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Cataract Femtosecond Lasers in Ophthalmology Duna Raoof-Daneshvar, MD and Roni M Shtein, MD, MS Kellogg Eye Center, University of Michigan, Michigan, US. Abstract The use of the femtosecond laser in ophthalmic surgery over the last decade has resulted in the development of innovative procedures. The ultra-short infrared laser pulses of the femtosecond laser can be applied precisely and predictably with minimal collateral tissue damage, making it an ideal tool for highly precise ophthalmic surgery. Flap creation in laser in situ keratomileusis (LASIK) is the most common use of this laser. It can also be used for other corneal refractive procedures, lamellar and full-thickness corneal transplantation, and cataract surgery. This article summarizes recent advanced applying femtosecond laser technology in ophthalmology. Keywords Femtosecond, laser, laser in situ keratomileusis (LASIK), cataract, femtosecond laser-assisted corneal surgery, femtosecond laser-assisted keratoplasty, intracorneal ring segment, astigmatism keratotomy, femtosecond laser-assisted cataract surgery Disclosure: The authors have no conflicts of interest to declare. Received: January 16, 2013 Accepted: February 20, 2013 Citation: US Ophthalmic Review, 2013;6(1):38–41 Correspondence: Roni M Shtein, MD, MS, Assistant Professor of Ophthalmology and Visual Sciences, University of Michigan WK Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105. E: ronim@med.umich.edu The versatility, predictability, and unique properties of the femtosecond laser have allowed its application in multiple avenues of anterior segment surgery. Femtosecond lasers generate ultra-short pulses utilizing small amounts of energy and minimizing damage to any of the surrounding tissues. extent, of passing through optically hazy media, such as an edematous cornea. The laser may be applied in multiple geometric patterns including vertical, spiral, or zig-zag cuts. Femtosecond Laser Systems There are multiple commercially available femtosecond laser models: In this article, we summarize the surgical techniques that have been developed in ophthalmic surgery utilizing the femtosecond laser since its approval by the US Food and Drug Administration (FDA) in 2001. The femtosecond laser was initially introduced for creation of corneal flaps for laser in situ keratomileusis (LASIK). Since then, the use of femtosecond lasers has expanded to other corneal surgeries and, more recently, to cataract surgery. • • • • • Intralase FS™ (Abbott Medical Optics, Abbott Park, Illinois); Femtec ® (20/10 Perfect Vision, Heidelberg, Germany); VisuMax Femtosecond System ® (Carl Zeiss Meditec, Jena, Germany); Femto LDV™ (Ziemer Group, Port, Switzerland); and Wavelight FS200 ® (Alcon, Fort Worth, Texas). Systems designed specifically for cataract surgery include: Femtosecond Laser Principles The femtosecond laser is an infrared laser (wavelength: 1,053 nm) with ultra-short pulse duration (10–15 s). Given its short pulse duration, the femtosecond laser has the ability to deliver laser energy with minimal collateral damage to the adjacent tissue. Thermal damage to neighboring tissue in the cornea has been measured to be in the order of 1 μm. 1 The tissue interaction this laser utilizes is known as photo-disruption, a process in which small volumes of tissue are vaporized resulting in the formation of cavitation gas (carbon dioxide and water) bubbles. 2 Furthermore, the femtosecond laser is unique in that it can be focused anywhere within or behind the cornea and is capable, to a certain 38 • • • • LenSx (Alcon, Fort Worth, Texas); Catalys (OptiMedica ® , Sunnyvale, California); LensAR (LensAR Inc., Orlando, Florida); and VICTUS (Technolas and Bausch and Lomb). The early femtosecond laser systems operated with a low repetition rate (15 KHZ) and thus required higher energy to operate. The new devices have an increased repetition rate (as high as 150 KHz), which leads to utilization of less energy and shorter procedure duration. In addition, the devices vary in their programmed and customizable geometric cut patterns. Each laser system has distinctive features allowing it to be popularized for use in specific procedures. © Touc h ME dical MEdia 2013