Bladeless Femto Laser Surgery - Technique, Advantages and Limitations

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Bladeless Femto Laser Surgery

An eye surgeon preparing for cataract surgery on elderly woman

Cataract surgery technique has now changed after two decades of conventional phaco. With the help of the Lensx Femtosecond laser and live OCT-guided imaging, a surgeon can perform the most challenging steps of cataract surgery with precision and ease. The laser thus provides patients with a blade-free, highly safe and a better alternative.

Advantages of Femto Laser

  • High Precision Unmatched by Human Hands: The laser ushers in a new era of automation, enhancing the skills of the surgeon, making the most difficult steps of Phaco surgery simple and 100% accurate, thereby improving the safety and visual outcomes of cataract surgery. Imagine drawing a circle with a computer-guided printer, compared to a human hand, and one can understand the difference.
  • Bladeless Cataract Surgery: Since the laser is the cutting tool during the entire surgery, no blades or knives are used during the procedure, also earning it the nomenclature of bladeless cataract surgery. A computer-controlled laser is a more precise and a better cutting tool than a hand-held For people who have a phobia for blades and needles, working on such a delicate system as the human eye, this procedure is a welcome relief.
  • Improves Vision: Conventional Phaco only addresses the problem of cataract, without having any impact on pre-existing astigmatism (cylindrical power) due to abnormal corneal curvature. Femto laser also corrects the pre-existing cylinder in a patient’s eye, using its astigmatic correction module (LRI) thereby resulting in a better outcome as compared to conventional Phaco. Henceforth, cataract surgery is not just a procedure for visual rehabilitation, but an experience of the enhanced result.
  • Safer: Phaco is considered a reasonably safe surgery; however, the femto laser system further enhances the safety by improving the performance of a surgeon and reducing the chances of human error. The computer controlled incisions made by the laser are more precise and accurate than manual incisions, regarding depth and architecture. Due to this, wound seals better and there are only fewer chances of infection.
  • A Basic Platform for Advanced Technology (AT) IOLs: Premium Intra-ocular lenses (IOLs) require a perfectly centered, round and fixed diameter capsular opening for best centering of the lens within the eye, with better focus and improved results possible only with Femto laser.
  • US-FDA Approved: After completing clinical trials, receiving the CE mark, and US FDA approval, the Femtosecond Laser cataract surgery machine is now available in India also. As of August 2013, there are currently 11 such lasers in India.

Limitations of the Procedure

The procedure is not advocated in patients with poorly dilating pupils, and in those with advanced glaucoma. It is not the procedure of choice for patients with corneal opacities.


The Femtosecond laser is docked on the eye using a Patient Interface (PI) and a soft specially designed contact lens. Live continuous 3-D OCT pictures are streamed on to the computer screen. Main incision, side port incision, and Capsular opening are marked on the computer screen. Astigmatic control incisions if required are also marked.

On a press of a button, the laser completes all the steps in approximately 45 seconds. The eye is undocked. The patient shifted to the main OT. The incisions are entered with a spatula. The fragmented nuclear material is aspirated out, and an IOL inserted. No sutures are required as the incisions are self-sealing.

The Femtosecond Laser Machine

The name of the machine is the LenSx Femtosecond Laser System, being introduced by Alcon, USA. The laser is designed to predictably perform many of the most challenging aspects of traditional cataract surgery.

Cylinder Correction in Femto

The cylinder component in Femto Bladeless Cataract Surgery can be corrected by three ways:

  1. LRI or Limbal Relaxing Incisions
  2. Toric Lenses with Verion Digital Axis Marking
  3. Toric Lenses with Manual Marking