Robert Weinstock, MD is interviewed and quoted in an article of Review of Ophthalmology speaking about Femto Laser Cataract and avoiding complications.
Like every new surgery, this one is associated with unique potential problems. Here’s how to keep things going smoothly. As more surgeons explore the possibility of femtosecond laser cataract surgery (in which the incision, capsulotomy and nucleus fragmentation are accomplished by the laser), the focus on the details of the surgery’s advantages and pitfalls has become more intense. #drrobertweinstock And as with any surgery, one of the most important details is potential complications.
“Any new surgical technique involves a learning curve, and complications will occur,” notes Ronald Yeoh, MD, medical director, founding partner and senior consulting ophthalmic surgeon at Eye & Retina Surgeons, Camden Medical Centre in Singapore. “The increasing trend towards femto-laser-assisted cataract surgery #cataractsurgery, or FLACS, means that we are encountering complications peculiar to this surgery. The transitioning surgeon needs to recognize these and modify surgical technique to manage them appropriately.”
Here, Dr. Yeoh and three other surgeons with extensive experience using femtosecond laser technology as part of cataract surgery share pearls taken from their experience with complications: what those potential complications are, how to manage them if they occur, and how to minimize the likelihood of them occurring in the first place.
For any surgery to succeed, appropriate patients must be chosen, and the patients must be made aware of possible postop concerns.
• Make sure the patient can lie flat and remain still. “There are some challenges that are unique to femtosecond cataract surgery—things that would not be a challenge in conventional surgery,” says Sonia H. Yoo, MD, professor of ophthalmology at the Bascom Palmer Eye Institute, University of Miami School of Medicine. “One is that the patient must have the ability to lie down flat in the right position and remain still.
During manual surgery we can give the patient IV sedation that can help if he has a tremor or neck pain, but during laser surgery the patient has to be alert and awake.
“That’s true for several reasons,” she continues. “For one thing, most surgeons have the laser in a different room from the operating arena, so the patient has to get up and be transferred to the other room after the laser part of the procedure. Also, we need to have the patient’s cooperation during the laser, so that he can look at the light or adjust his position. With IV sedation on board, that might not be possible—the patient might fall asleep; his head might bob; he’s more likely to move at an inopportune time. As a result, we don’t sedate patients before the femtosecond laser part. So when you evaluate patients you need to make sure they’ll be able to lie flat and remain still.” –
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Robert J. Weinstock, MD, can be reached at Eye Institute of West Florida, 148 13th St. NW, Largo, FL 33770; 727-478-1299; or at http://cataractsurgeons.com for a consultation.