I this article I present my own results and discuss where I think femto cataract surgery is going.
In my last article I looked at what published literature existed to try to bring some evidence into this discussion. It seemed to me that there is increasing evidence that with femtosecond cataract surgery there is mounting evidence for its superiority.
Last week I chaired a discussion at The Victoria Parade Surgical Centre (VPSC) in East Melbourne, along with a couple of other ophthalmologists who had also commenced performing it and with the current Royal Victorian Eye and Ear registrars. The purpose of the meeting was two fold. Firstly to introduce the registrars to the technology and secondly to have a frank discussion about the technology. The evening ended with a demonstration of the machine on a dummy eye.
Out of all the ophthalmologists who are current VPSC users, I am the most experienced with 50 cases. The nearest other surgeon had 12 and the third had 4. I presented my own data at that meeting.
My Results of Femtosecond Cataract surgery
To date 50 cases.
Follow up refractions 35 the remainder not yet reviewed.
Of these 35, the majority are within 0.1 D SE !
There are 5 outliers, the largest being 0.75D. This is a female whose target refraction was -2.5 (Her request) but ended up -3.25. It’s worth pointing out that this patient had a very small 21mm eye and that the lens calculations were performed by the lens manufacturers rather than ourselves.
The second outlier is 0.4D with the other 3 within 0.25D
Now, I have not compared these results with my non femto patients of the same time period, but I am sure that I am will not find such tight results when I do look at them.
Complications
To date I have had no complications related to the femto procedure itself.
I have had one case of CMO which most likely is unrelated and one case of an anterior capsular tear which still permitted implantation of the lens in the bag and was in a patient who poorly dilated and in whom I performed a small capsulorhexis.
I note that Brendan Vote from tasmania has reported a number of anterior capsular tears and has presented some histological findings that he purports to show that femto rhexis may not be as strong as non femto ones. I await more information as it is looked at it.
My thoughts and conclusions
I was asked at the registrar presentation wether I would choose femto cataract surgery for myself or for my own mother.
My answer is an unequivocal yes. My view is that I cannot see a single argument other than cost, not to have it.
If this technology does absolutely nothing more than produce neater wounds, a neater capsulorhexis (every time) with perfect overlap of the intraocular lens and broke up the lens so there is less work and phaco energy in removing it, then there can be no argument.
There is no doubt that cost will come down. In fact Catalys have already announced a 20% price reduction.
I also have no doubt that will not be seeing this in rural centres anytime soon, as no rural centre can afford the technology. I believe however that it will steadily replace phaco and with time it will probably be made smaller and integrated with the microscope or the phaco machine itself.
I will periodically revisit this subject as I collect more information