Surgical Method of Aspiration of the Soft Nucleus of the Lens After Femtolaser Fragmentation with Minimal Ultrasound Impact

Relevance One of the main causes of blindness and low vision in the world is cataract opacity [1]. In recent years, there has been a trend in phaco surgery to reduce the ultrasound exposure to the tissues of the eyeball during cataract phacoemulsification. Fragmentation and aspiration of soft cataracts require special surgical techniques and methods that differ from those used to remove the dense nucleus, including the use of a femtosecond laser. Objective To analyze the surgical method of aspiration of the soft nucleus of the lens after preliminary femtosecond laser fragmentation with minimization of ultrasound exposure. Material and methods The operations were performed on 63 patients (63 eyes). The average age was 31.5 years (from 23 to 40 years). The first group (27 eyes) - initial or immature cataract. The second group (36 eyes) included patients with high myopia and complex myopic astigmatism who underwent cataract extraction for refractive purposes. The volume of irrigation solution and cases of ultrasound use were assessed during the surgery. The VICTUS femtosecond laser system and the Centurion Vision System phacoemulsifier were used. The results were statistically processed using nonparametric methods. To achieve maximum fragmentation of the lens nucleus without ultrasound, a “grid” pattern of femtosecond laser fragmentation with a diameter of 3.5–4.5 mm and cells of 300 × 300 μm was used. The method minimizes the size of fragments in the central area of ​​the nucleus, which is necessary for aspiration without ultrasound. The energy of laser pulses was selected in the range of 6500–6700 nJ, which is lower than with high nucleus density (grades 3 and 4). Emulsification began with the central sections, and aspiration was performed with a high vacuum level (at least 600 mm Hg) without ultrasound. After aspiration of the central area, the peripheral sections were shriveled, which were then also aspirated without ultrasound. The procedure was completed with irrigation-aspiration of the cortical masses and implantation of the intraocular lens. Results The surgical intervention according to the method described above was performed without any complications. All patients received a capsulorhexis of an ideally round shape, with a diameter 0.5 mm smaller than the optics of the implanted IOL, which ensured the correct intracapsular position of the IOL in the postoperative period [2–4]. Conclusion The study showed that removal of the lens with a nucleus of I–II degree of density is possible without low-frequency ultrasound, if femtosecond laser fragmentation with a “grid” pattern is performed beforehand. The success of this technique depends on maintaining a high vacuum level during aspiration [5]. The results highlight the effectiveness and safety of the method in cataract surgery, which may improve intraocular correction in ophthalmology. Keywords: cataract; femtosecond laser fragmentation; ultrasound; emulsification; phaco surgery; femtosecond laser; aspiration; IOL