Safety and surgical outcomes of femtosecond laser-assisted cataract surgery (original) (raw)
Related papers
Journal of cataract and refractive surgery, 2017
To describe a large cohort of femtosecond laser-assisted cataract surgeries in terms of baseline characteristics and the related outcomes. Eighteen cataract surgery clinics in 9 European countries and Australia. Prospective multicenter case series. Data on consecutive eyes having femtosecond laser-assisted cataract surgery in the participating clinics were entered in the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO). A trained registry manager in each clinic was responsible for valid reporting to the EUREQUO. Demographics, preoperative corrected distance visual acuity (CDVA), risk factors, type of surgery, type of intraocular lens, visual outcomes, refractive outcomes, and complications were reported. Complete data were available for 3379 cases. The mean age was 64.4 years ± 10.9 (SD) and 57.8% (95% confidence interval [CI], 56.1-59.5) of the patients were women. A surgical complication was reported in 2.9% of all cases (95% CI, 2.4-3.5). The me...
Clinical Ophthalmology, 2018
The aim of the study was to determine whether femtosecond-assisted laser cataract surgery (FLACS) reduces the posterior capsular complication (PCC) rate compared to manual cataract surgery when performed by an experienced surgeon. Patients and methods: We reviewed 2,021 consecutive FLACS procedures between 1 June 2012 and 30 August 2017. All cases of posterior capsular rupture (PCR) with or without vitreous prolapse or zonular dialysis (ZD) that prevented an in-the-bag placement of the intraocular lens were included. Risk factors were noted and outcomes documented. Results: Six eyes of 2,021 (0.3%) who underwent FLACS had either a PCR or ZD. One eye (0.25%) of 403 eyes that had manual cataract surgery had a PCR. There was no significant difference in outcomes. Risk factors included advanced age, dense nuclei, pseudoexfoliation and small pupil. Only a single case in the FLACS series may have been directly attributed to the FLACS procedure. Conclusion: This study provides evidence that there is no significant difference in the PCC rate between FLACS and manual cataract surgery in the hand of an experienced surgeon who performs 350 cases annually. This low rate of complications may be achieved by less experienced surgeons adopting FLACS.
Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons
Journal of Academic Ophthalmology
Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a signific...
Femtosecond laser-assisted cataract surgery compared with conventional cataract surgery
Clinical & Experimental Ophthalmology, 2012
T he femtosecond laser (FSL) is useful in ocular surgeries due to its ultrafast pulses in the range of 10-15 seconds and its decreased energy requirements for tissue destruction, allowing for reduced unintended destruction of surrounding tissues. 1,2 While FSLs were previously FDA-approved for use in lamellar corneal surgery, the modality was approved in 2010 for cataract surgery. There are three companies-OptiMedica (Santa Clara, CA), LenSx (recently acquired by Alcon, Fort Worth, TX), and LensAR (Winter Park, FL)-which will be discussed in this review. LensAR recently received 501(k) FDA approval for lens fragmentation and anterior capsulotomy. LenSx is now approved for lens fragmentation, anterior capsulotomy, and corneal incisions. OptiMedica is currently seeking FDA approval and is already available outside of the United States. Although there may be other laser platforms, this review will focus on these three companies due to their presence in published literature. Lasers have been utilized in cataract surgery since the 1970s, when Krasnov reported a laser modality for phacopuncture. 3 Subsequently in 1987, Peyman and Katoh focused an Erbium:YAG laser on the lens nucleus, inducing photoablation. 4 These efforts were harbingers of laser use in ocular surgery, which eventually led to investigations into FSL-assisted cataract surgery (FLACS). Methods to increase accuracy and precision in cataract surgery are being investigated because as lens implants become more advanced, patient expectations for near-perfect vision are increasing. These premium intraocular lenses (IOLs) also depend more on precise centration for optimal performance. 5-7 Accuracy standards for cataract surgery were set in the United Kingdom by Gale et al. in 2006 to reach ±0.50 diopter (D) for 55% of cases, and ±1.00 D for 85% of cases. 8 In comparison to these guidelines, Murphy et al. showed that with standard cataract surgery methods, 45% of patients were within the 0.50 D range, and 72% of patients were in the 1.00 D range. 9 As cataract surgery is the most common operation in the United
