Laser frugal pour la chirurgie de la cataracte : concept innovant / Frugal laser for cataract surgery: an innovative concept
Seance of wednesday 19 october 2022 (Lasers et ophtalmologie - Invité d'honneur Gérard MOUROU Prix Nobel de Physique 2018 et la présence de Catherine DEROCHE, Présidente de la Commission des Affaires Sociales du Sénat)
DOI number : 10.26299/x4zr-py52/emem.2022.30.05
Abstract
Le laser femtoseconde (FS) a fait son entrée en Ophtalmologie avec la mise au point du microkératome laser pour la correction cornéenne de la myopie dans les années 2000, en alternative à la méthode de découpe mécanique. Devant son essor, d’autres champs d’applications ont été développés pour la cornée et la compensation de la presbytie par photo-ramollissement du cristallin a ainsi été envisagée puis testée. Peu efficace pour la presbytie, ce dernier développement a en revanche permis la mise au point de machines calibrées pour assister la chirurgie du cristallin lors de l’extraction de la cataracte. L’importante sophistication de ces machines et des procédures afférentes n’ont cependant pas permis la démocratisation de leur usage pour des raisons essentiellement médico-économiques. L’objet de cette présentation est de montrer le cheminement d’un projet alternatif débuté à Bordeaux en 2015 visant à promouvoir la diffusion du laser FS dans la chirurgie du cristallin. L’ambition fut dès lors de concevoir un objet technologique mais néanmoins assez frugal pour atteindre un meilleur compromis entre le coup et le service-rendu. La startup ILASIS a donc été fondée en 2019 pour répondre à un cahier des charges innovant, plutôt en rupture avec les habitudes inflationnistes des dispositifs médicaux laser de référence. Le système vise ainsi uniquement le capsulorhèxis, c'est-à-dire l’essentiel de ce que peut apporter l’usage du laser. Ce dernier consiste en une ouverture circulaire réalisée habituellement manuellement à la pince à la face avant du cristallin et qui se voudrait systématiquement régulier, concentrique et centré grâce au laser. Ce point est crucial pour optimiser le placement et l’effet réfractif des implants intraoculaires compensant le retrait du cristallin. Le laser permet également de le faire ce geste délicat en amont de l’ouverture de l’œil, sans perte de temps dans le circuit opératoire. L’outil est conçu pour diminuer drastiquement la complexité opératoire, l’encombrement et la maintenance des lasers FS traditionnellement disponibles. Il reste totalement asservi à la décision de centrage et de tir du chirurgien, en simple prolongation de sa main. Nous pensons que la conception épurée et la frugalité de l’outil laser ILASIS pourraient séduire le marché de la chirurgie prémium de la cataracte dans les années à venir.
Mots clés : laser, femtoseconde, frugalité, capsulorhèxis, cristallin
The femtosecond laser (FS) made its entry in Ophthalmology with the development of the laser microkeratome for corneal correction of myopia in the 2000s, as an alternative to the mechanical cutting method. In view of its rapid development, other fields of application were developed for the cornea and the compensation of presbyopia by photo-softening of the crystalline lens was thus envisaged and tested. Although not very effective for presbyopia, this latest development has enabled the development of calibrated machines to assist lens surgery during cataract extraction. The considerable sophistication of these machines and the related procedures have not, however, allowed their use to be democratized for essentially medio-economic reasons. The purpose of this presentation is to show the progress of an alternative project started in Bordeaux in 2015 to promote the diffusion of the FS laser in crystalline lens surgery. The ambition was then to design a technological object but nevertheless frugal enough to achieve a better compromise between the cost and the service rendered. The startup ILASIS was therefore founded in 2019 to meet an innovative set of specifications, rather at odds with the inflationary habits of the reference laser medical devices. The system is thus aimed solely at capsulorhexis, i.e. the essential part of what laser use can provide. The latter consists of a circular opening usually made manually with forceps on the anterior side of the lens, which should be systematically regular, concentric, and centered thanks to the laser. This is crucial to optimize the placement and the refractive outcomes of the intraocular implants designed to compensate for the lens removal. The laser also makes it possible to perform this delicate procedure before the eye is opened, without losing time in the operating workflow. The tool is designed to drastically reduce the operating complexity, space requirements and maintenance of traditionally available FS lasers. It remains totally subservient to the surgeon's centering and firing decision, simply by extending his hand. We believe that the streamlined design and frugality of the ILASIS laser tool could appeal to the premium cataract surgery market in the following years.
Key words : laser, femtosecond, frugality, capsulorhexis, crystalline lens
Mots clés : laser, femtoseconde, frugalité, capsulorhèxis, cristallin
The femtosecond laser (FS) made its entry in Ophthalmology with the development of the laser microkeratome for corneal correction of myopia in the 2000s, as an alternative to the mechanical cutting method. In view of its rapid development, other fields of application were developed for the cornea and the compensation of presbyopia by photo-softening of the crystalline lens was thus envisaged and tested. Although not very effective for presbyopia, this latest development has enabled the development of calibrated machines to assist lens surgery during cataract extraction. The considerable sophistication of these machines and the related procedures have not, however, allowed their use to be democratized for essentially medio-economic reasons. The purpose of this presentation is to show the progress of an alternative project started in Bordeaux in 2015 to promote the diffusion of the FS laser in crystalline lens surgery. The ambition was then to design a technological object but nevertheless frugal enough to achieve a better compromise between the cost and the service rendered. The startup ILASIS was therefore founded in 2019 to meet an innovative set of specifications, rather at odds with the inflationary habits of the reference laser medical devices. The system is thus aimed solely at capsulorhexis, i.e. the essential part of what laser use can provide. The latter consists of a circular opening usually made manually with forceps on the anterior side of the lens, which should be systematically regular, concentric, and centered thanks to the laser. This is crucial to optimize the placement and the refractive outcomes of the intraocular implants designed to compensate for the lens removal. The laser also makes it possible to perform this delicate procedure before the eye is opened, without losing time in the operating workflow. The tool is designed to drastically reduce the operating complexity, space requirements and maintenance of traditionally available FS lasers. It remains totally subservient to the surgeon's centering and firing decision, simply by extending his hand. We believe that the streamlined design and frugality of the ILASIS laser tool could appeal to the premium cataract surgery market in the following years.
Key words : laser, femtosecond, frugality, capsulorhexis, crystalline lens