Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery

Comparatively analysing the postoperative optical performance of different intraocular lenses: a prospective observational study

BACKGROUND

Postoperative performance, including best corrected distance visual acuity (BCDVA) and optical metrics (from the OQAS and iTrace devices), was compared among 4 different intraocular lenses (IOLs).

METHODS

This prospective observational study included 104 eyes from 104 subjects who underwent cataract surgery combined with implantation of 4 different IOLs: monofocal (Mon) IOLs, segmental refractive (SegRef) IOLs, diffractive (Dif) IOLs and extended depth of focus (EDoF) IOLs. Postoperative BCDVA and optical metrics were collected at the 6th month. The OQAS optical metrics included the objective scattering index (OSI), Strehl ratio (SR), modulation transfer function (MTF) cut-off frequency, and predicted visual acuity (PVA); the iTrace optical metrics included blur/double vision, glare/halo, starburst, mixed focus, night myopia, and night hyperopia.

RESULTS

There was no significant difference in BCDVA among the 4 groups (P = 0.059; power = 70.3%). Differences were observed in all OQAS optical metrics among the groups (all P < 0.001). Overall, Mon IOLs and EDoF IOLs exhibited better performance than Dif IOLs and SegRef IOLs. Starburst was the only iTrace optical metric that differed among the groups (P < 0.001): SegRef IOLs caused more starbursts than Mon IOLs (P = 0.001), Dif IOLs (P = 0.006) and EDoF IOLs (P < 0.001). Spearman rank correlation analysis was used to determine the relationships among the iTrace optical metrics, OQAS optical metrics and BCDVA: starburst was negatively correlated with BCDVA, PVA at contrasts of 100% and 20%, OSI, and MTF cut-off frequency (all P ≤ 0.001); mixed focus was positively correlated with BCDVA, PVA at contrasts of 100% and 20%, OSI, and MTF cut-off frequency (all P ≤ 0.001).

CONCLUSIONS

Postoperative BCDVA and optical metrics varied among the different IOLs, which should be taken into account in the selection and management of IOLs for cataract patients.

TRIAL REGISTRATION

This study was approved by the First Affiliated Hospital of Guangzhou Medical University Ethical Review Board (No. 50 2022).

Pattern of Preferred Cataract Surgery Practices in Morocco: A Survey-Based Study

Aim and methodology The aim of the study was to describe the preferred cataract surgery practices among Moroccan ophthalmologists and compare them with practices in other countries. An online survey consisting of 29 multiple-choice questions was sent to Moroccan ophthalmologists. The questions were centered on the preferred cataract surgical practices of the participants. All the data obtained were collected and analyzed. Results A total of 276 participants responded to the survey. Of these, 178 (64,50%) were in the age group of 31-50 years. The visual acuity for which the operative indication was made was 4/10 for 144 (52.4%) participants). The most popular type of anesthesia was topical, reported by 172 (62.4%). Stop-and-chop was the most used technique for routine cataract surgeries, while hydroprolapse of the nucleus was the leading technique for soft cataracts. The two measures are considered crucial for postoperative endophthalmitis prophylaxis: Povidone-iodine instillation into the conjunctival sac and intracameral antibiotics were performed by 267 (97%) and 276 (100%) participants, respectively. Nonsteroidal anti-inflammatory drugs were prescribed by only 128 (46.5%) surgeons. Conclusion This study provides some insight into the present cataract surgery techniques in Morocco, which might differ considerably from one country to another. Studies in various countries need to be undertaken to develop a consensus and reach some evidence-based patterns. This study may serve as a guide for young surgeons starting their careers based on what the standard procedures are among their seniors and peers.

Update on Femtosecond Laser-Assisted Cataract Surgery: A Review

The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.

Implantation of a capsular tension ring during cataract surgery attenuates predicted remodeling of the post-surgical lens capsule along the visual axis

Introduction: Cataract surgery permanently alters the mechanical environment of the lens capsule by placing a hole in the anterior portion and implanting an intraocular lens (IOL) that has a very different geometry from the native lens. We hypothesized that implant configuration and mechanical interactions with the post-surgical lens capsule play a key role in determining long-term fibrotic remodeling. Methods: We developed the first finite element-growth and remodeling (FE-G&R) model of the post-surgical lens capsule to evaluate how implantation of an IOL with and without a capsular tension ring (CTR) impacted evolving lens capsule mechanics and associated fibrosis over time after cataract surgery. Results: Our models predicted that implantation of a CTR with the IOL into the post-surgical lens capsule reduced the mechanical perturbation, thickening, and stiffening along the visual axis in both the remnant anterior and posterior portions compared to implantation of the IOL alone. Discussion: These findings align with patient studies and suggest that implantation of a CTR with the IOL during routine cataract surgery would attenuate the incidence of visually-debilitating capsule fibrosis. Our work demonstrates that use of such modeling techniques has substantial potential to aid in the design of better surgical strategies and implants.

Study on the impact and clinical effect of high-quality nursing intervention on the quality of life of elderly cataract patients

Objective

To evaluate the impact and clinical effect of high-quality nursing intervention on the quality of life of elderly cataract patients and its clinical effect.

Methods

This is a clinical comparative study. One hundred and twenty elderly cataract patients admitted to Tianjin Medical University Eye Hospital for surgical treatment were recruited and randomly divided into two groups: the control and experimental group, with 60 cases in each group from January 15, 2021 to January 15, 2022. Patients in the control group were given conventional nursing care in the perioperative period, while those in the experimental group were given high-quality nursing intervention in the perioperative period. The differences in anxiety (SAS) scores, depression (SDS) scores, intraocular pressure (IOP) recovery, the incidence of surgical complications and satisfaction before and after treatment between the two groups were compared and analyzed.

Results

No statistically significant difference was observed between the two groups in physical functioning, psychological functioning, social functioning and material life status scores before intervention(P>0.05). After the intervention, the above indicators improved significantly in the experimental group compared to the control group, with statistically significant differences (P=0.00). Moreover, SAS and SDS decreased significantly in the experimental group compared to the control group, with statistically significant differences(P=0.00).

Conclusions

High-quality nursing intervention improves various benefits in the treatment of elderly cataract patients, such as effectively reducing intraocular pressure, ameliorating patients' quality of life, lowering the incidence of postoperative complications, and improving patient satisfaction.

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification

BACKGROUND

During anesthesia administration for cataract surgery, low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing, with the use of additional drops intraoperatively increasing the risk of complications. Accordingly, there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.

AIM

To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.

METHODS

A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study. Patients were divided into the proparacaine surface anesthesia (SA) group (65 cases) and the compound acupuncture-medicine anesthesia group (CAMA group, 65 cases). Patients in the CAMA group were provided acupuncture analgesia in addition to SA. Preoperative anxiety [Self-Rating Anxiety Scale (SAS) score and state anxiety inventory (SAI) score], intraoperative stress, vital signs, analgesia, and cooperation, as well as postoperative adverse events, were compared between groups.

RESULTS

More marked reductions in anxiety were observed among patients in the CAMA group, with corresponding reductions in SAS and SAI scores. During the operation, no change in the secretion of E, NE, or Cor group compared to the preoperative period was observed in the CAMA, which was markedly lower than that in the SA group. Heart rate, blood pressure, and respiratory rate were more stable intraoperatively in the CAMA group. In addition, the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group. Accordingly, patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery. Furthermore, marked reductions in intraoperative adverse effects were observed in the CAMA group, indicating greater overall safety.

CONCLUSION

Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery

BACKGROUND

Cataract is the leading cause of blindness in the world and, as such, cataract surgery is one of the most commonly performed operations globally. Surgical techniques have changed dramatically over the past half century with associated improvements in outcomes and safety. Femtosecond lasers can be used to perform the key steps in cataract surgery, such as corneal incisions, lens capsulotomy and fragmentation. The potential advantage of femtosecond laser-assisted cataract surgery (FLACS) is greater precision and reproducibility of these steps compared to manual techniques. The disadvantages are the costs associated with FLACS technology.

OBJECTIVES

To compare the effectiveness and safety of FLACS with standard ultrasound phacoemulsification cataract surgery (PCS) by gathering evidence from randomised controlled trials (RCTs).

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov; the WHO ICTRP and the US Food and Drug Administration (FDA) website. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 May 2022.

SELECTION CRITERIA

We included RCTs where FLACS was compared to PCS.

DATA COLLECTION AND ANALYSIS

Three review authors independently screened the search results, assessed risk of bias and extracted data using the standard methodological procedures expected by Cochrane. The primary outcome for this review was intraoperative complications in the operated eye, namely anterior capsule, and posterior capsule tears. The secondary outcomes included corrected distance visual acuity (CDVA), quality of vision (as measured by any validated patient-reported outcome measure (PROM)), postoperative cystoid macular oedema complications, endothelial cell loss and cost-effectiveness. We assessed the certainty of the evidence using GRADE.

