Surgical technique for lens fragmentation using a femtolaser to aspirate the soft core

Relevance In recent years, phaco surgery has sought to reduce the ultrasound exposure to eye tissue during phacoemulsification. Technologies have been developed that reduce the time of ultrasound work, which is important when removing a lens with a dense core [1]. When removing soft cataracts, emulsification using a femtolaser and minimal ultrasound is recommended to prevent complications and preserve the structure of the capsular bag [2]. This is especially important in refractive lens removal, as the requirements for the results of IOL implantation are increased [3]. Studies show that ultrasonic emulsification of the soft cataract core can be performed without fragmentation under high vacuum in a phacoemulsifier, but this increases the risk of corneal endothelial injury due to increased ultrasound exposure [4]. Modern control of fluid flow and vacuum during phacoemulsification allows aspiration of the soft lens without ultrasound, using the method of fragmentation of the nucleus. In this process, a notch is formed in the center of the nucleus, fixed with a high vacuum, and then fragmented with a chopper. Femtolaser systems fragment the lens nucleus with various patterns, reducing the size of the fragments and reducing the ultrasound effect. Despite the increase in laser energy, reducing the ultrasound time minimizes the load on the eyeball [5]. Objective Development of a technique for aspiration of the lens nucleus during its preliminary femtolaser fragmentation without the use of ultrasound. Material and methods Surgical treatment was performed in 63 patients. The operation was performed using a VICTUS femtolaser and a Centurion phacoemulsifier. For intraocular correction, monofocal and multifocal IOLs and toric IOLs with the VERION navigation system were used. The results were analyzed using nonparametric methods. Results The use of a femtosecond laser in phaco surgery significantly improves the quality of surgical intervention; it is possible to remove a lens with a nucleus of I–II density grade without ultrasound with a “grid” pattern, provided that a high vacuum level is maintained during aspiration. Conclusion Femtosecond laser fragmentation of the lens nucleus together with high-vacuum phacoemulsifiers allows for effective removal of the soft lens without the use of low-frequency ultrasound and reduces the size of the central fragments of the lens, which simplifies their aspiration. Keywords: cataract; surgical treatment; femtosecond laser; phacoemulsification; intraocular lens; IOL