Dr. Alek Topov: At "Tokuda" we operate on cataracts with new equipment in 10 minutes

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Dr. Alek Topov: At "Tokuda" we operate on cataracts with new equipment in 10 minutes
Dr. Alek Topov: At "Tokuda" we operate on cataracts with new equipment in 10 minutes
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Dr. Topov, what is cataract and how is it treated over the years?

- Cataract is a darkening of the human biological lens and is the most common eye disease. When the lens darkens, it results in blurred vision. The only treatment is surgery - the cataract is removed and an artificial lens is implanted in its place. It is the most commonly performed operation in the world.

When I started practicing ophthalmology in 1996, phacoemulsification came in, which means breaking up the diaphragm with ultrasound. This method is still considered the gold standard in the treatment of cataracts. Before him, the eye incision reached about 10 mm. At the beginning of the application of phacoemulsification as a technique, the incisions were 3.5 mm, and currently they are 1.8 mm.

But two years ago, femtosecond laser cataract surgery entered almost all leading clinics in the world. We are already implementing this innovation at Tokuda Hospital.

What are the advantages of the new method?

- The idea is

to reduce risks

from performing manual manipulations in the eye. The femtolaser first makes extremely precise cuts on the cornea, exactly the same size and always in the same place. If done by hand, sometimes the incision can be made smaller or longer. If the patient moves, other problems can occur.

The second advantage of the femtolaser is that it has a safe capsulorhexis. The biological lens is located in a capsule. In order to be able to remove the lens, we have to make, simply put, a hole in the anterior capsule with an optimal size between 4.8 and 5.2 mm. When made by hand, there are always deviations of this size. Whereas with a laser, we get the size we set, and the capsulorhexis is always perfectly round, right in the center.

Many scientific papers have already stated that for complicated cataracts, long ultrasound time should not be used, and nuclear breaking should also be done with laser.

Until now, we only broke and aspirated the nucleus manually, whereas the femtolaser allows us to use very little energy on the corneal endothelium. This will also reduce the risk of corneal complications. One of the most common complications allowed by a younger and inexperienced surgeon is clouding of the cornea as a result of using too much ultrasound energy. Then keratoplasty is required. So the femtolaser reduces that risk as well.

How long does the femtolaser surgery take and is the patient conscious?

- The femtolaser manipulation itself lasts 4-5 minutes and the implantation of the lens even longer. In total, the whole operation takes between 10 and 12 minutes.

To anxious patients,

who do not wish to be awake during the manipulation, general anesthesia is administered. Otherwise, drop anesthesia of the eye is practiced.

Years ago, ophthalmologists waited for the curtain to mature. Is this necessary now?

- Older colleagues are still supporters of the thesis to wait for the veil to mature and then to be operated on. For modern surgery, this is an absolutely wrong approach. Because the incisions are a maximum of 1.8 - 2.2 mm and the biological lens is 12 mm in diameter. If we wait for the cataract to mature, it becomes extremely hard and it's like breaking a stone inside the eye. This carries huge risks, especially if the surgeon is more inexperienced. In such cases, it is preferable to perform an operation according to the old methodology of 20 years ago, with which the patient would have not great, but at least sufficient vision.

It is an absolute mistake nowadays, with this technique, with which the complications are below 1%, even below 0.5%, minor ones at that, to wait for the veil to ripen.

Does the patient recover quickly after femtolaser surgery?

- The patient can see immediately after the operation. But we put a bandage on it, because microerosions of the epithelium occur in the areas of the incisions. They irritate and there is tearing. It takes about 12 hours for these incisions to heal and for the patient to feel nothing. We do not put stitches. They are only done if the cataract is too mature or there was a complication during the operation.

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