MAIN RESULTS

We included 42 RCTs conducted in Europe, North America, South America and Asia, which enrolled a total of 7298 eyes of 5831 adult participants. Overall, the studies were at unclear or high risk of bias. In 16 studies the authors reported financial links with the manufacturer of the laser platform evaluated in their studies. Thirteen of the studies were within-person (paired-eye) studies with one eye allocated to one procedure and the other eye allocated to the other procedure. These studies were reported ignoring the paired nature of the data. There was low-certainty evidence of little or no difference in the odds of developing anterior capsular tears when comparing FLACS and PCS (Peto odds ratio (OR) 0.83, 95% confidence interval (CI) 0.40 to 1.72; 5835 eyes, 27 studies) There was one fewer anterior capsule tear per 1000 operations in the FLACS group compared with the PCS group (95% CI 4 fewer to 3 more).  There was low-certainty evidence of lower odds of developing posterior capsular tears with FLACS compared to PCS (Peto OR 0.50, 95% CI 0.25 to 1.00; 5767 eyes, 26 studies). There were four fewer posterior capsule tears per 1000 operations in the FLACS group compared with the PCS group (95% CI 6 fewer to same).  There was moderate-certainty evidence of a very small advantage for the FLACS arm with regard to CDVA at six months or more follow-up, (mean difference (MD) -0.01 logMAR, 95% CI -0.02 to 0.00; 1323 eyes, 7 studies). This difference is equivalent to 1 logMAR letter between groups and is not thought to be clinically important. From the three studies (1205 participants) reporting a variety of PROMs (Cat-PROMS, EQ-5D, EQ-SD-3L, Catquest9-SF and patient survey) up to three months following surgery, there was moderate-certainty evidence of little or no difference in the various parameters between the two treatment arms. There was low-certainty evidence of little or no difference in the odds of developing cystoid macular oedema when comparing FLACS and PCS (Peto OR 0.84, 95% CI 0.56 to 1.28; 4441 eyes, 18 studies). There were three fewer cystoid macular oedema cases per 1000 operations in the FLACS group compared with the PCS group (95% CI 10 fewer to 6 more).  In one study the incremental cost-effectiveness ratio (ICER) (cost difference divided by quality-adjusted life year (QALY) difference) was GBP £167,620 when comparing FLACS to PCS. In another study, the ICER was EUR €10,703 saved per additional patient who had treatment success with PCS compared to FLACS. Duration ranged from three minutes in favour of FLACS to eight minutes in favour of PCS (I2 = 100%, 11 studies) (low-certainty evidence).  There was low-certainty evidence of little or no important difference in endothelial cell loss when comparing FLACS with PCS (MD 12 cells per mm2 in favour of FLACS, 95% CI -40 to 64; 1512 eyes, 10 studies).  AUTHORS' CONCLUSIONS: This review of 42 studies provides evidence that there is probably little or no difference between FLACS and PCS in terms of intraoperative and postoperative complications, postoperative visual acuity and quality of life. Evidence from two studies suggests that FLACS may be the less cost-effective option. Many of the included studies only investigated very specific outcome measures such as effective phacoemulsification time, endothelial cell count change or aqueous flare, rather than those directly related to patient outcomes. Standardised reporting of complications and visual and refractive outcomes for cataract surgery would facilitate future synthesis, and guidance on this has been recently published.

Cataract Surgery-Indications, Techniques, and Intraocular Lens Selection

BACKGROUND

Opacification of the lens of the eye (cataract) is usually due to aging. It is a painless, progressive condition that affects contrast and color perception and alters refraction, leading to visual loss that may be total. In cataract surgery, the turbid lens is replaced by an artificial lens. An estimated 600 000 to 800 000 such procedures are performed in Germany each year.

METHODS

This review is based on pertinent publications retrieved by a selective search in PubMed, including meta-analyses, Cochrane reviews, and randomized controlled clinical trials (RCTs).

RESULTS

Cataract is the most common reversible cause of blindness around the world (approximately 95 million people). The surgical replacement of a turbid lens with an artificial lens is usually carried out under local anesthesia. The standard technique for fragmentation of the nucleus of the lens is ultrasonic phacoemulsification. RCTs have not shown the superiority of the femtosecond laser over phacoemulsification for this purpose so far. The spectrum of artificial intraocular lenses, aside from the conventional type with a single focus, include lenses with multiple foci, extended-depth-of-focus (EDOF) lenses, and astigmatism-correcting lenses.

CONCLUSION

In Germany, cataract surgery is usually performed on an outpatient basis under local anesthesia. Artificial lenses with various additional functions are available nowadays; the choice of lens depends on the needs of the individual patient. Patients must be adequately informed about the advantages and disadvantages of the different lens systems.

Comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on corneal impact: A meta-analysis and systematic review

This meta-analysis aims to compare corneal injuries and function after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS). A comprehensive literature search of PubMed, EMBASE, and the Cochrane Controlled Trials Register was conducted to identify randomized controlled trials (RCT) and high-quality prospective comparative cohort studies comparing FLACS with CPS. Endothelial cell loss percentage (ECL%), central corneal thickness (CCT), endothelial cell density (ECD), endothelial cell loss (ECL), percentage of the hexagonal cell (6A), and coefficient of variance (CoV) were used as an indicator of corneal injury and function. Totally 42 trials (23 RCTs and 19 prospective cohort studies), including 3916 eyes, underwent FLACS, and a total of 3736 eyes underwent CPS. ECL% is significantly lower in the FLACS group at 1-3 days (P = 0.005), 1 week (P = 0.004), 1 month (P<0.0001), 3 months (P = 0.001), and 6 months (P = 0.004) after surgery compared to CPS. ECD and ECL appeared no statistically significant difference between the two groups, except for the significant reduction of ECD at 3 months in the CPS group (P = 0.002). CCT was significantly lower in the FLACS group at 1 week (P = 0.05) and 1 month (P = 0.002) early postoperatively. While at 1-3 days (P = 0.50), 3 months (P = 0.18), and 6 months (P = 0.11), there was no difference between the FLACS group and the CPS group. No significant difference was found in the percentage of hexagonal cells and the coefficient of variance. FLACS, compared with CPS, reduces corneal injury in the early postoperative period. Corneal edema recovered faster in the FLACS group in the early postoperative period. In addition, FLACS may be a better option for patients with corneal dysfunction.

Femtosecond laser-assisted cataract surgery: Update and perspectives

Cataract surgery is among the most frequently performed surgical procedures worldwide and has a tremendous impact on patients' quality of life. Phacoemulsification (PCS) is accepted as a standard of care; its technique has continuously evolved and already achieved good anatomical, visual, and refractive outcomes. Lasers in ophthalmology are widely used in clinical practice, femtosecond lasers (FSLs) for corneal surgery in particular. It was natural to assess the usefulness of FSL in cataract surgery as this technology was within reach. Indeed, precise and reproducible cuttings provided by FSL platforms could improve standardization of care and limit the risk associated with the human element in surgery and provide a step toward robot-assisted surgery. After docking and planning the procedure, femtosecond lasers are used to perform corneal incisions, capsulorhexis, lens fragmentation, and arcuate incisions in an automated manner. A well-constructed corneal incision is primordial as it offers safety during the procedure, self-seals afterward, and influences the refractive outcome. Capsulorhexis size, centration, and resistance to shearing influence the surgery, intraocular lens (IOL) centration and stability, and posterior capsular opacification formation. Lens fragmentation is where most of the energy is delivered into the eye, and its amount influences endothelial cell damage and potential damage to other ocular structures. The arcuate incisions offer an additional opportunity to influence postoperative astigmatism. Femtosecond laser-assisted cataract surgery (FLACS) has been a topic of research in many studies and clinical trials that attempted to assess its potential benefits and cost-effectiveness over PCS and is the subject of this mini-review.

Longitudinal evaluation of trifocal and extended depth of focus lenses implantation using standard automated perimetry parameters

PURPOSE

To evaluate reliability and global indices parameters from standard automated perimetry (SAP) in normal eyes undergoing phacoemulsification cataract surgery with implantation of trifocal or extended depth of focus intraocular lens (IOL).

METHODS

Prospective study to evaluate the effect of trifocal IOL AcrySof IQ PanOptix® and extended depth of focus intraocular lens (EDOF) Tecnis Symfony® IOL implantation on visual field parameters. Patients underwent SAP pre- and postoperatively. Reliability indices (false negative rate-FN, false positive rate-FP), global indices (foveal sensitivity threshold, visual field index-VFI, standard pattern deviation-PSD, mean deviation MD) and test duration were analyzed.

RESULTS

A total of 23 eyes from 13 patients were in the trifocal IOL group and a total of 22 eyes from 14 patients were in the EDOF group. The following results were obtained by analyzing pre- and postoperative SAP of EDOF IOL: the rate of change of FN was 1.95/1.41% (p = 0.61); FP 1.64/1.27 (p = 0.60); MD - 1.60/- 1.08 dB (p = 0.15); foveal sensitivity was 34.5/33.9 dB (p = 0.41); VFI 98.5/98.4% (p > 0.99); PSD 1.85/1.86 (p = 0.07); and for test duration 305.81/298.36 s (p = 0.35); all respectively. Analysis of pre- and postoperative parameters of trifocal IOL were the rates of change of FN 1.22/1.83% (p = 0.29); FP 1.65/1.48% (p = 0.95); MD - 1.55/- 1.37 dB (p = 0.19); foveal sensitivity 33.9/34.9 dB (p = 0.47); VFI 98.6/98.3% (p = 0.62); PSD 1.58/2.05 (p = 0.02); and test duration 297.17/298.57 s (p = 0.87); all respectively.

