Purpose:

To describe the outcomes of femtosecond laser assisted cataract surgery (FLACS) in difficult and challenging cases presenting through a charitable outreach program.

Methods:

This study comprised a retrospective chart review of cases performed as part of Mission Cataract, an annual charitable service performed at Center for Sight, Sarasota, FL. During the years 2015 – 2020, inclusive, approximately 450 patients underwent FLACS (LENSAR, Orlando, FL) through this program. Multiple systemic and ocular comorbidities were present in this population, as well as difficult and challenging cases such as Morgagnian, dense posterior subcapsular and polar cataracts. Many patients were legally blind prior to surgery.

Results:

Challenging cases included 28 eyes of 23 patients with 4+ nuclear sclerosis (5), white cataract (6), mature cataract (3), rubescent cataract with pseudo exfoliation (2), rubescent cataract (1), traumatic cataract (1), Morgagni an cataract (1), large pterygium (1), corneal endothelial dystrophy (5), and history of retinal detachment (2). Preoperative corrected visual acuity was CF or worse in 12 eyes. There was poor or no view of the fundus in 20 eyes. Postoperative corrected visual acuity was 20/20 in 17 (60.7%) and 20/40 or better in 22 (78.6%) eyes. Visual acuity improved in all eyes. Vitreous prolapse occurred in 1 eye with white cataract, which achieved 20/30 corrected visual acuity.

Conclusions:

FLACS offers a viable approach to difficult and challenging cases. Charitable outreach provides a valuable service to the community by alleviating the burden of preventable blindness.