UBM-criteria for a safe femtosecond laser-assisted cataract surgery after microinvasive non-penetrating deep sclerectomy

PURPOSE: To evaluate the safety criteria of femtolaser impact during femtosecond laser–assisted cataract phacoemulsification on the filtration zone after microinvasive non-penetrating deep sclerotomy based on ultrasound bio- microscopy data.

MATERIALS AND METHODS: 12 patients (15 eyes) with operated primary open-angle glaucoma, 7 women and 5 men, were kept under observation. The average age of the patients was 64±11 years. Femtosecond laser–assisted cataract phacoemulsification was performed 6-12 months after microinvasive non-penetrating deep sclerectomy. In addition to standard research methods all patients underwent ultrasound biomicroscopy prior to surgery. The femtolaser stage of the surgery was performed using FEMTO LDV Z8 device («Ziemer», Switzerland). Ultrasonic cataract phacoemulsification was performed using Centurion VisionSystem («Alcon», USA) according to the standard phaco-chop technique. Ultrasonic biomicroscopy follow-up was performed 1 day and 1 month after the operation.

RESULTS: Study results indicate the need to include ultrasound biomicroscopy into the list of mandatory diag nostic research methods for patients with previously operated glaucoma prior to femtosecond laser–assisted cataract surgery. To ensure a safe performing of femtolaser cataract surgery in patients after microinvasive non-penetrating deep sclerectomy, one has to take into account a combination of such features as the preservation of the linear profile of the trabeculodecemetic membrane, the absence of its dense adhesions with surrounding tissues, and the presence of an intrascleral cavity with a height of 0.25 mm and above. Failure to respect these conditions when using femtosecond laser technology can lead to adverse changes of the newly formed drainage system.

CONCLUSION: Femtosecond laser–assisted cataract surgery for patients who previously underwent microinvasive non-penetrating deep sclerotomy (MNSE) is a safe and effective technology when performed after a preliminary selection of patients based on filtration zone ultrasound biomicroscopy (UBM).

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