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Femtosecond Laser Surgery and the Main Incision

The newest advance in cataract surgery – Femtosecond Laser Surgery and the main incision

Cataract surgery has always been on the leading edge of innovation and the latest development is no exception. There are numerous advantages of Femtosecond Laser Cataract Surgery and in this blog I am going to limit the discussion to the main incision. The first thing to understand about this procedure is the incredible accuracy achieved. Using suction to hold the eye immobile, a built in imaging system identifies the different structures to the surgeon who then verifies that the software has correctly identified where the incisions are to be made. The laser then makes these incisions with an accuracy that cannot be matched by human hands.

The main incision is made in the clear cornea and is 2.5 mm in width. This incision closes without sutures (thus “no-stitch” cataract surgery) and is traditionally made using a stainless steel scapel that is used once. The correct construction of a self-sealing incision would require a 3 step incision that would look like a “Z” with the middle being straight instead of on a diagonal. This construction is probably NEVER achieved by hand, but I’m sure we come very close since wound problems are unusual in a traditional surgery. The problems of poor wound construction consist of wound leaks and infection, either of which is undesirable. Also, if the wound is made too short, you can easily have the iris prolapse or “fall” out of the eye during the surgery which results in an irregular pupil at the end of the surgery.

Femtosecond main incisions are ALWAYS the correct length and have the 3 step construction that makes sure the wound closes just by the normal pressure of the eye. The area where the incision is to be made is identified by the scanning technology and the software determines where the incision should be placed. The surgeon then can make changes as needed or just accept what is shown. Once confirmed the surgeon presses the foot pedal and can see the Femtosecond laser making the incision which takes under 10 seconds. After the laser makes the incision, the eye is not actually open! This gives the staff as much time as they need to get ready for the next stage of the procedure. The surgeon then uses a blunt instrument to gently peel open the incision and finish the surgery. At the end, you have a perfect incision every time!


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