Surgeon: Give up the surgical limbus and use clear cornea instead

Femtosecond laser entry into the cataract surgery arena had a positive influence on the key steps of cataract surgery, namely anterior capsulotomy, softening of the lens nucleus, lens fragmentation and self-sealing corneal incisions. A full-thickness corneal incision is a must for cataract surgery in order to gain access to the cataractous lens nucleus and surrounding cortex and to implant an IOL within the capsular bag. In doing so, there can be induced iatrogenic corneal astigmatism. Ophthalmic surgeons have long focused on decreasing the size and location of corneal incisions to obtain the best access to the lens while trying to achieve an astigmatically neutral corneal incision or targeting the least amount of induced iatrogenic corneal astigmatism.Femtosecond laser-assisted cataract surgery permits making, in a reproducible manner, corneal incisions that are more precise, which is clearly considered superior to any of the manual corneal incisions. Additionally, surgeons also have the option of making these anterior chamber entry incisions in the plus axis to decrease pre-existing corneal astigmatism, which can be combined with additional corneal incisions as needed, all in an effort to decrease corneal astigmatism to zero or near zero without flipping the axis of astigmatism. This is in line with what our present-day cataract surgery patients would like, namely the best quality of vision, as we now intentionally drift from routine cataract surgery to femtosecond laser-assisted refractive cataract surgery.