Femtosecond laser assisted cataract surgery in phacovitrectomy. (original) (raw)
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Eye and Vision, 2016
Background: Femtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures. We decided to perform a comparative study to standard manual incision phacoemulsification surgery. Methods: This is a single-center, single-intervention, and prospective comparative data evaluation of 133 consecutive cases subjected to cataract surgery. Group-A (Phaco), manual capsulorhexis & ultrasound phacoemulsification (n = 66); Group-B femtosecond-laser assisted capsulorhexis and lens fragmentation (n = 67), employing the LenSx laser (Alcon Surgical, Ft. Worth, TX). All cases were evaluated for refraction, visual acuity, keratometry, tomography, pachymetry, endothelial cell counts, intraocular pressure, and type of intraocular lens (IOL) implanted. The groups were matched for age, gender, pre-operative vision metrics, and cataract grade, and were followed up to 1 year. Results: In group-A post-operative uncorrected distance visual acuity (UDVA) was 20/20 or better in 61.5 % and 20/25 or better in 78.5 % of the eyes. The femtosecond laser group-B had improved outcomes (p = 0.075 and p = 0. 042, respectively): post-operative UDVA was 20/20 or better in 62.7 % of the eyes and 20/25 or better in 85.1 %. Linear regression scatterplots of achieved versus attempted spherical equivalent had excellent regression coefficients (r 2 = 0.983 in group-A and 0.979 in group-B). There were 75.2 % cases in group-A and 80.6 % in group-B (p = 0.8732) within ±0.50 D of targeted refractive equivalent. Slight trend of under-correction was noted in group-A. Average residual manifest cylinder in the toric subgroup-A was-0.50 D (95 % Limit-of-Agreement (LoA) =-0.78 D), and in toric subgroup-B-0.45 D (LoA =-0.45 D). Conclusions: Mean spherical equivalent refraction and visual acuity are comparable with laser cataract surgery compared with manual capsulorhexis & ultrasound phacoemulsification. Improved astigmatism correction may be among the benefits of femtosecond laser-assisted cataract surgery. Transient corneal edema may be a first day transient disadvantage in femtosecond laser-assisted cataract surgery.
Digital Journal of Ophthalmology, 2017
We describe a case of femtosecond laser-assisted cataract surgery (FLACS) in an eye with multiple comorbidities, including retinal detachment surgery, high myopia, posterior chamber phakic intraocular lens (PC pIOL) and residual, emulsified, silicone oil located in the anterior chamber. FLACS was affected by the optical blockage, but the incomplete capsular tear was recoverable. The case suggests that silicone oil bubbles concentrated at the dome of the posterior corneal surface, along with the PC pIOL optic edges and scars after corneal astigmatic relaxing incisions can lead to incomplete anterior capsulotomy.
Femtosecond laser-assisted cataract surgery versus 2.2 mm clear corneal phacoemulsification
Indian Journal of Ophthalmology, 2017
Phacoemulsification is the surgical procedure of choice for cataract, providing excellent visual and safety outcomes. Femtosecond laser-assisted cataract surgery (FLACS) is an addition to the surgical armamentarium. The study aims to compare the outcomes of FLACS using LenSx ™ (Alcon Inc., USA) to standard 2.2 mm clear corneal phacoemulsification. Prospective case-control, comparative, interventional study was conducted in a tertiary care center. Methods: In each group, 55 eyes of 55 patients underwent cataract surgery using either FLACS or conventional phacoemulsification (control group). The primary outcome variables, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), specular microscopy, pachymetry, mean absolute error (MAE), and anterior chamber depth (ACD) were compared between two groups at 4 weeks postoperatively. Intraoperative effective phaco time (EPT), postoperative circularity of the rhexis, capsular overlap over the edge of the intraocular lens (IOL), and decentration of the IOL were the secondary variables which were compared. Results: No significant difference was found between the groups for UCVA, pachymetry, MAE, and ACD at 4 weeks postoperatively. The FLACS group had better BCVA (P = 0.0294). Circularity of capsulorrhexis (P = 0), circular overlap over the edge of IOL (P = 0), and centration of IOL (P = 0.002) at 4 weeks postoperatively were better in the FLACS group. EPT was lower in FLACS for similar grade of cataract (P = 0). Endothelial cell loss in FLACS group was 4.2% more (P = 0.032). Conclusions: FLACS is superior to conventional phaco in the circularity of rhexis, capsular overlap, and centration of the IOL and uses less EPT. However, conventional phacoemulsification is equivalent to FLACS in most other parameters.
