Femtosecond lasers in ophthalmology.

Purpose: To provide an update and review of femtosecond (FS) lasers in clinical ophthalmology.

Design: Perspective, literature review, and commentary.

Methods: Selected articles from the literature and the authors' clinical and laboratory studies.

Results: The FS laser employs near-infrared pulses to cut tissue with minimal collateral tissue damage. Although its major use at present is in the cutting of laser in situ keratomileusis flaps, the laser has proven its versatility in laser-assisted anterior and posterior lamellar keratoplasty, cutting of donor buttons in endothelial keratoplasty, customized trephination in penetrating keratoplasty, tunnel creation for intracorneal ring segments, astigmatic keratotomy, and corneal biopsy. Current laboratory studies include all-FS laser refractive keratomileusis sans flap, cutting corneal pockets for insertion of biopolymer keratoprostheses, noninvasive transscleral glaucoma surgery, retinal imaging and photodisruption, presbyopia surgery, and anterior lens capsulorrhexis.

Conclusions: Advances in ultra-fast laser technology continue to improve the surgical safety, efficiency, speed, and versatility of FS lasers in ophthalmology.