Pioneering cataract surgery with the femtosecond laser

During cataract surgery, incisions are made in the cornea, a circular opening is made in the capsule, the inner parts of the natural lens are suctioned, and an artificial lens is placed into the capsular sac. We are using the most advanced LENSAR laser for the following incisions:

• A miniature incision into the outer edge of the eye
• A circular opening in the anterior lens capsule (capsulotomy)
• Fragmentation of the lens
• The highly precise correction of astigmatism by curved incisions
• Marking the cornea for toric lenses

In contrast to competing models, the LENSAR femtosecond laser (Topcon) has a so-called 3D CSI camera system, allowing it to create an accurate 3D reconstruction of the eye. The technology is based on a derivative of the Scheimpflug camera which is also used in diagnostics. The courses of beams of the camera and the laser are identical, i.e. they are using the same optical path. For you, this means additional security and accuracy during the operation.

An extensive meta-analysis of several peer-reviewed studies presented at the European Congress of Cataract and Refractive Surgeons in September 2016 compared laser operations with manual cataract operations. The meta-analysis of the Universität Frankfurt's ophthalmological clinic examined 34 studies in which the results of 6,492 eyes operated with a femtosecond laser were compared to those of 6,707 eyes operated with the manual method.

The conclusion was: The femtosecond laser-assisted cataract surgery's advantages and risks are comparable to those of the manual cataract surgery. Overall, the laser surgery seems to be superior to the manual method.

Select the degree of painlessness you want

The outpatient operation only takes 20 minutes. A relaxed and pleasant mood in the operation theater is very important to us. We guarantee that surgery will be painless and enjoy the luxury for you and for us that you can choose your preferred type of anesthesia. If there are additional risks, we would perform the laser cataract surgery as an inpatient procedure. Please choose one of the following options:

• Twilight sleep after injection
• Twilight sleep and an injection next to the eye (peribulbar anesthesia). In 10 years, no eyeball has been injured by this technique in our practice
• General anesthesia for phobic patients
• Local anesthesia with eye drops for courageous patients

Your hair and body are covered, and the skin around the eye to be operated is disinfected. Then, the surgeon carefully applies an eye speculum ensuring that the eye remains open. He places the contact lens (patient interface) of the laser on your eye and centers it exactly above the natural lens. However, the Lensar device also allows for orientation along the optical axis.

With our LENSAR laser, we are taking perfection to extremes: First, an iris adjustment is performed to avoid angular errors with toric lenses and curved keratotomies (corneal incisions). This is made possible by improved corneal diagnostics.

Under the surgeon's control, the laser makes a small incision at the outer edge of the eye which has been calculated precisely before. For 10 years, Dr. Breyer has been using the minimally invasive technique (keyhole surgery) and has made a significant contribution to spreading this technique on international congresses. The main incision is only 1.8mm wide, the secondary incisions are 0.9mm. Thus, corneal curvature due to the incisions is avoided, and the eye's stability is improved.

Subsequently, a circular opening is made in the anterior lens capsule (capsulotomy). The circular capsulotomy, in particular, can never be made so precisely manually even by very experienced surgeons. This causes elevation of the long-term stability and centering of the artificial lens to a previously unachievable level to make your vision as good as possible also in the long term.

The laser then breaks up the natural lens. Since the laser measures the clouding of the lens exactly before the operation, we use as little laser energy as necessary during cataract surgery to avoid damage to your eye. Our surgeons are planning each of these steps very precisely in advance and perform them exactly as planned while monitoring the procedure in real time on the integrated camera system's screen.

Using the nanosecond laser

To fully remove the already broken up lens nucleus, ultrasound energy has been used previously (phacoemulsification). Nowadays, a nanosecond laser can be used for this also to treat your eye as gently as possible.

Implanting the lens

Subsequently, the surgeon places an artificial lens in the lens capsule, which is now empty, under the surgical microscope. Due to the more precise incision lines of the laser, the lens can be positioned much more precisely, and accordingly, the resulting vision after the operation can be predetermined better. Good to know: We are implanting all modern types of lenses - regardless of the manufacturer, after we have selected a custom-made premium lens with our registered MI-LENS system for you. We are using our research results gained in the last 10 years with the Universität Heidelberg to select the best lens for you. Modern premium lenses are made from soft material and are inserted into as small an opening as possible while folded. They return to their original form only when inside the eye.

You can find further specialist literature references on this topic at the end of this page.

Whether you have presbyopia and want to gain independence from your reading glasses or whether you are already suffering from the symptoms of a cataract, i.e. clouding of a lens: In both cases, a laser lens replacement could be a possible therapy for you. We would be happy to discuss with you what you are hoping to achieve with the treatment and what you are expecting in terms of quality of vision after an operation.

By the way, cataract surgery is one of the most frequently performed operations in humans. In Germany alone, over 600,000 cataract operations are performed annually. Due to the use of modern laser technology, it is becoming gentler for your eyes and more precise.

Before an operation, we will perform very thorough examinations to achieve the ideal result for your vision and to provide you and us with a feeling of security. The results of our examinations are considered in the treatment and are the basis for the individual selection and calculation of your premium lenses. If you have astigmatism, it can be balanced by placement of a toric lens. In this case, measuring with the Cassini LED topographer is particularly helpful during placement of the lens.