These are the cases where it is best to use laser in cataract surgery

Advanced laser technologies are now integrated into various eye surgery, including cataract surgery. The use of laser in cataract surgery is not necessary, but it has many advantages. Here are some of them

The laser saves the first two steps. Laser cataract surgery (Photo: shutterstock)

Laser surgery (Photo: ShutterStock)

In recent years, laser technology has also come into use in cataract surgery, which laser is used to perform the first two stages of surgery: opening the lens casing and cutting the lens and preparing it for crushing. While laser use makes it easier for the surgeon and ensures greater accuracy in performing the same steps, the laser has an advantage in the complex cases, especially in the complex cases. In most "normal" cases, the laser does not have a significant advantage. Therefore, its high cost does not necessarily pay off in all cases.

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What is Laser Cataract Surgery?

Each cataract surgery actually consists of several main steps:

• Open the box (casing) of the lens
• Refraction and cutting of the lens
• Crushing and pumping the lens
• Artificial lens implant

The difference between laser cataract surgery and "normal" cataract surgery is that, in normal surgery, all stages are performed by the surgeon; However, in laser cataract surgery, the first two steps are performed with the help of a dedicated laser device, and only then proceed to surgery by the surgeon (usually in another, sterile operating room). That is, with the help of the laser, the iris can be opened with external access (with the eye closed) very accurately, and in addition, the lens can be sliced ​​into thin slices to prepare it for crushing.

Can a cylinder download also be included in the analysis?

Another laser action that can be done with cataract surgery is cylinder repair (in cases where there is a cylinder). With the laser you can make a kind of specific cuts in the cornea, different from the surgical cuts, which allow the cornea to be shaped so that the cylinder is significantly repaired or dropped.

However, this laser use has not yet been sufficiently researched and there is insufficient information regarding the design of the incisions. Therefore, it is sometimes inaccurate and the result does not always match expectations.

Is Laser Cataract Surgery Priority?

As mentioned, the use of laser in cataract surgery makes it possible to perform the first two steps with an external approach, without human contact, thus making it easier for the surgeon. However, in terms of patients (results of the surgery), the laser has an advantage mainly in complex cases, while in most "standard" cases, there is no significant advantage over the standard manual surgery. Therefore, its relatively high cost is not necessary.

What are the advantages of laser cataract surgery in complex cases?

In special lens transplant cases ("premium" lenses): Because opening the iris casing with the laser is very accurate, the laser has a particular advantage in cases where special lenses are transplanted, such as: cylinder repair lenses or multifocal lenses. This is because transplantation of this type of lens is of greater importance for accuracy. When the casing is opened very accurately, the lens also "sits" in the eye more precisely.

In cases of advanced cataract: When cataract is already in advanced stage, it tends to be stiffer. Therefore, greater energy is required to crush the lens. In these cases, the laser deploys the lens in a computerized manner, from the outside, without human contact. In doing so, the laser actually facilitates the crushing phase and saves "negative" energy.

The laser has an advantage especially in complex cases. Eye with cataract (Photo: shutterstock)

Eye examination - cataract (Photo: ShutterStock)

In cases where the patient is being treated with alpha-agonist medicines: One of the common side effects, in cases where the patient is taking benign prostatic hyperplasia (alpha-agonist family drugs), is called Intraoperative Floppy Iris Syndrome (IFIS), Causing the surgery to shrink and the iris becomes "fluid" and portable. In these cases, laser use is advantageous, since the laser allows the first two steps to be performed from the outside, without the need to open the eye. In this, the laser performs its operation when the pupil is still undisturbed because the eye has not yet opened physically and no eye pressure change has occurred. As the surgery continues, even if the pupil shrinks and there is IFIS, continuing the surgery is easier and more convenient.

Corneal endothelial dystrophy: In a guttate or corneal endothelial dystrophy, there is a deficiency in the endothelial cells whose density decreases. The problem is that the endothelial cell reserves, which are responsible for maintaining corneal transparency and compactness, are smaller. Because the energy used in the lens crushing phase necessarily hits the same layer in the cornea, the laser has an advantage, since the laser prepares the lens for crushing by cutting, thereby reducing the amount of energy needed to crush and pump the lens.

Lens Strength Weakness (Sunsets): The natural lens is reinforced to the eye wall with the help of the sunsets. Zonulas can be weakened in some cases (such as pseudopolation, or after sabotage or previous eye surgery). Because surgery or pressure is applied at various levels on the lens and strings, the laser has an advantage, as it allows two stages of surgery to be performed without human contact, thus "saving" unnecessary tension on the soles.

In summary, laser cataract surgery makes it easier for the surgeon, but they have the advantage, especially in complex cases. In most cases, there is no medically significant benefit. Therefore, it is advisable to consider the benefit of laser surgery versus the health benefit, cost, and patient convenience.

Dr. Adi Michaeli is a surgeon, a specialist in cataract surgery and corneal surgery at Ein Tal Medical Center