Stability of a non-applanating handheld liquid patient interface for femtosecond laser-assisted cataract surgery
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ORIGINAL PAPER
Stability of a non-applanating handheld liquid patient interface for femtosecond laser-assisted cataract surgery Karl Thomas Boden . Martina Mariacher . Kai Januschowski . Katrin Boden . Annekatrin Rickmann . Peter Szurman . Berthold Seitz . Siegfried Mariacher
Received: 3 October 2019 / Accepted: 23 May 2020 Ó Springer Nature B.V. 2020
Abstract Purpose A stable and reliable vacuum is crucial for the correct planning and performance of femtosecond laser-assisted cataract surgery (FLACS) in order to avoid complications such as suction loss and cyclorotation. This study investigates, for the first time, the impact of different vacuum levels on the stability of the application of a liquid patient interface for FLACS in view of break-away forces. Methods Break-away forces were measured using a multifunctional material testing machine with a mounted digital manometer. Sixteen porcine eyes were docked to the patient interface of a femtosecond laser platform (FEMTO LDV Z8), and the impact of different vacuum levels between 300 and 500 mbar investigated. Results Mean break-away forces for each vacuum level were as follows: 1.78 N (± 0.58 N) for 300 mbar; 2.24 N (± 0.68 N) for 350 mbar; 2.66 N K. T. Boden (&) M. Mariacher K. Januschowski K. Boden A. Rickmann P. Szurman S. Mariacher Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar, An der Klinik 10, 66280 Sulzbach, Germany e-mail: [email protected] K. Januschowski P. Szurman Centre for Ophthalmology, University Eye Hospital Tuebingen, Schleichstr. 12, 72076 Tuebingen, Germany B. Seitz Department of Ophthalmology, Saarland University Medical Center UKS, Homburg Saar, Germany
(± 0.68 N) for 400 mbar; 2.86 N (± 0.77 N) for 420 mbar; and 3.49 N (± 0.86 N) for 500 mbar. Conclusion The stability increases with the vacuum in a nearly linear manner. Vacuum levels higher than 500 mmHg and lower than 350 mmHg are not recommended for FLACS. Keywords Liquid patient interfaces Laser-assisted cataract surgery FLACS Break-away forces Cataracts
Introduction Femtosecond laser-assisted cataract surgery (FLACS) requires a stable connection between the laser’s optic and the patient’s eye. The so-called patient interfaces that are docked to the ocular surface using suction rings with a vacuum offer the possibility to meet this requirement because a stable connection is crucial for safe application of the femtosecond laser beam [1]. In particular, the level of the vacuum could influence the stability of the patient interface. Most femtosecond lasers are stationary devices. Only the FEMTO LDV Z8 was designed as a real mobile femtosecond laser platform. Furthermore, the patient interface is a handheld part of the laser [1]. It can be positioned by the surgeon using his/her own manual forces guided by haptic feedback. However,
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each manufacturer has designed their own patient interface [2, 3]. The Ziemer LDV Z8 can create either an applanating (flat) or non-applanating (liquid)
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