Combined Carbon Dioxide Laser Lateral Canthotomy and Femtosecond Laser-Assisted Cataract Surgery

Purpose: The purpose of this study was to evaluate a new procedure aimed at lengthening the palpebral fissure to facilitate femtosecond laser-assisted cataract surgery in patients with small eyes. Method: A quick procedure using the CO2 laser was adapted for patients with small eyes undergoing laser-assisted cataract surgery using the Catalys system. The UniPulse CO2 laser (Nidek) was used for laser lateral canthotomy on patients with small palpebral fissures to allow fitting of the Liquid OpticTM Interface eyepiece. Results: Lateral canthotomies were performed on 19 women and 7 men (ages ranged from 45 to 93 years) with lower eyelid lengths equal to or shorter than 32 mm who then underwent femtosecond laser-assisted cataract surgery. A total of 33 eyelids received laser lateral canthotomy with the CO2 laser; only one eyelid had lateral canthotomy with cold-steel tenotomy scissors. Dockings were completed for all 34 eyes with eyelids receiving lateral canthotomies. The 33 eyes with eyelids that received laser canthotomy with the CO2 laser had successful femtosecond laser-assisted cataract surgery. The one eye with the eyelid that received cold-steel canthotomy could not have femtosecond laser-assisted cataract surgery despite successful docking because of pupillary constriction. The findings were statistically significant; Fisher Exact Test showed a p-value of 0.0294. Conclusion: Laser lateral canthotomy with CO2 laser is a safe and effective method to allow docking and completion of femtosecond laser-assisted cataract surgery.