Femtosecond Laser-Assisted Cataract Surgery and Its Learning Curve
The Annual ASCRS and ASOA Symposium and Congress, 2014
Background: Cataract surgery after penetratingkeratoplasty (PKP) is often challenging due to changes in the integrity of the cornea caused by PKP. For example, corneal endothelial cell (CEC) loss and corneal edema commonly occur after traditional phacoemulsification cataract surgery in patients that previously had successful PKP. Recent studies have reported that femtosecond laser-assisted cataract surgery (FLACS) significantly reduces the need for ultrasound energy minimizing mechanical damage to the cornea and results in a reduction of CEC loss and corneal edema. Case presentation: We report a case in which FLACS was used in a patient with previous PKP. Conclusion: This case supports the suggestion that the use of the femtosecond laser improves the surgical outcome of cataract surgery after PKP. This improvement may be result of the precise incision, controlled capsulorhexis, and reduced lens fragmentation experienced with the femtosecond laser which helps to reduce potential complications of cataract surgery after PKP.
Indian Journal of Ophthalmology
The purpose of this study is to assess the learning curve in the initial 100 cases of cataract surgery performed using femtosecond laser-assisted cataract surgery (FLACS) by experienced cataract surgeons without prior experience in femtosecond laser platform. Methods: This study was conducted at tertiary care eye hospital, South India. This was a prospective interventional study. The first 100 consecutive eyes undergoing FLACS were studied to understand docking time, number of docking attempts, problems encountered during docking, and complications attributable to docking. Phacoemulsification performed after femtosecond laser was also studied for complications, need for additional instrumentation, and total time required for surgery. Comparison was also made between two operating surgeons. Results: Successful docking was recorded in 70% eyes at the first attempt. Mean time taken for successful docking was 9.3 ± 6.4 min (median = 6 min, interquartile range (IQR) = 5-10 min, range = 4-35 min). When surgeries were divided into quartiles, docking time reduced significantly from 16.2 ± 7.9 min in the first quartile to 6.2 ± 2.7 min in the fourth quartile (P < 0.001). Phacoemulsification postdocking required 12.9 ± 6.2 min (median = 10 min, IQR = 9-17.5 min). Six eyes showed anterior capsular tags, one had radial extension of capsulorhexis, and two eyes showed pupillary miosis after femtosecond laser application. At 6 weeks, 79% eyes attained uncorrected vision of 20/20, and all eyes had best-corrected vision of 20/20. Conclusion: Approximately 25-30 cases were required before obtaining reproducible results with FLACS, irrespective of cataract surgical experience, suggesting that training programs must offer a minimum 25 surgeries. Very few complications occurred during the learning curve, making it patient friendly.
Ophthalmology, 2018
Femtosecond laser-assisted cataract surgery (FLACS) has emerged as an alternative to manual cataract surgery (MCS) for corneal incision and capsulorhexis creation, as well as nuclear fragmentation. This study compares postoperative refractive and visual outcomes in eyes receiving MCS or FLACS. Single-center, comparative, retrospective cohort analysis. Consecutive eyes receiving FLACS and MCS from July 1, 2012, to July 31, 2015, at a single tertiary care center. Demographic data, ocular history, preoperative measurements and biometry, and postoperative surgical results were retrospectively obtained and statistically analyzed using a generalized linear mixed model adjusting for differences in baseline characteristics and within-patient correlation. A 2-tailed P value <0.05 was considered statistically significant throughout the study. Percentage of eyes achieving absolute error (AE) ≤0.5 diopters (D). Secondary outcomes included percentage of eyes with AE ≤0.25 D and ≤1.0 D, and pe...
The journey to femtosecond laser-assisted cataract surgery: new beginnings or a false dawn?
