NANOSECOND LASER

Nanosecond laser may be safe for cataract surgery at a lower cost than femtosecond laser

 “A minimal level of energy is applied to the eye. There is no thermal alteration in the anterior chamber, no mechanical or thermal side effects,” Jérôme C. Vryghem, MD, said at the European Society of Cataract and Refractive Surgeons meeting.

The nanosecond laser delivers energy comparable to a grenade but in a very small area of 2 µm to 3 µm, he said.

“We have more than 50 times less energy distributed in the eye during cataract surgery compared to phaco surgery,” Vryghem said.

The currently available system, the Cetus, produced by the German company A.R.C., can be connected to any phaco system and is triggered by the air impulse of the vitrectomy mode. Laser energy is transferred to the probe by a quartz fiber optic, aspiration is done through the probe and irrigation through a sleeve or a separate handpiece in case of bimanual surgery.

Vryghem used the system to treat 141 eyes of 74 patients, and in 81% of them he implanted a PhysIOL trifocal IOL (FineVision).

He used a bimanual technique with no sleeve through 1.4-mm incisions.

“There is a learning curve, which accounted for the eight cases of posterior capsule rupture I had at the beginning. There are no problems if the anterior chamber is deep and the cataract not too hard,” he said.

“My impression is that on day 1 the eye is very calm, there is less would leakage and visual recovery is faster.”

He said he purchased the laser essentially for marketing reasons because patients want laser surgery and because clinics that have a femtosecond laser are now very competitive. The nanosecond laser is a more affordable alternative, he said.

“It costs less than €70,000, the disposables are €40 per eye, and you can easily integrate it into your practice because the laser is directly connected to your phaco system.” 

OFTALMÓLOGO ESTEPONA