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W. W. Culbertson, IV, G. Schuele, M. W. Wiltberger, P. Gooding, D. Angeley, N. J. Friedman, B. Seibel, J. H. Talamo, D. V. Palanker, M. S. Blumenkranz; Oct-Guided Femtosecond Laser System for Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5445.
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Cataract surgery is a manual procedure that is highly dependent on surgical skills and patient idiosyncrasies. We describe a combined Optical Coherence Tomography (OCT) and femtosecond laser system to increase the precision and reproducibility of cataract surgery.
A long range spectral domain OCT system was developed to automatically discern the anterior and posterior surfaces of the lens and cornea for treatment planning of capsulotomy, lens segmentation and corneal incisions. OCT was co-registered with a scanning femtosecond laser (1.03um, <700fs, 10-50kHz, 1-10uJ). Cutting parameters for all procedures were established on cadaveric eyes. Cut quality was evaluated by optical and scanning electron microscopy (SEM). Retinal safety was verified using Dutch Belted rabbits.
Round (aspect ratio > 0.98) and highly precise (less than ±0.1mm variation in diameter) capsulotomies are achieved. SEM of laser incised capsules show smooth, clean edges. Lens conditioning patterns facilitate its easy splitting into quadrants and nucleus softening. Even dense cataracts were able to be removed with minimal use of phaco power. The OCT is able to identify the surfaces of the cornea and lens to within 50um and the treatment planning software accurately places the femtosecond laser patterns within those structures. The OCT-guided laser maintains a well defined safe distance from the posterior lens capsule to ensure its integrity. Multi-planar corneal incisions provide for unique self-sealing wound constructions. The treated eye is immobilized without amaurosis. No retinal damage was found in Dutch Belted rabbits at 8 times the retinal exposure used for clinical settings.
OCT-guided femtosecond laser cataract surgery greatly improves precision and reproducibility. The laser produces sharp-edged continuous capsular cuts while lens treatment simplifies phacoemulsification, especially with dense cataracts. This integrated system offers a previously unattainable level of exactitude that promises improved centration of intraocular lenses and correction of residual corneal astigmatism.
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