Early Experience with the Femtosecond Laser for Cataract Surgery

Objective: To describe the intraoperative complications and to evaluate the learning curve with femtosecond laser cataract surgery. Design: Prospective, consecutive cohort study. Participants: The first 200 eyes undergoing femtosecond laser cataract surgery and refractive lens exchange in a single center. Methods: The initial 200 eyes undergoing cataract surgery between April 2011 and June 2011 by 6 surgeons were included in the study. The cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the femtosecond laser. The procedure was completed by phacoemulsification and insertion of an intraocular lens. Data were collected about patient demographics, preoperative investigations and intraoperative complications. The cases were divided into 4 groups-group 1 included the first 50 cases, group 2 included cases 51 through 100, group 3 included cases 101 through 150, and group 4 included cases 151 through 200-and were analyzed. Main Outcome Measures: Intraoperative complication rates. Results: The mean age of patients included was 69.2 +/- 9.8 years. Of the 200 eyes, 74.5% underwent a complete procedure of laser capsulotomy, lens fragmentation, and corneal incisions. Five eyes had suction breaks during the laser procedure that led to the remainder of the laser procedure being aborted. Twenty-one (10.5%) eyes showed the presence of small anterior capsular tags. The number of eyes with free-floating capsulotomies was 35 (17.5%). The other complications during the study were anterior radial tears (n = 8; 4%), posterior capsular ruptures (n = 7; 3.5%), and dropped nucleus (n = 4; 2%). A significant difference was noted among the sequential groups with respect to the number of docking attempts (P<0.001), miosis after the laser procedure (P<0.001), and free-floating capsulotomies (P<0.001), suggesting an improving learning curve. The surgeons with prior experience with femtosecond lasers had fewer complications in the first 100 cases (P<0.001). No difference in complications was observed after the initial 100 cases. Conclusions: In this case series, there was a clear learning curve associated with the use of femtosecond lasers for cataract surgery. Adjustment to surgical technique and prior experience with a femtosecond laser seemed to flatten the learning curve.