CONCLUSION

We identified a change in the PSD parameters in the trifocal IOL group. No other significant changes were identified in SAP parameters after implantation of trifocal AcrySof IQ PanOptix® and EDOF Tecnis Symfony® IOL. Longitudinal evaluation showed no changes in SAP after Trifocal and EDOF IOL implantation in normal subjects.

Correlations of Immediate Corneal Tomography Changes with Preoperative and the Elapsed Phaco Parameters

Purpose

The ability to predict corneal edema and understand its relationship with imaging parameters enables optimization of decision-making in terms of cataract surgery. Therefore, we aimed to elucidate the immediate tomographic alterations after phacoemulsification.

Patients and Methods

In this prospective study, we evaluated clinical and corneal tomographic data of 30 patients with cataracts, obtained using a rotating Scheimpflug tomographic system before and after cataract surgery with a phacoemulsification system. Corneal thickness and volume were measured, and Pentacam Nucleus Staging, keratometry, and specular microscopy were performed preoperatively and immediately postoperatively. The Wilcoxon signed-rank test was used to compare pre-and postoperative values. We calculated the correlations between the changes in these values and multiple parameters related to phacodynamics, including “ultrasound (US) elapsed” (phaco time), “US average” (average power used), and “US absolute” (energy effectively dissipated, a product of the other two parameters).

Results

There were increases in corneal volume (p<0.0001) and pachymetry (p<0.0001), and a decrease in endothelial cell count (p<0.0001) after surgery. The mean differences in pre- and postoperative specular microscopy, corneal volume, and pachymetry were −335.13±236.21 cells/mm³, 1.33±0.56 mm³, and 61.33±23.73 microns, respectively. The difference in pre-and postoperative corneal volume in patients with US elapsed ≥40 s was 0.75 mm³ greater than that in patients with US elapsed <40 s (95% confidence interval [CI]: 0.24–1.25; p=0.005); that of pachymetry in patients with US elapsed ≥40 s was 31.76 microns greater than that in patients with US elapsed <40 s (95% CI: 9.55–53.97; p=0.007). Spearman correlation revealed that, for every 1% increase in cataract density, the US average value increased by 0.31% (coef.: 0.3110; 95% CI: 0.0741–0.5490; p=0.012).

Conclusion

Knowledge of Pentacam Nucleus Staging and the effect of US elapsed on differences in corneal volume and pachymetry before and after cataract surgery should be of particular value for surgeons who routinely encounter patients with hard cataracts.

Ultrasound-assisted ocular drug delivery: A review of current evidence

Efficient ocular drug delivery is a challenging clinical problem with various therapeutic options but no clearly preferred methodology. Given the ubiquity of ultrasound as a diagnostic technique, the safety profile of ultrasound in an ocular context, and the prospect of custom-made ultrasound-sensitive contrast agents, ultrasound presents an attractive ocular drug delivery modality. In this review, we evaluate our present understanding of ultrasound as it relates to ocular drug delivery and significant knowledge gaps in the field. In doing so, we hope to call attention to a potentially novel drug delivery pathway that could be manipulated to treat or cure ocular diseases.

Efficacy of Balanced Torsional Phacoemulsification Tip for Cataract Surgery

Purpose:

To compare the efficacy of the Intrepid® Balanced torsional phacoemulsification tip to that of the 30° Ozil® and 45° Kelman® tips using Centurion Vision System.

Methods:

This study included 150 eyes that underwent torsional phacoemulsification surgery using 30° Ozil^® tip (Group 1, 48 eyes), Intrepid^® Balanced tip (Group 2, 52 eyes), or 45° Kelman^® tip (Group 3, 50 eyes). Ultrasound time (UST), cumulative dissipated energy (CDE), average phaco power, average torsional amplitude, balanced salt solution volume, aspiration and operation time, and preoperative, postoperative corrected distance visual acuity, central corneal thickness were recorded.

Results:

The mean UST, CDE, average phaco power, average torsional amplitude were 49.9 ± 15.7 s, 10.8 ± 4.5%-s, 23.9 ± 4.6%, and 51.4 ± 5.7% in the Ozil^® group and 47.5 ± 10.6 s, 5.3 ± 2.2%-s, 12.5 ± 5.3%, and 28.9 ± 7.2% in the Intrepid® Balanced group, and 48.1 ± 12.7 s, 6.9 ± 3.3%-s, 18.9 ± 5.9%, and 39.2 ± 7.9% in the Kelman^® group, respectively. The CDE, average phaco power, and average torsional amplitude of the Intrepid® Balanced group were significantly lower than other groups (P < 0.05). There was no statistically significant difference between the three groups in terms of UST and operation time (P > 0.05).

Conclusion:

Intrepid^® Balanced tip, by means of its distinctive “double bent” design and balanced energy distribution, offers more effective phacoemulsification compared to conventional 30° Ozil^® and 45° Kelman^® tips.

CONTEMPORARY PRACTICES IN CATARACT SURGERY - SUBJECTIVE PREFERENCES OF CZECH CATARACT SURGEONS

AIMS

The aim of the work was to find out the current subjective preferences of Czech cataract surgeons in terms of individual procedures, techniques and materials used during cataract surgery.

MATERIAL AND METHODS

This study was conducted in the form of a questionnaire (online, a total of 44 questions). The survey respondents were members of the Czech Society of Refractive and Cataract Surgery. Questions 1-10 concerned the characteristics of the respondent (age, number of operations performed, type of workplace, etc.). Questions 11-20 focused on the surgical procedure used by the specific surgeon (anaesthesia, viscomaterial, position of the main incision, use of antibiotics at the end of the operation, etc.). Questions 21-34 concerned the type of intraocular lens used. Lastly, in questions 35-44, respondents were asked about their individual preferences if cataract surgery were to be performed on them.

RESULTS

The questionnaire was fully or partially completed by 72 surgeons (26% of the originally approached subjects). Most of the respondents were experienced surgeons, 74.5% of them have been performing surgeries for more than 10 years, out of which 55.5% perform more than 500 operations per year. The average age of the respondents was 50 years. 65.3% of surgeons use hydroxypropylmethylcellulose during surgery, 74% do not use a femtosecond laser for surgery, 50% never perform posterior circular capsulorhexia, and 98% apply antibiotics to the anterior chamber at the end of surgery. Surgeons predominantly use hydrophobic (80.8%), aspherical (72.3%), clear (54.3%), single-focal (97.9%) and non-preloaded (78.3%) lenses. However, if they were not limited or restricted in any way in their choice, they would prefer aspherical lenses (94.6%), multifocal or extended-focus lenses (78%) and preloaded lenses (96.8%).

CONCLUSION

The subjective preferences of Czech cataract surgeons are relatively variable regarding the individual steps. Often the procedures used do not always correspond with the actual preferences of the surgeon. On the contrary, there is almost complete unity in the steps recommended by professional societies (intracameral antibiotics at the end of the operation).

Phacoemulsification: Proposals for Improvement in Its Application

A cataract is defined as opacity of the crystalline lens. It is currently one of the most prevalent ocular pathologies and is generally associated with aging. The most common treatment for cataracts is surgery. Cataract surgery is a quick and painless process, is very effective, and has few risks. The operation consists of removing the opacified lens and replacing it with an intraocular lens. The most common intraocular lens removal procedure that is currently used is phacoemulsification. The energy applied in this process is generated by ultrasonic waves, which are mechanical waves with a frequency higher than 20 kHz. A great deal of research on the different ways to perform the stages of this surgical procedure and the analysis of the possible side effects of the operation has been published, but there is little information on the technical characteristics, the intensities applied, and the use of ultrasound-emitting (U/S) equipment for cataract removal. More studies on the method and depth of absorption of ultrasonic waves in our visual system when performing the phacoemulsification procedure are needed. It would be advisable for health authorities and medical professionals to develop guidelines for the handling and use of ultrasonic wave-emitting equipment, such as those that exist for ultrasound and physiotherapy. This could help us to reduce undesirable effects after the operation.

Refractive Outcomes in Fuchs' Endothelial Corneal Dystrophy: Conventional and Femtosecond Laser-Assisted Cataract Surgery

Purpose

To investigate the refractive outcomes of eyes with Fuchs’ endothelial corneal dystrophy (FECD) following phacoemulsification.

Methods

This is a retrospective chart review of patients with FECD who underwent phacoemulsification. Manifest refraction at the early postoperative period (1–6 weeks) and late postoperative period (3–12 months) was collected. The spherical equivalent (SE) and variance of SE from target in diopters (D) were analyzed.

Results

A total of 219 eyes from 175 FECD patients (73 FLACS, 146 conventional phacoemulsification) were included. In the early postoperative period, when comparing variance from intended target, 62% (n=126) had a SE variance of ≤0.5 D, 22% (n=44) >0.5 D and ≤1 D, and 17% (n=34) >1 D. In the late postoperative period, 62% (n=85) had a SE variance of ≤0.5 D, 19% (n=26) >0.5 D and ≤1 D, and 20% (n=27) >1 D. There was no difference in the variance of SE comparing FLACS versus conventional phacoemulsification in either the early postoperative period (p=0.78) or the late postoperative period (p=0.29).