Medicine, 2019
The purpose of our study was to compare the selected parameters of the anterior segment of the eye in patients after femtosecond laser-assisted cataract surgery (FLACS) with the results of microincision cataract surgery (MICS) and conventional phacoemulsification surgery (CPS). This single-center prospective randomized comparative observational study included 87 patients. Patients were randomly selected into group A (FLACS), group B (MICS) and group C (control group). All the surgeries were performed by the same experienced surgeon. Preoperative and postoperative parameters were evaluated: best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss percentage (ECL%), central corneal thickness (CCT), central anterior and posterior corneal astigmatism induction, posterior corneal elevation map were measured. Intraoperative parameters: effective phacoemulsification time (EPT), balanced salt solution use (BSS use), total surgical time and suction time were analyzed. Examination was performed preoperatively and on the first, seventh day, one and six months postoperatively. The follow up period was 6 months. There was no statistically significant difference in BCVA, central anterior and posterior astigmatism induction between studied groups. The ECL% was statistically significant lower in the group A on the 7th day, 1 month and 6-months postoperatively (P < .05). The CCT was statistically significant lower in the group A and in the group B than in the group C on the 7th postoperative day (P = .002). However, in the 6 months follow-up there was no statistically significant difference in the CCT between studied groups (P = .133). We observed statistically significant difference in change of the posterior corneal elevation map at the periphery assessed within the 90°to 120°meridian range between group A, group B and group C at every timepoint postoperatively (P < .05). The EPT and BSS use were statistically significant lower whilst total surgery time was statistically significant higher in the FLACS group (P < .05). To conclude in the 6 months follow-up there was statistically significant difference found between eyes undergoing FLACS, MICS and CPS with respect to the posterior corneal elevation map assessed within the studied range, ECL%, EPT, BSS use and total surgery time. Postoperative BCVA, central anterior and posterior astigmatism induction, CCT were comparable between studied groups. Abbreviations: BCVA = best-corrected visual acuity, BSS use = balanced salt solution use, CCT = central corneal thickness, CPS = conventional phacoemulsification surgery, ECD = endothelial cell density, ECL% = endothelial cell loss percentage, EPT = effective phacoemulsification time, FDA = Food and Drug Administration, FLACS = femtosecond laser-assisted cataract surgery, IOL = intraocular lens, LCS = laser cataract surgery, LOCS = Lens Opacities Classification System, MICS = microincision cataract surgery, NC = nuclear color, NO = nuclear opacity, OVD = ophthalmic viscosurgical device, RCTs = randomized controlled trials, SD = standard deviation; MD = mean difference, SICS = small incision cataract surgery.
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.
Clinical & experimental ophthalmology, 2017
To compare the safety and outcomes of femtosecond laser assisted cataract surgery and conventional phacoemulsification in post-vitrectomy eyes. To compare visual outcomes and adverse outcomes of femtosecond laser assisted cataract surgery and conventional phacoemulsification in vitrectomised eyes. Single surgeon, retrospective study set in a private clinic in Auckland, New Zealand. Patients selected in a chronological manner, without masking or randomisation. Only patients undergoing cataract extraction following vitrectomy were included. The last 25 surgeries performed prior to acquisition of the femtosecond laser and the first 25 surgeries performed following acquisition of the femtosecond laser were included. Patient demographic data, pre and post-operative visual acuities were collected. Intra and post-operative complications were compared. Follow-up ranged from 1-74 months. The main outcome measures are post-operative visual outcomes and intra and post-operative complications f...
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.
BMC Ophthalmology, 2019
Background: In this analysis, we aimed to systematically compare the complications which were associated with femtosecond laser-assisted cataract surgery (FLACS) versus the conventional phacoemulsification surgery (CPE). Methods: Commonly used search databases, specifically MEDLINE, Cochrane Central, EMBASE, and http://www. clinicaltrials.gov were carefully searched for English publications comparing FLACS versus CPE. The selected endpoints which were assessed included incomplete capsulotomy, anterior capsulotomy tag, anterior capsule tear, posterior capsule tear, injury to the descemet's membrane, zonular dialysis, vitreous loss, macular or corneal edema, and elevated intra-ocular pressure. Statistical analysis was carried out by the latest version of the RevMan software (version 5.3) and represented by risk ratios (RR) with 95% confidence intervals (CI). Results: A total number of 7156 participants were included. Three thousand five hundred and fifty four (3554) participants were assigned to the FLACS group. The risks for incomplete capsulotomy, anterior capsulotomy tag, and anterior capsular tear were significantly higher with FLACS (RR: 22.