Stephen G. Slade, MD.

In addition, the platform’s performance as a flap-maker rivals that of any other commercially available femtosecond laser that has cornea-only applications, said Dr. Slade, private practice, Slade and Baker Vision, Houston.

“The . . . laser can be changed from cataract mode to a flap-maker and it works quickly to create flaps with pristinely smooth stromal beds,” he said. “For surgeons interested in acquiring a femtosecond laser for cataract surgery who can also take advantage of a flap-maker, the convenience and cost-saving advantages of the 2-in-1 . . . laser make its choice a no-brainer decision.”

Alcon unveiled the flap-making software for the laser at the 2015 meeting of the American Society of Cataract and Refractive Surgery. However, Dr. Slade had the opportunity to work with it for about 18 months before its commercial debut.

He noted that even with its initial use, the laser was creating high quality flaps with good thickness predictability.

“An analysis of data collected for the first 100 eyes operated on showed the standard deviation in mean flap thickness was only 6.5 μm,” Dr. Slade said. “We had no cases of aborted flaps, all of the flaps lifted easily, and the quality of the flaps graded by a masked observer was excellent.”

Since that early experience, the manufacturer has made refinements to the laser’s hardware and software. While the laser was already cutting excellent flaps, the updates have made the system easier and quicker to use, noted Dr. Slade.

In addition to its versatility, the integrated optical coherence tomography (OCT) system also distinguishes the laser from other femtosecond lasers that have only corneal applications, he noted.

The ability to harness image guidance for flap-making will be forthcoming with future software updates.

Dr. Slade foresees great potential for the increased control it will afford.

“Eventually, surgeons could be able to adjust the flap cut based on real-time OCT,” he said. “Then, for example, if they see some irregularity in the cornea, they could make the dissection parallel to Descemet’s membrane rather than Bowman’s membrane to create a smooth, regular lamellar cut.”

Stephen G. Slade, MD

E: sgs@visiontexas.com

Dr. Slade is a consultant to Alcon Laboratories, and he receives lecture fees and holds stock in Novartis.