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Cataract The LENSAR ® Laser System–fs 3D for Femtosecond Cataract Surgery Mark Packer, 1 Stephen D Klyce 2 and Craig Smith 3 1. Clinical Associate Professor, Oregon Health and Science University, Oregon, US; 2. Adjunct Professor of Ophthalmology, Mount Sinai School of Medicine, NY, US; 3. Principal Systems Engineer, LENSAR ® Inc., Orlando, Florida, US Abstract The LENSAR ® Laser System’s ergonomic design permits flexible functionality in any operating environment. Its low-pressure liquid interface eliminates corneal compression and facilitates accurate and complete capsulotomy construction. The Augmented Reality™ imaging system utilises a variable super luminescent diode for scanning structured illumination to provide high-contrast, high-definition targets, which guide the laser. Real-time imaging adjustments compensate for minute degrees of tissue displacement, permitting unrivalled precision in corneal incision architecture. Precise laser spot application allows fragmentation of all grades of cataract, without the need for unnecessarily large safety margins. Iris registration compensates for cyclotorsion in the construction of arcuate incisions by aligning preoperative corneal biometry to intraoperative imaging. The ability to define the cataract grade intraoperatively facilitates efficient phacofragmentation by permitting surgeon-specified preset patterns for the full range of nuclear densities. The LENSAR Laser System represents the state of the art in femtosecond cataract surgery. Keywords Femtosecond laser, cataract, capsulotomy, corneal incision, arcuate incision, iris registration, phacoemulsification, intraocular lens, ultrasound, phacofragmentation Disclosure: Mark Packer is a consultant to LENSAR ® , Inc., and has a financial interest in the company. Stephen D Klyce is a consultant to LENSAR ® , Inc. and has a financial interest in the company. Craig Smith is an employee of LENSAR ® , Inc. Received: 22 July 2014 Accepted: 27 August 2014 Citation: European Ophthalmic Review, 2014;8(2):93–8 Correspondence: Mark Packer, 4075 Southpointe Dr, Eugene, Oregon, US. E: Support: The publication of this article was supported by LENSAR ® , Inc. Since the introduction of ultrasound phacoemulsification in 1967, cataract surgery has become the most commonly performed outpatient operation in the US. While phacoemulsification has been shown safe and effective, application of ultrasound power within the eye does carry some risk of ocular injury, such as endothelial cell loss. In addition, the manual method of creating the anterior capsulotomy, which is performed using the continuous curvilinear capsulorhexis (CCC), cannot ensure that the capsulotomy is consistently centred or circular, 1–3 thereby affecting the effective lens position (ELP). This is especially significant for multifocal, accommodating and toric intraocular lenses (IOLs) with more complex optical designs. Recently, there has been increasing interest in the use of femtosecond lasers as an adjunct to ultrasound phacoemulsification in cataract surgery. Clinical studies have demonstrated incremental improvements with femtosecond laser-assisted cataract surgery compared with standard ultrasound. 4 Femtosecond lasers deliver ultrashort pulses of infrared energy so that collateral tissue damage is avoided. They cut tissue by photodisruption, that is, vapourisation of targeted tissue, generation of cavitation bubbles and creation of cleavage planes within tissue. 5 As transparent tissues do not absorb the lasers’ infrared wavelengths, photodisruption can be focused precisely at a given depth within the anterior segment of the eye. Four femtosecond laser systems have been cleared by the US Food and Drug Administration (FDA) for capsulotomy, phacofragmentation © To u ch MEd ica l MEdia 201 4 and construction of corneal incisions in the context of cataract surgery: LenSx ® (Alcon, Fort Worth, Texas), Catalys ® (Abbott Medical Optics, Santa Ana, California), LENSAR ® (LENSAR, Orlando, Florida) and Victus ® (Bausch & Lomb, Rochester, New York). This article discusses the technological specifications and clinical applications of the LENSAR Laser System. Specifications and Performance The LENSAR Laser System was designed from the beginning to meet the strictest standards of accuracy and precision specifically for refractive cataract surgery. Optimal docking, imaging and guidance set the stage for accurate laser shot placement and effective cutting, making the LENSAR Laser System the perfect preparation for phaco aspiration, IOL implantation and wound sealing. The intrinsic qualities of LENSAR’s optical laser, coupled with its novel, patented proprietary imaging technology and user-friendly patient interface, provide predictable and reproducible results, including free-floating anterior capsulotomies, ultrasound-sparing phacofragmentation patterns, easily opened clear corneal incisions (CCIs) and precise arcuate cuts. The outstanding safety and effectiveness of these advanced algorithms drive enhanced outcomes and improved satisfaction for all IOL patients. In addition, the capability for integration of preoperative imaging and intraoperative guidance through iris registration allows increased efficiency and accuracy of arcuate incisions. Finally, the intraoperative ability to define the cataract nuclear density facilitates optimal phacofragmentation. 93