Conclusion

Patients with mild-to-moderate FECD had favorable refractive outcomes with phacoemulsification. There was no difference in refractive outcomes in eyes with FECD between the group that underwent FLACS versus the group that underwent conventional phacoemulsification.

Clinical outcomes and complications between FLACS and conventional phacoemulsification cataract surgery: a PRISMA-compliant Meta-analysis of 25 randomized controlled trials

AIM

To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS).

METHODS

A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials (RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool.

RESULTS

Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity (CDVA), uncorrected distant visual acuity (UDVA), and central corneal thickness (CCT) at the long-term follow up, although FLACS showed better CDVA at 1wk postoperatively, and less increase in CCT at 1d and 1wk. FLACS had better postoperative endothelial cell count (ECC) at 1 and 4-6wk, while there was no significantly difference between FLACS and CPCS at 1d, 3 and 6mo [weighted mean difference (WMD): 51.54, 95% confidence interval (CI): -5.46 to 108.54, P=0.08; WMD: 48.52, 95%CI: -17.54 to 114.58, P=0.15; WMD: 12.17, 95%CI: -48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss (ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6wk, and 3mo (P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6mo (WMD: -30.36, 95%CI: -78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio (OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears (OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change (OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group (OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group (WMD: -0.78, 95%CI: -1.23 to -0.34, P=0.0006).

CONCLUSION

No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.

Long-term visual field changes after femtosecond laser-assisted cataract surgery in glaucoma patients, case series

Purpose

To assess the short and long-term changes in Visual Field (VF) Mean Deviation (MD), Visual Field Index (VFI), and intraocular pressure (IOP) after femtosecond laser-assisted cataract surgery (FLACS) in glaucomatous eyes.

Materials and methods

Interventional, prospective case series. Patients with glaucoma, who required cataract surgery were included. All patients underwent a complete ophthalmologic assessment and Visual Fields. FLACS was performed in all patients by a single experienced surgeon. IOP was measured during surgery immediately before and after pretreatment suction docking. Changes from baseline in VF MD and VFI, IOP, visual acuity (VA), and number of glaucoma medications were evaluated up to one-year follow-up.

Results

Fourteen eyes of 11 patients were included. Eighty-five percent were female, with a mean age of 74.2 ± 7.9 years. Nine (64.3%) and 5 (35.7%) were diagnosed with primary angle closure glaucoma (PACG) and primary open angle glaucoma (POAG), respectively. We found a slight IOP reduction after the docking phase during FLACS in both glaucoma subtype groups. No significant changes in visual field mean deviation (MD) and visual field index (VFI) were found from baseline to 12 months after surgery in both groups. A significant reduction in IOP values was found in all cases from baseline up to one year follow up. No significant changes were observed in BCVA and number of topical glaucoma medications after one year in both groups.

Conclusion

In our patients, there was an IOP reduction immediately after suction docking FLACS pretreatment. Mean IOP at final follow-up showed a reduction from baseline. There was no change in VF MD and VFI from baseline to final one-year follow-up. FLACS appears to be well tolerated in early and moderate glaucoma and appears to be a safe tool for glaucoma patients undergoing cataract surgery. Similar results to traditional surgery can be obtained with the advantages of femtosecond laser precision.

Cataract Surgery Practice in the Republic of Korea: A Survey of the Korean Society of Cataract and Refractive Surgery 2020

PURPOSE

To describe current cataract surgery practice patterns and trends among Korean ophthalmologists.

METHODS

A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys.

RESULTS

The largest percentage of respondents (39%) had <5 years of practical experience, and 40% had >11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks.

CONCLUSIONS

This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients' needs.

[Fixation of an intraocular lens using reverse optic capture with haptic tuck for intraoperative posterior capsule rupture]

Exact positioning and optimal axial alignment are mandatory to achieve satisfactory postoperative refractive results after implantation of a toric or presbyopia correcting intraocular lens (IOL). Posterior capsule rupture can preclude stable capsular fixation. In such cases, reverse optic capture with haptic tuck results in stable fixation of the lens with respect to centering, rotation and axial position. Only the haptics are positioned in the capsule, behind the anterior capsulorrhexis. The optic remains in the sulcus; thus, the lens is fixed in the rhexis, providing long-term stability despite the presence of posterior capsule rupture.

Visual Performance and Optical Quality after Implantation of a New Generation Monofocal Intraocular Lens

Purpose

To evaluate the performance of two intraocular lenses (IOLs). The new monofocal IOL using a higher-order aspheric optic (Tecnis Eyhance ICB00) was compared to a standard monofocal IOL (Tecnis monofocal ZCB00) of the identical platform and material.

Methods

The medical records of the patients who had undergone cataract surgery with implantation of either the ZCB00 or the ICB00 in the dominant eye from March 2020 to August 2020 and with available data from the 3-month visit were reviewed. Subjects with ocular comorbidities or corneal astigmatism greater than 1.00 diopters were excluded. The uncorrected near, intermediate, distance visual acuity and corrected distance visual acuity were the main outcome measures. Optical quality parameters measured using an optical quality analysis system, clinical records including age, sex, laterality, ocular dominance, and information related to refractory errors was also collected. Parameters related to the refractory errors were all uniformly based on the Barrett Universal II formula.

Results

Of the 197 recruited patients, 111 and 86 were implanted with the ICB00 and ZCB00, respectively. No statistically significant differences in baseline parameters were observed between the two groups. While no statistically significant differences in distance visual acuity or optical quality were found between the two groups, compared to the ZCB00 group, the ICB00 group showed significantly higher intermediate visual acuity (p < 0.001) and near visual acuity (p < 0.05) 3 months postoperatively.

Conclusions

ICB00 provided superior intermediate vision and comparable distance performance and photic phenomena compared to a standard monofocal IOL.

Use of Speckle Tracking Echocardiography to Detect Induced Regional Strain Changes in the Murine Myocardium by Acoustic Radiation Force

BACKGROUND

It is difficult to simulate the abnormal myocardial strain patterns caused by ischemic coronary artery disease (CAD) which are a precursor to heart failure (HF) within an animal model. Simulation of these strain changes could contribute to better understanding of the early formative stages of HF. This is especially important in investigating the poorly understood pathogenesis of heart failure with preserved ejection fraction (HFpEF). Here, we discuss delivery of high intensity focused ultrasound (HIFU) in a murine model to alter left ventricular (LV) regional longitudinal strain (RLS), and use of speckle tracking echocardiography to detect these changes.

METHODS

HIFU pulses (pressure amplitude 1.7 MPa) were generated by amplifying a sinusoidal waveform from a function generator into a piezoelectric transducer. These pulses were then directed extracorporeally towards the anterior LV surface of C57BI6 mice during three time periods (early, mid, and late diastole). Speckle tracking echocardiography was then used to quantify changes in RLS within six segments of the LV.

RESULTS

We observed an increase in LV RLS with acoustic augmentation during all three time periods. This augmentation was most prominent near the anterior apical region in early diastole and near the posterior basilar region during late diastole.

CONCLUSIONS

Our findings demonstrate the application of HIFU to non-invasively induce changes in RLS within a murine model. Our results also reflect the capability of speckle tracking echocardiography to analyze and quantify these changes. These findings represent the first demonstration of ultrasound-induced augmentation in LV RLS within a small animal model.

Comparison of Femtosecond Laser-Assisted and Ultrasound-Assisted Cataract Surgery with Focus on Endothelial Analysis

Femtosecond laser-assisted cataract surgery has the potential to make critical steps of cataract surgery easier and safer, and reduce endothelial cell loss, thus, improving postoperative outcomes. This study compared FLACS with the conventional method in terms of endothelial cells behavior, clinical outcomes, and capsulotomy precision.

METHODS

In a single-center, randomized controlled study, 130 patients with cataracta senilis received FLACS or conventional cataract surgery.

RESULTS

A significant endothelial cell loss was observed postoperatively, compared to the preoperative values in both groups. The endothelial cell counts was significantly better in the FLACS group in cataract grade 2 (p = 0.048) patients, compared to conventionally at 4 weeks. The effective phaco time was notably shorter in grade 2 of the FLACS group (p = 0.007) compared to the conventional. However, no statistically significant differences were found for the whole sample, including all cataract grades, due to the overall cataract density in the FLACS group being significantly higher (2.60 ± 0.58, p < 0.001) as compared to conventional methods (2.23 ± 0.42).

CONCLUSIONS

Low energy FLACS provides a better result compared to endothelial cell loss, size, and shape variations, as well as in effective phaco time within certain cataract grade subgroups. A complete comparison between two groups was not possible because of the higher cataract grade in the FLACS. FLACS displayed a positive effect on endothelial cell preservation and was proven to be much more precise.

