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The anatomy of a cataract treated with the femtosecond laser is fundamentally different from a standard cataract. Specifically, the cortex is fused at the capsulotomy, and standard hydrodissection fails due to pneumodissection. This paper will evaluate a technique of direct irrigation to facilitate cortical removal in FLACS cases.
Lake, et al, described a technique of "second-wave" hydrodissection to facilitate the separation of cortex from the capsule in femtosecond laser-assisted cataract surgeries. Their technique was to direct a jet of irrigating BSS from outside the capsule toward the junction of fused cortex and cut capsule. This author has found that piercing the cortical layer near the junction of the fused cortex and capsule facilitates entry to this plane. The irrigation then has direct access to the cortico-capsular plane. With either technique, any disruption in the cortical layer will disrupt the progression of the wave.
The technique is quite effective in removing cortex nearly completely, but only in specific situations. By utilizing the directed flow of irrigation in several locations around the edge of the capsule, cortical separation can still be facilitated. This paper will review 100 consecutive FLACS procedures for the suitability and efficacy of this technique.
"Second-Wave Hydrodissection" as described by Lake, et al, is a highly effective method of removing cortex in FLACS. Its efficacy is dependent on an intact cortical layer following nuclear removal. By slightly modifying the original technique, the utility of the second-wave is enhanced, and can be used to facilitate cortical removal in FLACS.