[Future perspectives of the femtosecond laser in anterior segment surgery]

Around 12 years after its introduction laser cataract surgery (LCS) has enabled remarkable progress, such as extremely precise capsulotomy and lens fragmentation with reduced or no ultrasound energy at all (zero phako); however, another innovation push is necessary to bring this technology to its full potential. Among the many benefits that have not yet been fully explored are primary posterior laser capsulotomy (PPLC) and the use of the femtosecond laser in pediatric cataract patients. In the present collective of patients in whom a PPLC was carried out at the end of the operation, a clearly reduced prevalence of secondary cataract could be observed, whereas the short additional intervention was not associated with notable complications. The LCS in infants is best carried out as an off-label procedure, which has been rendered more precise by the Bochum formula. In the near future, postoperative laser fine tuning will enable the target refraction to be achieved in most patients. Laser-induced refractive index change (LIRIC) will enable very exact refraction alterations on an already implanted intraocular lens (IOL), on a contact lens and on a treatment native cornea. A new version of the Scheimpflug camera will be used just prior to surgery to analyze the morphology and kernel density of the lens opacity and to carry out a real-time grading of lens hardness. Based on this categorization, where the system classifies the results into five different density grades, the surgeon is automatically provided with an individualized fragmentation pattern defined preoperatively by the operator. A further innovation of the same system involves microcorneal incisions for fine tuning of residual refractive deficits.