Femtosecond-Laser Assisted Surgery of the Eye: Overview and Impact of the Low-Energy Concept

This article provides an overview of both established and innovative applications of femtosecond (fs)-laser-assisted surgical techniques in ophthalmology. Fs-laser technology is unique because it allows cutting tissue at very high precision inside the eye. Fs lasers are mainly used for surgery of the human cornea and lens. New areas of application in ophthalmology are on the horizon. The latest improvement is the high pulse frequency, low-energy concept; by enlarging the numerical aperture of the focusing optics, the pulse energy threshold for optical breakdown decreases, and cutting with practically no side effects is enabled.

Femtosecond laser-assisted cataract surgery compared with phacoemulsification: the FACT non-inferiority RCT

BACKGROUND

Cataract surgery is one of the most common operations. Femtosecond laser-assisted cataract surgery (FLACS) is a technique that automates a number of operative steps.

OBJECTIVES

To compare FLACS with phacoemulsification cataract surgery (PCS).

DESIGN

Multicentre, outcome-masked, randomised controlled non-inferiority trial.

SETTING

Three collaborating NHS hospitals.

PARTICIPANTS

A total of 785 patients with age-related cataract in one or both eyes were randomised between May 2015 and September 2017.

INTERVENTION

FLACS (n = 392 participants) or PCS (n = 393 participants).

MAIN OUTCOME MEASURES

The primary outcome was uncorrected distance visual acuity in the study eye after 3 months, expressed as the logarithm of the minimum angle of resolution (logMAR): 0.00 logMAR (or 6/6 if expressed in Snellen) is normal (good visual acuity). Secondary outcomes included corrected distance visual acuity, refractive outcomes (within 0.5 dioptre and 1.0 dioptre of target), safety and patient-reported outcome measures at 3 and 12 months, and resource use. All trial follow-ups were performed by optometrists who were masked to the trial intervention.

RESULTS

A total of 353 (90%) participants allocated to the FLACS arm and 317 (81%) participants allocated to the PCS arm attended follow-up at 3 months. The mean uncorrected distance visual acuity was similar in both treatment arms [0.13 logMAR, standard deviation 0.23 logMAR, for FLACS, vs. 0.14 logMAR, standard deviation 0.27 logMAR, for PCS, with a difference of -0.01 logMAR (95% confidence interval -0.05 to 0.03 logMAR; p = 0.63)]. The mean corrected distance visual acuity values were again similar in both treatment arms (-0.01 logMAR, standard deviation 0.19 logMAR FLACS vs. 0.01 logMAR, standard deviation 0.21 logMAR PCS; p = 0.34). There were two posterior capsule tears in the PCS arm. There were no significant differences between the treatment arms for any secondary outcome at 3 months. At 12 months, the mean uncorrected distance visual acuity was 0.14 logMAR (standard deviation 0.22 logMAR) for FLACS and 0.17 logMAR (standard deviation 0.25 logMAR) for PCS, with a difference between the treatment arms of -0.03 logMAR (95% confidence interval -0.06 to 0.01 logMAR; p = 0.17). The mean corrected distance visual acuity was 0.003 logMAR (standard deviation 0.18 logMAR) for FLACS and 0.03 logMAR (standard deviation 0.23 logMAR) for PCS, with a difference of -0.03 logMAR (95% confidence interval -0.06 to 0.01 logMAR; p = 0.11). There were no significant differences between the arms for any other outcomes, with the exception of the mean binocular corrected distance visual acuity with a difference of -0.02 logMAR (95% confidence interval -0.05 to 0.00 logMAR) (p = 0.036), which favoured FLACS. There were no significant differences between the arms for any health, social care or societal costs. For the economic evaluation, the mean cost difference was £167.62 per patient higher for FLACS (95% of iterations between -£14.12 and £341.67) than for PCS. The mean QALY difference (FLACS minus PCS) was 0.001 (95% of iterations between -0.011 and 0.015), which equates to an incremental cost-effectiveness ratio (cost difference divided by QALY difference) of £167,620.

LIMITATIONS

Although the measurement of outcomes was carried out by optometrists who were masked to the treatment arm, the participants were not masked.

CONCLUSIONS

The evidence suggests that FLACS is not inferior to PCS in terms of vision after 3 months' follow-up, and there were no significant differences in patient-reported health and safety outcomes after 12 months' follow-up. In addition, the statistically significant difference in binocular corrected distance visual acuity was not clinically significant. FLACS is not cost-effective.

FUTURE WORK

To explore the possible differences in vision in patients without ocular co-pathology.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN77602616.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 6. See the NIHR Journals Library website for further project information. Moorfields Eye Charity (grant references GR000233 and GR000449 for the endothelial cell counter and femtosecond laser used).

Clinical Results After Precision Pulse Capsulotomy

Purpose

To compare residual refractive error and complication rates between eyes undergoing a manual capsulotomy and those receiving a precision pulse capsulotomy using an automated device.

Patients and Methods

This study was a non-interventional two-arm retrospective chart review of clinical results after bilateral cataract surgery or refractive lens exchange (RLE) surgery with a monofocal toric intraocular lens (IOL) or a trifocal IOL where a manual capsulorhexis (Manual) or automated precision pulse capsulotomy (PPC) was performed.

Results

Exams from 243 eyes (122 PPC, 121 Manual) from 124 patients were reviewed; about 75% of which had a trifocal IOL implanted. There was no statistically significant difference in the MRSE with either IOL type, or overall. The overall percentage of eyes with residual refractive cylinder ≤ 0.50 D was significantly higher in the PPC group (89% vs. 79% in the manual group, p = 0.03), primarily driven by results with the toric IOL. Best corrected distance visual acuity was not statistically significantly different by group. Capsulotomy-related complications were lower in the PPC group relative to the manual group (4.1% vs. 6.6%), but this result was not statistically significant (p = 0.38).

Conclusion

Significantly more eyes had refractive cylinder ≤0.50 D in the PPC group. For all other measures, the automated PPC device produced clinical results equivalent to those achieved with a manual capsulorhexis.

Long-Term Evaluation of Capsulotomy Shape and Posterior Capsule Opacification after Low-Energy Bimanual Femtosecond Laser-Assisted Cataract Surgery

Purpose

To evaluate capsulotomy shape and posterior capsule opacification (PCO) during an 18-month follow-up for bimanual femtosecond laser-assisted cataract surgery (FLACS).

Methods

74 eyes operated by a well-trained surgeon with bimanual FLACS technique using low-energy LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) were included in the study. The follow-up period was 18 ± 2 months. Another 91 eyes, which underwent standard bimanual microincision cataract surgery (B-MICS), served as a control group. In all cases, a BunnyLens AF (Hanita Lenses, Israel) intraocular lens was implanted in the bag. A digital image of the capsule with slit-lamp retroillumination was performed in all patients at 18 months of follow-up. Image analysis software (ImageJ) was used to evaluate the shape of the capsulotomy in terms of diameter, area, and circularity. PCO score was evaluated using EPCO 2000 software. Best corrected visual acuity (BCVA) and endothelial cell count (ECC) were evaluated before and after surgery at 1 and 18 ± 2 months.

Results

At 18 months, mean capsulotomy diameter was 5.34 ± 0.21 mm while capsulorhexis was 5.87 ± 0.37 mm (p < 0.001) and the deviation area from baseline was 1.13 ± 1.76 mm² in FLACS and 2.67 ± 1.69 mm² in B-MICS (p < 0.001). Capsulotomy circularity was 0.94 ± 0.04 while capsulorhexis was 0.83 ± 0.07 (p < 0.001). EPCO score was 0.050 ± 0.081 in the FLACS group and 0.122 ± 0.239 in the B-MICS group (p=0.03). The mean BCVA improvement was significant in both groups, without a significant difference at 18 months. We noticed a statistically significant difference in endothelial cell loss at 18 months (FLACS 12.4% and B-MICS 18.1%; p=0.017).

Conclusions

Bimanual FLACS is a safe and effective technique, as determined in a long-term follow-up. Capsulotomy shape presented higher stability and circularity in the FLACS group over the 18-month observation period. FLACS resulted in lower PCO scores and endothelial cell loss at 18 months in comparison to B-MICS standard technique.

Profiling of circular RNAs in age-related cataract reveals circZNF292 as an antioxidant by sponging miR-23b-3p

Age-related cataract (ARC) is one of the major causes of visual impairment and reversible blindness worldwide. Accumulating evidence has revealed that circular RNAs (circRNAs) are involved in multiple regulatory processes in various ocular diseases. However, the expression profile, regulatory roles, and underlying mechanisms of circRNAs in ARC remain largely unknown. Herein we deep-sequenced circRNAs of anterior lens capsules from normal and ARC lenses, and detected 23,787 candidate circRNAs. Of these, 466 were significantly differentially expressed, and a higher correlation in down-regulated circRNAs between ARC and diabetic cataract was observed compared with up-regulated ones. Subsequent bioinformatics analysis disclosed that certain differentially expressed circRNAs participated in oxidative stress and apoptosis-related signaling pathways in ARC. Notably, the level of circZNF292 was significantly decreased, while miR-23b-3p was significantly increased in ARC. The target region prediction and dual-luciferase reporter assays proved that circZNF292 acted as a competitive endogenous RNA to regulate the expression of anti-oxidative genes through competing with miR-23b-3p. Our results indicate that circZNF292, a down-regulated circRNA in the anterior lens capsule of ARC patients, may be involved in resistance to oxidative damage and apoptosis of lens epithelial cells by sponging miR-23b-3p, providing a potential target for prevention and treatment of ARC.

