Femtosecond laser assisted cataract and corneal surgery

This information is aimed at patients suitable for laser assisted cataract or corneal procedure. The suitability for laser assisted surgery will be determined at consultation with your surgeon. Kindly read the following information that is intended to explain the benefits and risks. Please read this in conjunction with the cataract or corneal information leaflet provided to you in the respective clinics.

How are cataracts treated?

In order to restore vision, cataract surgery involves removal of the cloudy lens from the eye and replacing it with an artificial lens, known as an intraocular lens (IOL). The procedure is normally performed under local anaesthetic and takes 20-30 minutes.

Is cataract surgery safe?

Cataract surgery is the most commonly performed surgery in the UK today, with over 300,000 procedures per year.

What is a femtosecond laser?

A femtosecond laser is a specialized infrared laser which allows surgeons to make precisely targeted cuts in the eye for ophthalmic procedures such as cataract and corneal surgery.

What is the difference between conventional cataract surgery and femtosecond laser cataract surgery?

With conventional cataract surgery, the entire procedure is performed manually by the surgeon. In order to remove the cloudy lens, the surgeon first makes an incision in the cornea. The lens is located in a fine membrane capsule behind the pupil.

To access the lens, the surgeon makes a circular cut in the capsule, a step called capsulotomy. Then, using a small instrument which delivers ultrasound waves, the cloudy lens is fragmented into small pieces for easier removal under suction in a process called phacoemulsification. Finally, the replacement intraocular lens is injected through the incision into the capsular bag where it unfolds into position. Normally the surgery is performed through micro-incisions which are self-sealing and do not require sutures.

In femtosecond laser surgery the surgeon uses the laser for preparatory steps in cataract or corneal surgery. The laser precisely makes the corneal incisions, provides accurate shape to the capsulotomy and in addition fragments the lens before surgical removal. The femtosecond laser provides precision and accuracy to surgical steps in cataract and corneal surgery.

A similar difference exists between conventional corneal transplantation surgery and femtosecond assisted procedures, where the laser provides precision to incisions in corneal surgery.

Are all patients suitable for laser assisted eye surgery?

Not all patients are suitable for femtosecond laser surgery due to variations in eye anatomy, type of cataract or other patient factors. This will be advised during consultation and routine conventional surgery will be offered to those patients.

What are the alternative options?

For patients found unsuitable for laser assisted cataract surgery, conventional phacoemulsification cataract surgery would be the alternate option.

For patients with corneal problems unsuitable for lasers, conventional manual corneal surgery will be offered and discussed at the time of consultation.

What to expect during femtosecond laser cataract surgery?

The laser surgery is performed as an outpatient procedure under local anaesthetic. After numbing the eye, you will first undergo the laser procedure in the laser room. Whilst you are lying down on a laser bed, the surgeon will gently position the laser beam over the eye via a contact lens. The surgeon will precisely plan the laser treatment and control the laser procedure which only takes a few minutes. You will then be taken to the operating theatre to undergo the second part of the cataract surgery (phacoemulsification) to remove the cataract fragments and implant the replacement intraocular lens. The whole operation takes 20-30 minutes. Corneal procedures sometimes require a general anaesthetic and could take up to an hour and a half.

What happens after laser cataract surgery?

Following surgery, a protective shield will be placed over your eye. You will be ready to return home on the same day after a short time in the recovery room. You will need someone with you who can drive you home. Please ensure you use the eye drops post operatively and as instructed by the discharge team.

Patients undergoing corneal procedures are occasionally admitted as inpatients to provide adequate recovery from the general anaesthesia and surgery.

What are the risks associated with laser cataract or corneal surgery?

The risks for laser assisted surgery are the same as conventional cataract or corneal surgery. The risks specific to laser procedure would include:

• Inability to engage the eye to the laser
• Inadvertent pupil constriction
• Incomplete delivery of laser leading to incomplete incision, all requiring manual conventional surgery to aid completion of procedure.

Recovery following laser cataract surgery

You should see an improvement in two to three days following surgery. You should be able to return to normal activities in a week. Avoid touching your eye or getting soap or water in the operated eye for two weeks following surgery. The post-operative instructions are given in the cataract information booklet.

Recovery following laser assisted corneal surgery

Recovery could take a few weeks depending on the severity of your corneal condition. Your surgical team will have provided post-operative instructions and arrange a follow up visit within a week following the surgery.

Contacts / further information

Please call the cataract clinical specialist nurses on telephone number 01223 216711 if you have any questions or concerns about this procedure or your appointment.

If you have any concerns regarding to sight or are getting pain or discharge from your eye following the operation you should contact:

Monday to Friday 08:00 to 16:00 – cataract clinic on 01223 216711

After 16:00 and at weekends: ward M5 emergency eye service: 01223 256336

References

NHS - cataract surgery (opens in a new tab)