Correct technique, tools can optimize femtosecond surgery outcomes

Modern-day cataract surgery requires lysis of most, if not all, corticocapsular adhesions toward the outer lens surface and freeing cortical-nuclear attachments in the interior of the cataractous lens. Hydrodissection is utilized to shear corticocapsular adhesions, while hydrodelineation breaks the epinuclear-nuclear adhesions. These surgical steps will facilitate in-the-bag nuclear rotation, thus assisting in lens division and removal by the technique of the surgeon’s choice. Further, such separation of the cortex from the lens capsule will simplify cortical cleanup and help preserve an intact posterior lens capsule for in-the-bag IOL placement. Incomplete lysis of corticocapsular adhesions can impede effective nuclear rotation and may result in possible zonular stretch and/or zonular lysis that can compromise the capsule-zonular complex.With the application of femtosecond laser technology to cataract surgery, the capsulorrhexis has become more precise, accurate and reproducible, and there usually is a significant reduction of effective phacoemulsification time and mean phaco energy during laser-assisted lens fragmentation. However, with such precise laser capsulorrhexis and nuclear fragmentation, the usual hydrodissection techniques and cortical removal may be somewhat challenging due to possible laser-induced bubbles in the fluid path and enhanced corticocapsular adhesions and relative absence of cortical tails or strands that can be easily grasped and aspirated. Hence, there is a need for continued modifications in surgical techniques, which will further improve and assist in simplification of femtosecond laser-assisted cataract surgery.