[Current value of femtosecond laser-assisted cataract surgery]

After more than 10 years of experience with the femtosecond laser in cataract surgery, it can be concluded that the safety profile of femtosecond laser-assisted cataract surgery (FLACS) is comparable to that of conventional cataract surgery. This technique offers the possibility to perform incisions with a precision superior to that of any surgeon in the world, based on the connection of preoperative and intraoperative diagnostics. This results in new possibilities to revolutionize the surgical procedure of cataract surgery and to generate new therapeutic approaches for the treatment of cataracts. The combination of keratotomy for correcting astigmatism, intraocular lenses supported by capsulotomy and individually adapted fragmentation patterns is already a component of a personalized cataract surgery.

Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application

INTRODUCTION

Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery.

METHOD

The PubMed and Web of Science platforms were used to search for scientific literature.

RESULTS

The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique.

CONCLUSIONS

The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.

A randomised controlled trial comparing femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: 12-month results

AIMS

To report 12-month outcomes of randomised controlled trial comparing conventional phacoemulsification surgery (CPS) with femtosecond laser-assisted cataract surgery (FLACS).

METHODS

This was a single-centre, prospective single-masked randomised case-controlled trial. Four hundred patients were randomised to CPS or FLACS with the LenSx platform (Alcon Laboratories Inc.). Visual acuity, refraction, central corneal thickness, endothelial cell loss (ECL), adverse events and quality of life outcomes, using EuroQOL 5-dimensions (EQ-5D-3 L) and cataract surgery patient-reported outcome measures (PROMs) questionnaires (Cat-PROM5), were recorded.

RESULTS

Two hundred and thirty four patients (58.5%) attended 12-month follow-up (116 FLACS, 118 CPS). Mean LogMAR unaided distance visual acuity) (±SD) was 0.12 (0.18) with FLACS and 0.13 (0.19) with CPS (p=0.68; 95% Confidence Interval [CI]-0.06,0.04). Mean spherical equivalent (SE) refraction was -0.1±0.6 diopters (D) with FLACS and -0.2±0.6 D with CPS (p=0.44; 95% CI -0.09, 0.21). Mean corrected distance visual acuity (±SD) was -0.01 (0.1) with FLACS and 0(0.1) with CPS (p=0.45; 95% CI -0.04,0.02). Two patients per group underwent YAG laser capsulotomy for posterior capsular opacification (p=1). Mean ECL (per mm²±SD) was 301±320 with FLACS and 228±303 with CPS (p=0.07; 95% CI -7.26, 153.26). Mean Cat-PROM scores (±SD) were -5.5 (2.6) with FLACS and -5.8 (2.5) with CPS (p=0.3; 95% CI 0.31,1.01). EQ5-3DL mean index score (±SD) was 0.92 (0.13) with FLACS and 0.89 (0.14) with CPS (p=0.1; 95% CI -0.1, 0.01). Vector analysis comparing manual limbal relaxing incisions (LRIs) and intrastromal femtosecond laser-assisted astigmatic keratotomies (iFAKs) showed a greater correction index (p=0.02; 95% CI 0.06 to 0.60) and smaller difference vector (p=0.046; 95% CI -0.54, -0.01) with iFAK.

CONCLUSIONS

There were no differences in vision, refraction, adverse postoperative events or PROMs between FLACS and CPS groups at 12 months. iFAKs may provide more effective astigmatic correction compared to LRIs, 12 months postoperatively.

A Novel Sequential Docking Technique: Use of Femtosecond Arcuate Keratotomy and Femtosecond Assisted Cataract Surgery Using a Pupil Expansion Ring on a Patient with Intraoperative Floppy Iris Syndrome

Purpose

The purpose of this study was to evaluate the efficacy of a novel double-docking technique, incorporating the use of femtosecond laser arcuate keratotomy (FSAK) in correcting low-degree astigmatism and Malyugin ring, in a patient with intraoperative floppy iris syndrome (IFIS).

Methods

A case report of a 72-year-old man with grade 4 cataract, low-degree astigmatism (<2D), and IFIS (pupil size <4 mm, intraoperatively) is presented. The patient underwent cataract surgery using a femtosecond laser to treat low-degree astigmatism because the patient requested for the use of a multifocal  intraocular lens (IOL). The first docking was performed to complete arcuate keratotomy, produce the mainparacentesis incisions, and create clear corneal incisions. Insertion of the Malyugin ring was performed after the first docking, whereas the second one was executed to complete continuous curvilinear capsulotomy and lens fragmentation. The patient's uncorrected visual acuity (UCVA) was measured pre- and post-operatively. The complications were evaluated post-operatively and 3 months later during the follow-up visit.

Results

The patient's UCVA for distance improved from 0.3 (6/12 Snellen equivalent) to 0 (6/6 Snellen equivalent) logMAR post-operatively. During the follow-up visit, the patient's uncorrected near visual acuity was at J2. His corneal astigmatism changed from -1.0 Diopter @177° pre-operative to -0.12 D @173° post-operative. No other intraoperative or post-operative complications were observed.

Conclusion

The double-docking technique, with the use of FSAK, and Malyugin ring produced successful surgical outcomes for the patient. The benefits of this technique allow surgeons to avoid changing the shape of the patient's cornea from the injection of the viscoelastic device into the anterior chamber, which could lower the femtosecond laser's precision and docking location.

Alport Syndrome and Femtosecond Laser-assisted Cataract Surgery

We report the surgical management of a patient with bilateral anterior lenticonus due to Alport syndrome using femtosecond laser-assisted cataract surgery (FLACS) and the Optiwave Refractive Analysis (ORA) system. A 38-year-old man with Alport syndrome presented to our department with visual loss due to anterior lenticonus in both eyes. Adjustments during bilateral FLACS were performed with the software's calipers to manually delineate the anterior capsulotomy. Multifocal toric intraocular lenses (IOLs) were selected and placed in the posterior chamber with the aid of intraoperative aberrometry. The intended postoperative positioning parameters for the IOL as well as the planned visual acuity and refraction were achieved. The implementation of FLACS and intraoperative wavefront aberrometry is a safe and useful surgical approach for the management of cataract in challenging cases such as patients with anterior lenticonus due to Alport syndrome.

Application of Femtosecond Laser in Anterior Segment Surgery

Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.

Femtosecond Laser-Assisted Cataract Surgery Versus Phacoemulsification Cataract Surgery (FACT): A Randomized Noninferiority Trial

Purpose

To report the 3-month results of a randomized trial (Femtosecond Laser-Assisted Cataract Trial [FACT]) comparing femtosecond laser-assisted cataract surgery (FLACS) with standard phacoemulsification cataract surgery (PCS).

Design

Multicenter, randomized controlled trial funded by the UK National Institute of Health Research (HTA 13/04/46/).

Participants

Seven hundred eighty-five patients with age-related cataract.

Methods

This trial took place in 3 hospitals in the UK National Health Service (NHS). Randomization (1:1) was stratified by site, surgeon, and 1 or both eyes eligible using a secure web-based system. Postoperative assessments were masked to the allocated intervention. The primary outcome was unaided distance visual acuity (UDVA) in the study eye at 3 months. Secondary outcomes included corrected distance visual acuity, complications, and patient-reported outcomes measures. The noninferiority margin was 0.1 logarithm of the minimum angle of resolution (logMAR). ISRCTN.com registry, number ISRCTN77602616.

Main Outcome Measures

We enrolled 785 participants between May 2015 and September 2017 and randomly assigned 392 to FLACS and 393 to PCS. At 3 months postoperatively, mean UDVA difference between treatment arms was −0.01 logMAR (−0.05 to 0.03), and mean corrected distance visual acuity difference was −0.01 logMAR (95% confidence interval [CI], −0.05 to 0.02). Seventy-one percent of both FLACS and PCS cases were within ±0.5 diopters (D) of the refractive target, and 93% of FLACS and 92% of PCS cases were within ±1.0 D. There were 2 posterior capsule tears in the PCS arm and none in the FLACS arm. There were no significant differences between arms for any secondary outcome.

Conclusions

Femtosecond laser-assisted cataract surgery is not inferior to conventional PCS surgery 3 months after surgery. Both methods are as good in terms of vision, patient-reported health, and safety outcomes at 3 months. Longer-term outcomes of the clinical effectiveness and cost-effectiveness are awaited.

Comparative clinical outcomes of Tecnis toric IOL implantation in femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery

AIM

To compare the short-term visual outcomes, residual refractive cylinder, and rotation stability after Tecnis toric intraocular lens (IOL) implantation during femtosecond laser-assisted cataract surgery (Femto phaco) and conventional phacoemulsification surgery (Conventional phaco).

METHODS

In a prospective cohort study, Conventional phaco and Femto phaco (anterior capsulotomy and lens fragmentation by a femtosecond laser) with Tecnis toric IOL implantation were performed in 40 eyes from 36 patients and 37 eyes from 33 patients, respectively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction were assessed during 1d, 1wk, and 1mo follow-ups. The orientation of the Tecnis Toric IOL was evaluated during 1wk and 1mo follow-ups.