Br J Ophthalmol, 2013
Femtosecond laser-assisted cataract surgery (FLACS) represents a potential paradigm shift in cataract surgery, but it is not without controversy. Advocates of the technology herald FLACS as a revolution that promises superior outcomes and an improved safety profile for patients. Conversely, detractors point to the large financial costs involved and claim that similar results are achievable with conventional small-incision phacoemulsification. This review provides a balanced and comprehensive account of the development of FLACS since its inception. It explains the physiology and mechanics underlying the technology, and critically reviews the outcomes and implications of initial studies. The benefits and limitations of using femtosecond laser accuracy to create corneal incisions, anterior capsulot-omy, and lens fragmentation are explored, with reference to the main platforms, which currently offer FLACS. Economic considerations are discussed, in addition to the practicalities associated with the implementation of FLACS in a healthcare setting. The influence on surgical training and skills is considered and possible future applications of the technology introduced. While in its infancy, FLACS sets out the exciting possibility of a new level of precision in cataract surgery. However, further work in the form of large scale, phase 3 randomised controlled trials are required to demonstrate whether its theoretical benefits are significant in practice and worthy of the necessary huge financial investment and system overhaul. Whether it gains widespread acceptance is likely to be influenced by a complex interplay of scientific and socio-economic factors in years to come.
Femtosecond Laser Versus Manual Clear Corneal Incision in Cataract Surgery
Journal of Refractive Surgery, 2014
everal factors can lead to poor incision architecture during phacoemulsification. These include incorrect construction by an inexperienced or even an experienced surgeon and stretching of the wound during difficult surgical cases. 1 A study showed that when experienced surgeons attempted three-plane incisions only 32% were threeplane tunnels, 64% were two-plane tunnels, and 4% were one-plane tunnels. 1 Studies using anterior segment optical coherence tomography (AS-OCT) after cataract surgery for corneal assessment at the incision site disclosed the most frequent architectural features of the cornea. 2 Although contact ultrasound pachymetry is widely considered the gold standard for measurement of central corneal thickness, AS-OCT presents advantages in corneal imaging over ultrasonic devices, including twodimensional imaging of the anterior segment that allows measurements from a cross-sectional image through a precise selected corneal location and the absence of any contact with the surface of the eye during examination. 3-5 Recently, the use of femtosecond laser was introduced in cataract surgery to perform corneal incisions, capsulorhexis, and nuclear fragmentation. 6,7 In a preliminary study on cadaver eyes, Masket et al. demonstrated that femtosecond laser-assisted cataract incisions were reproducible and stable, particularly for corneal incisions with a length of 2.0 mm. 8 Femtosecond laser performance of CCI could potentially improve incision architecture by increasing the precision with which the automated incision is made and reducing S ABSTRACT PURPOSE: To compare functional and morphological outcomes of femtosecond laser clear corneal incision (CCI) versus manual CCI during cataract surgery. METHODS: Sixty eyes of 60 patients who underwent CCI during cataract surgery were randomized into two groups: femtosecond laser CCI (30 eyes) and manual CCI (30 eyes). RESULTS: There were no significant between-group differences in uncorrected distance visual acuity, corrected distance visual acuity, surgically induced astigmatism, and corneal aberrations. Keratometric astigmatism was significantly lower in the femtosecond laser CCI group compared to the manual CCI group at 30 and 180 days (P < .05). Central endothelial cell count was significantly higher in the femtosecond laser CCI group compared to the manual CCI group at 7 and 30 days postoperatively (P < .05). A lower increase of corneal thickness at the incision site was observed at 30 and 180 days postoperatively in the femtosecond laser CCI group compared to the manual CCI group (P < .05). In addition, femtosecond laser CCI showed a better morphology (lower percentage of endothelial and epithelial gaping and endothelial misalignment) compared to manual CCI at different time points. Total phacoemulsification time was significantly lower in the femtosecond laser CCI group (P < .05). CONCLUSIONS: The femtosecond laser procedure was safe, efficient, and less damaging, as evidenced by lower central endothelial cell loss, lower increase of corneal thickness at the incision site, and better tunnel morphology compared to the manual technique.