A new and exciting paradigm shift in cataract surgery technique has become increasingly popular in the last year. True laser cataract surgery is here now. Where ‘standard’ cataract surgery involves making incisions with blades and manually opening up the cataract capsule (capsulorhexis) with needles and forceps and breaking up the hard core (nucleus) of the cataract by ultrasound energy and a metal’ chopper’ , FLACS is now bladeless cataract surgery and the use of the laser to open up the cataract capsule and break up the nucleus is more precise and uses less ultrasound energy. This results in more precise outcomes and greater safety.

More precise outcomes refers to the accuracy of the refractive outcome; something which is increasingly important with the use of advanced technology lens implants (AT IOLs) like multifocal and multifocal toric lens implants. Ideally we should try and achieve a zero degree outcome and there is increasing evidence that FLACS gives us these more precise refractive outcomes. Surgeons at ERS have access to the most widely used Femtolaser , the Lensx system supplied by Alcon( Fig 1). This system is able to make incisions, open up a perfectly round opening in the cataract and then divide up the nucleus efficiently and safely. What can you expect with FLACS? FLACS starts off with the femtolaser step in which the incisions, capsulorhexis and nuclear division are done under topical (eye drop)anaesthesia. The eye then looks like Fig 2 above. You will then be moved over to another operating room where the incisions are opened up, the cataract removed using less ultrasound energy and an appropriate lens implanted. It is a painless and quick procedure.

Post-operatively it is to be expected that the eye is a little redder than normal due to the suction applied during the laser step. This redness will fade in 1-2 weeks. This is what a well performed FLACS eye looks like a month after surgery Fig 3.

Whilst this new technology is undoubtedly attractive, not every patient is suitable for FLACS. Your doctor will discuss the pros and cons and help you decide whether to have a standard procedure or a FLACS procedure. Please feel free to ask for more information.

Drs Ong and Yeoh were early adopters of FLACS techniques in Singapore. Dr Yeoh is a trainer for Alcon in training surgeons beginning FLACS and conducts many round table discussions on adopting FLACS.

Source: ERS