RESULTS

There were no significant differences in UDCA or CDVA between two groups at 1mo postoperatively, though relatively more subjects had UDVA values of 20/25 or better in Femto phaco group than in the Conventional group (P>0.05). A lower but not significantly lower rate of having more than 5° of IOL rotation was observed in Femto phaco group at the 1-month follow-up, while a significant lower rate of residual astigmatism of ≤1 D was observed in Femto phaco group.

CONCLUSION

The Femto phaco group has significantly more subjects with the residual astigmatism of ≤1 D, but there are no significant differences in rotation stability and visual outcomes as compared with the Conventional phaco group after the application of the Tecnis toric IOL in this cohort.

Cataract Surgery Practices in the Republic of Korea: A Survey of the Korean Society of Cataract and Refractive Surgery 2018

Purpose

To describe current cataract surgery practice patterns and changing trends among Korean ophthalmologists.

Methods

A survey of members of the Korean Society of Cataract and Refractive Surgery was performed in July 2018. One hundred and two (12.7%) of 801 questionnaires were returned for analysis. The data were analyzed using descriptive statistics and compared with previous surveys.

Results

Most of the respondents (75%) had been in practice for 6 or more years and performed an average of 31 cataract surgeries per month. The preferred method for cataract surgery was phacoemulsification (95%); 5% used a femtosecond laser. The use of topical anesthesia markedly increased from 69% (2012) to 80% (2018). The use of optical biometry exceeded that of ultrasound A-scan biometry. A multifocal intraocular lens was used by 76% of the respondents compared with 44% of the respondents in 2012. Topical nonsteroidal anti-inflammatory drugs were used by 70% of the respondents postoperatively. Most (59%) of these anti-inflammatory drugs were prescribed for 4 weeks.

Conclusions

This survey provided a comprehensive update of the present cataract surgery practices in the Republic of Korea. The results emphasized the increasing use of premium intraocular lenses, optical biometry, and topical anesthesia.

Comparing refractive outcomes of a standard industry toric IOL calculator using anterior corneal astigmatism and total corneal refractive power

PURPOSE

To evaluate refractive outcomes for a standard industry calculator using anterior corneal astigmatism or total corneal refractive power.

METHODS

This prospective interventional study evaluated the refractive outcomes of 56 eyes using a standard industry calculator (Zeiss ZCalc) and a digital IOL alignment software. After A-constant optimisation the ZCalc was recalculated with two different keratometry values using appropriate refractive indices: anterior corneal astigmatism (ACA) by IOLMaster 700 and total corneal refractive power (TCRP) by Pentacam. The Barrett toric calculator was used as a reference.

RESULTS

Undercorrection of 0.04 ± 0.42 D after 1 week and 0.13 ± 0.48 D after 3 months was achieved for the spherical equivalent by using a standard industry calculator. IOL misalignment was 2.8° ± 3.4° using a digital alignment system. For the ZCalc, the mean absolute error could be reduced from 0.19 ± 0.40 D using ACA to 0.04 ± 0.48 D when considering total corneal refractive power (p = 0.06). The Barrett calculator delivered better refractive outcomes than using a standard industry calculator with ACA measurements only (- 0.06 ± 0.43 D; p < 0.01).

CONCLUSION

Reliable and accurate refractive outcomes in toric IOL calculation were achieved by using the ZCalc calculator. The prediction error for a widely used standard industry toric IOL calculator could be reduced by using measured total corneal refractive power.

Localized delivery of compounds into articular cartilage by using high-intensity focused ultrasound

Localized delivery of drugs into an osteoarthritic cartilaginous lesion does not yet exist, which limits pharmaceutical management of osteoarthritis (OA). High-intensity focused ultrasound (HIFU) provides a means to actuate matter from a distance in a non-destructive way. In this study, we aimed to deliver methylene blue locally into bovine articular cartilage in vitro. HIFU-treated samples (n = 10) were immersed in a methylene blue (MB) solution during sonication (f = 2.16 MHz, peak-positive-pressure = 3.5 MPa, mechanical index = 1.8, pulse repetition frequency = 3.0 kHz, cycles per burst: 50, duty cycle: 7%). Adjacent control 1 tissue (n = 10) was first pre-treated with HIFU followed by immersion into MB; adjacent control 2 tissue (n = 10) was immersed in MB without ultrasound exposure. The MB content was higher (p < 0.05) in HIFU-treated samples all the way to a depth of 600 µm from AC surface when compared to controls. Chondrocyte viability and RNA expression levels associated with cartilage degeneration were not different in HIFU-treated samples when compared to controls (p > 0.05). To conclude, HIFU delivers molecules into articular cartilage without major short-term concerns about safety. The method is a candidate for a future approach for managing OA.

Pain Perception and Acceptance of Illness in Patients Undergoing Phacoemulsification Cataract Surgery under Drip Anesthesia

For many years, cataracts have been the main cause of vision loss and vision impairments in the world (43% and 33%, respectively). Currently, the most common surgical method for treating cataracts is phacoemulsification. The aim of this study was to assess the pain perception and acceptance of illness connected with awaiting phacoemulsification cataract surgery under intravenous drip anesthesia, as well as to determine the effect of selected sociodemographic factors on the above. Methods: The study was conducted in a group of patients of the Department of Ophthalmology, University Clinical Hospital in Białystok, Poland suffering from cataracts, who underwent phacoemulsification surgery under intravenous drip anesthesia. The study group consisted of 151 people. The study used an original short questionnaire and three standardized psychometric scales: The acceptance of illness scale (AIS), the Beliefs about Pain Control Questionnaire (BPCQ), and the Coping Strategies Questionnaire (CSQ). Results: The median overall AIS point value was 24 points, which is considered an average score in terms of disease acceptance. Respondents assessed the influence of individual factors on the level of perceived pain and the impact of individual strategies for coping with pain similarly. The level of perceived pain decreased with the patient’s age. People with a higher education level experienced a greater level of pain; however, this relationship was not statistically significant. The place of residence did not affect the level of pain experienced during the procedure. Women had a greater level of acceptance of illness. The respondents’ education level negligibly differentiated the approach to the disease. The place of residence also did not affect the assessment of illness acceptance as measured by the AIS. Whether the surgery pertained to the first or second eye did not significantly affect the approach to the disease. Conclusions: The level of acceptance of illness and pain perception were at a moderate level among the patients. The acceptance of illness was significantly influenced by the age of patients and the waiting period for phacoemulsification, and this level of acceptance decreased significantly with the increasing age of patients. The longer the waiting period for surgery, the lower the acceptance of illness. Sex significantly differentiated the level of pain experienced during the procedure. Education and place of residence did not significantly affect the acceptance of illness and the feeling of pain.

Comparison of changes in corneal endothelial cell density and central corneal thickness between conventional and femtosecond laser-assisted cataract surgery: a randomised, controlled clinical trial

BACKGROUND/AIM

To identify changes in endothelial cell density (ECD) and central corneal thickness (CCT) in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification surgery (CPS).

METHODS

This is an intraindividual randomised, controlled clinical trial. One eye was randomised to receive FLACS, while the contralateral eye of the same patient received CPS. The femtosecond laser pretreatment included creating main and side-port corneal incisions, capsulotomy and lens fragmentation. Non-contact endothelial cell microscopy and pachymetry were performed preoperatively and at postoperative day 1, week 1, month 1 and month 3.

RESULTS

A total of 134 paired eyes from 67 patients were included in the analysis. ECD was not significantly different between the two groups at either postoperative month 1 (2370±580 cells/mm² and 2467±564 cells/mm² in FLACS and CPS groups, respectively; p=0.18) or at postoperative month 3 (2374±527 cells/mm² and 2433±526 cells/mm² in FLACS and CPS groups, respectively; p=0.19). No significant difference was observed in the mean CCT values between the two groups over the follow-up period (p>0.05).

CONCLUSION

Postoperative corneal ECD and CCT were comparable between FLACS and CPS during the 3 months' follow-up period.

Performance of femtosecond laser-assisted cataract surgery in Chinese patients with cataract: a prospective, multicenter, registry study

BACKGROUND

This study aimed to investigate the completion rate, visual performance, and adverse outcomes of femtosecond laser-assisted cataract surgery (FLACS) in Chinese patients.

METHODS

This is a prospective, single-arm, multicenter registry study of 19 cataract surgery clinics in China. Chinese patients with cataract who underwent FLACS using the Alcon LenSx® laser system in single eye (n = 1140) or both eyes (n = 201) were enrolled and data were collected between March 2015 and August 2016. Clinical characteristics were recorded before surgery, and on postoperative days 1, 7, and 30. For surgery on both eyes, the second eye was included in the analysis only if it was operated within 30 days after the first eye surgery. The primary outcome was the completion rate of circular anterior capsulotomy. Secondary outcomes for lens fragmentation, corneal incision, and intraocular lens (IOL) implantation included best corrected distance visual acuity (BCDVA) and completion rates. Adverse events (AEs) were recorded.

