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2 What does the data say? Safety, efficacy, and clinical outcomes of laser-assisted cataract surgery by Sumit "Sam" Garg, MD Fragmentation and capsulorhexis creation: Perspectives from a teaching institution opalescence (NO) grade. Groups 1 and 2 treated NO3 with standard cataract surgery and LACS, re- spectively. Groups 3 and 4 treated NO5 (brunescent cataract) with standard cataract surgery and LACS, respectively. Significantly Two hundred forty eyes were separated into 4 groups based on the Lens Opacities Classification System III (LOCS III) with either standard cataract surgery or LACS. Patients were grouped according to nuclear Femtosecond laser- assisted surgery offers advantages in routine and complex cases O ngoing research con- tinues to show that femtosecond laser-as- sisted cataract surgery (LACS) offers advan- tages compared with traditional cataract surgery. Recent research Recent research has demonstrat- ed benefits of LACS. A study by Hatch et al. compared the effec- tive phacoemulsification time (EPT) with femtosecond laser- assisted cataract surgery (LACS) versus standard phacoemulsifi- cation. 1 and aspiration alone, and faster visual recovery. 5,6 The femtosecond laser offers improved wound architecture. Surgeons can create reverse side cuts, 3D incisions that allow us to create shorter incisions, making it easy to aspirate the subincisional cortex. 7 These incisions are also more self-sealing. Complex cases There is a lot of information on the femtosecond laser improving the ability to treat traumatic cases and soften the lens, which makes it easier to remove it. It also is useful in patients with Fuchs' dystrophy because it causes less trauma to the corneal endotheli- um, enabling the surgeon to pre- serve the residual endothelial cells as much as possible. 8 Research also has shown in patients with poor zonular support, such as those with pseudoexfoliation, the femtosecond laser is kinder to the zonules and less traumatic. 9 The most significant advantage I have seen with the femtosecond laser is in treating a hypermature lens. The capsule is prone to tear and create an Argentinian flag sign. Because we can rapidly create the capsuloto- my, it improves capsule viability without resulting in radial tears extending to the periphery. 10 Conclusion The outlook for LACS is bright. Almost all presbyopic IOLs in development will require perfect capsulotomy sizes. In the future, cataract sur- gery will depend on fluidics rather than ultrasound energy. There- fore, less energy will be delivered into the eye. In addition, the femtosecond laser will be very helpful in com- plex cases. New developments, such as the ability to identify the steep axis and place incisions automatically, will make it easier for refractive surgeons to reduce refractive errors. In addition, increased accuracy is encouraging many surgeons who were reticent to use the femtosecond laser to enter the LACS arena. The goal of LACS is to make all ophthalmolo- gists better surgeons. References 1. Nagy Z, et al. Initial clinical evalu- ation of an intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009;25:1053–60. 2. Ewe SY, et al. A comparative cohort study of visual outcomes in femtosecond laser-assisted versus phacoemulsifica- tion cataract surgery. Ophthalmology. 2016;123:178–182. 3. Reddy KP, et al. Effectiveness and safety of femtosecond laser-assisted lens frag- mentation and anterior capsulotomy versus the manual technique in cataract surgery. J Cataract Refract Surg. 2013;39:1297– 1306. 4. Huseynova T, et al. Evaluating the differ- ent laser fragmentation patterns used in laser cataract surgeries in terms of effec- tive phacoemulsification time and power. Clin Ophthalmol. 2015;9:2067–2071. 5. Grewal DS, et al Femtosecond laser- assisted cataract surgery—current status and future directions. Surv Ophthalmol. 2016;61:103–131. 6. Nagy ZZ, et al. Femtosecond laser cata- ract surgery. Eye Vis (Lond). 2015;2:11. 7. Donnenfeld E, et al. A randomized prospective evaluation of the primary phacoemulsification incision with a femtosecond laser 110° reverse side cut, 70° forward side cut and a keratome. 2016 ASCRS•ASOA Symposium & Congress 8. Gavris M, et al. Fuchs' endothelial corne- al dystrophy: is femtosecond laser-assisted cataract surgery the right approach? Rom J Ophthalmol. 2015;59:159–163. 9. Donaldson KE, et al. Femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2013;39:1753–1763. 10. Hatch KM, et al. Femtosecond laser- assisted compared with standard cataract surgery for removal of advanced cataracts. J Cataract Refract Surg. 2015;41:1833– 1838. Dr. Donnenfeld practices with Oph- thalmic Consultants of Long Island and Connecticut, and is clinical professor of ophthalmology, New York University. He can be contacted at firstname.lastname@example.org. Practice pearl: Femtosecond laser cataract surgery pro- vides many advantages in comparison with traditional phacoemulsification surgery. Perfectly centered capsuloto- mies and lens softening for dense nuclei are particularly helpful. Additionally, in com- plex cases, LACS can decrease some of the complexity, po- tentially improving outcomes. –Sumit "Sam" Garg, MD " In our teaching institution, I discourage residents from performing LACS until they are comfortable with manual surgery. " –Sumit "Sam" Garg, MD continued from page 1