Femto Cataract Surgery Steps: Is it a complete alternative to Phacoemulsification?
By Dr. Mahmoud Hassaan, Consultant Vitreoretinal Surgery and Cataract & Lens Implantation Surgery at Mashreq Eye Center .. Fellow of the Royal College of Ophthalmologists of Glasgow, England .. Fellow of the International Council of Ophthalmology in Geneva, Switzerland .. Member of the Royal College of Surgeons of Edinburgh, Scotland ..
With the enormous technological advancements in eye surgeries, femtosecond laser technology emerged as a new addition to the world of cataract surgery, and many believed it would revolutionize and completely eliminate traditional methods. However, from a realistic medical and surgical perspective, it became clear that the matter required a more objective and scientifically sound approach. In this guide, we will review the steps of femto-cataract surgery together and discuss with clarity and credibility the reality of this technology and why phacoemulsification surgery remains the golden standard and best for patient eye safety.
What is Femto-Cataract Technology?
Femto-Cataract surgery relies on the introduction of femtosecond laser pulses to assist in automating some of the initial steps usually performed manually by the surgeon. The goal of its invention was to increase the precision of surgical incisions, but clinical practice has shown that the laser's role in this surgery remains very limited and does not negate the need for a surgical blade or ultrasound waves to complete the procedure.
Detailed Steps of Femto-Cataract Procedure
Cataract surgery using femtosecond laser passes through several consecutive stages, as follows:
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Eye Imaging and Planning: The patient is placed under the femtosecond laser device, which performs a 3D scan of the cornea and lens to precisely determine the dimensions of the incisions.
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Laser Incisions: The femtosecond laser makes the main corneal incision, in addition to opening the anterior capsule surrounding the cataract (Capsulotomy).
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Partial Lens Fragmentation: Laser rays are used to divide the opaque lens nucleus into smaller pieces to facilitate its subsequent breakdown.
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Transition to Phacoemulsification Surgery: Here lies the surprise for many patients; the laser does not absorb or remove the cataract from the eye. After the laser steps are completed, a phacoemulsification device (ultrasound waves) is used to completely aspirate the fragmented lens pieces, which is the same as what we explain in detail in the guide Cataract Surgery Techniques.
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Lens Implantation: In the final step, the surgeon implants one of the latest types of advanced intraocular lenses to replace the removed natural lens and restore sharp vision.
Why Femto-Cataract Technology is No Longer a Revolutionary Option? (Objective Medical Opinion)
Despite the massive marketing campaign that accompanied the introduction of femtosecond laser into cataract surgeries, experienced surgeons prefer to rely on "phacoemulsification" as the primary and essential choice for several scientific reasons:
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Limited Steps: The laser performs only 10% to 15% of the total surgery (initial incisions and capsule opening), while the rest of the procedure relies entirely on the surgeon's skill and the phacoemulsification device for aspirating the cataract and implanting the lens.
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Longer Procedure Time: The procedure requires two separate stages; the patient is first placed under the laser device, then their position is adjusted to begin the actual surgery, which prolongs the total procedure time and increases patient fatigue compared to phacoemulsification surgery, which is performed smoothly in a few minutes.
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Not Suitable for All Cases: In cases of very advanced cataracts or problems with pupil dilation, the femtosecond laser cannot effectively penetrate the lens, and here the surgeon must immediately intervene with phacoemulsification to safely complete the procedure.
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Additional Cost without Real Benefit: Laser technology significantly increases the cost of cataract surgery due to the prices of consumables for the laser device, without offering a real surgical advantage or improvement in the patient's final visual acuity compared to phacoemulsification, which is performed with utmost precision by an experienced surgeon.
Conclusion: Phacoemulsification Remains the True Champion
Medical credibility and professionalism dictate that we clarify that the use of laser in cataracts has not canceled or replaced surgery; instead, "phacoemulsification" remains the safest, fastest, and most efficient technique for dealing with various degrees of ocular opacity. More important than marketing technology is accurate diagnosis and knowing when to perform cataract surgery to avoid any complications, and choosing the appropriate lens that ensures the patient the best possible vision quality for many years.