RESULTS

The completion rates of circular anterior capsulotomy, lens fragmentation, corneal incision, and IOL implantation were 98.6% (95% CI: 97.8-99.1%), 99.5% (95% CI: 99.1-99.8%), 97.6% (95% CI: 96.7-98.3%), and 100% (95% CI: 99.8-100%), respectively. BCDVA preoperatively and at postoperative day 30 were 1.134 ± 0.831 logMAR and 0.158 ± 0.291 logMAR, respectively. The proportion of eyes with BCDVA of 20/20 or better was 1.6% at baseline and 41.3% at postoperative day 30. AE incidence was 0.32%, with posterior capsule rupture present in 0.19% of eyes.

CONCLUSION

FLACS using the LenSx® laser system can achieve satisfactory results in a real-world setting.

Architecture evaluation of the main clear corneal incisions in femtosecond laser-assisted cataract surgery by optical coherence tomography imaging

Purpose

To assess the stability and reliability of femtosecond laser-assisted cataract surgery (FLACS) incisions design and dimensions using anterior segment optical coherence tomography (AS-OCT) imaging.

Setting

Renato Ambrósio Ophthalmologic Study Center from Hospital Oftalmológico de Brasília, Brasília, Brazil.

Design

Prospective nonrandomized controlled case series.

Methods

Eyes undergoing FLACS with triplanar main temporal clear corneal incision (CCI) were evaluated at the end of the case. Eyes that required any incision hydration, surgical complications or lacked follow-up were excluded. The AS-OCT was performed after femtosecond delivery; at the end of the case; at 1 day and at 30 days after surgery. Data of pachymetry, endothelial and epithelial gaps, Descemet detachment and CCI architecture were compared.

Results

Eleven eyes from 11 patients completed follow-up. Corneal thickness was statistically different between after femtosecond delivery and the end of the case (P-value <0.05), but without difference compared to 30 days evaluation. There was an increase of Descemet detachments (P-value <0.05) and endothelial gaps (P-value =0.0133) at the end of the case compared to post-femtosecond delivery. As for the architecture of the CCI, significant difference was found between the parameters of entry angle and exit angle measured with AS-OCT and the programmed.

Conclusion

The AS-OCT was capable of visualizing changes in the cornea at the CCI. Despite the stress caused by manipulation, results indicated good stability of incision and reproducibility of tunnel length.

Synopsis

Difference of corneal thickness at the CCI between after femtosecond and after phacoemulsification measurements (P-value <0.05), with increase of endothelial gaps (P-value =0.0133) and Descemet detachments (P-value <0.05).

Impact of 0.1% sodium hyaluronate and 0.2% sodium hyaluronate artificial tears on postoperative discomfort following cataract extraction surgery: a comparative study

Background

Recent artificial tear preparations have provided 0.2% concentration of sodium hyaluronate. However, no published data exist on their potential superiority against 0.1% in alleviating dry-eye-disease symptoms in cataract extraction surgery.

Methods

A total of 180 patients that underwent cataract extraction surgery were randomly divided into 2 groups according to their postoperative regime: Study group (SG) received fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks, and additionally 0.2% sodium hyaluronate provided in the COMOD® device quid for 6 weeks. Control group (CG) received fixed combination of tobramycin and dexamethasone (FCTD) quid for 3 weeks, and additionally 0.1% sodium hyaluronate provided in the COMOD® device quid for 6 weeks. The following indexes were evaluated at 3 postoperative checkpoints: 1) Surface discomfort index (SDI) which was derived by four direct 10-scale Likert-type questions that were addressed to the patient and pertained to: a) foreign body sensation (FBS), b) blinking discomfort (BD), c) stinging sensation (SS), d) tearing sensation (TS), 2) Tear break-up time (TBUT), 3) Schirmer’s test, 4) Central corneal thickness (CCT), and 4) Central Corneal Sensitivity (CCS).

Results

Both groups showed reduced CCS values at all postoperative examination points; however, SG participants had significantly better CCS (all p < 0.05). SG had better TBUT than CG at the 3rd (p = 0.03) and 6th examination points (p = 0.04). Moreover, SG had better SDI scores at the 3rd (SDI = 9.26 ± 0.55) and 6th weeks (SDI = 9.47 ± 0.48) vs. CG participants (p = 0.03 and p < 0.01, respectively).

Conclusion

The increased 0.2% sodium hyaluronate concentration in the artificial tears provided in the COMOD® device seems to address dry-eye-disease symptoms better in patients who underwent phacoemulsification surgery than the 0.1% concentration.

Trial registration

ClinicalTrials.govIdentifier:NCT03705949 Oct 15, 2018, retrospectively registered.

[Comparison of clinical and functional results of conventional and femtosecond laser-assisted cataract phacoemulsification]

PURPOSE

To perform a comparative analysis of ultrasound and hydrodynamic parameters, and the outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS).

MATERIAL AND METHODS

This prospective cohort study included 246 eyes. The first group consisted of 138 patients who underwent FLACS, second group - 108 patients after CPCS.

RESULTS

Total ultrasound time was 95.36±47.93 and 113.3±97.71 seconds (p=0.04) in the 1^st and the 2^nd groups, respectively. The duration of torsional ultrasound was 84.72±50.03 seconds in 1^st group (p=0.04) and 113.3±97.71 seconds in the 2^nd group (p=0.04). Aspiration time was 208.3±95.86 seconds in the 1^st group (p=0.04) and 258.43±158.81 seconds in the 2nd group (p=0.04). On the 3-4^th day after the surgery, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly better in the 1^st group - 0.62±0.21 (LogMAR 0.20±0.19) and 0.53±0.15 (LogMAR 0.30±0.21) (p=0.01), respectively, compared to the 2^nd group with UDVA of 0.75±0.18 (LogMAR 0.10±0.16) and CDVA of 0.69±0.19 (LogMAR 0.20±0.15) (p=0.04). Central corneal thickness (CCT) was 573.41±33.12 and 632.43±58.30 μm in the 1^st and 2^nd groups, respectively (p=0.020). At 1 month post-op there were no statistically significant differences in UDVA (p=0.17), CDVA (p=0.40) or CCT (p=0.50) between the groups.

CONCLUSION

Compared with CPCS, total ultrasound time (p=0.04), torsional ultrasound time (p=0.04) and aspiration time (p=0.04) were significantly lower in the FLACS group. CCT was significantly lower (p=0.02), while UDVA (p=0.04) and CDVA (p=0.01) were significantly higher in the FLACS group in the early post-operative period (3-4 days after surgery). There were no statistically significant differences in the parameters between the groups 1 month after the surgery.

Bimanual femtosecond laser-assisted cataract surgery compared to standard bimanual phacoemulsification: A case–control study

Purpose:

To evaluate the efficacy and safety of bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions compared to standard bimanual phacoemulsification (bimanual microincision cataract surgery).

Design:

Prospective, non-randomized comparative case series.

Methods:

Bimanual femtosecond laser-assisted cataract surgery with microincisions was performed on 80 eyes (Group A) with the low-energy Ziemer LDV Z8; a matched case–control series of 80 eyes performed with standard bimanual microincision cataract surgery technique was selected for comparison (Group B). All interventions were performed by the same experienced surgeon. Intraoperative parameters were recorded as well as intra- and postoperative complications. Best corrected visual acuity, surgically induced astigmatism, central corneal thickness and endothelial cell count were evaluated before surgery and at 1 and 3 months post intervention.

Results:

The mean effective phaco times were 3.79 ± 2.19 s (Group A) and 4.49 ± 1.84 s (Group B) (p = 0.041). No major intra- or postoperative complications occurred. An overall significant mean best corrected visual acuity improvement was noted at 3 months, but was not statistically different between the groups. No significant changes were observed for surgically induced astigmatism or corneal pachymetry. A significant loss of endothelial cell count in both groups was detected at 3 months, with Group A reporting a significantly lower endothelial cell count loss compared to Group B (p = 0.009).

Conclusion:

Bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions by an expert surgeon was proven to be safe and effective in this study. This technique has advantages compared with standard bimanual microincision cataract surgery in terms of endothelial preservation.

Cell death and survival following manual and femtosecond laser-assisted capsulotomy in age-related cataract

AIM

To study molecular and morphological changes in lens epithelial cells following femtosecond laser-assisted and manually performed continuous curvilinear capsulotomy (CCC) in order to get information about these methods regarding their potential role in the induction of development of secondary cataract.

METHODS

Anterior lens capsules (ALC) were removed from 40 patients with age-related cataract by manual CCC and by femtosecond laser-assisted capsulotomy (FLAC). Samples removed by manual CCC were assorted in group 1, FLAC samples were classified in group 2. Morphology of lens epithelial cells was examined with light and electron microscopes. Following capsulotomy, expressions of p53, Bcl-2 and cyclin D1 genes were analyzed with reverse transcriptase polymerase chain reaction. Immunohistochemistry was used to detect the pro-apoptotic p53 in the epithelial cells.

RESULTS

Light and electron microscopic examination showed that ALC of group 1 contained more degenerating cells following manual CCC than after FLAC. The expression level of p53 was higher after manual than laser-assisted surgery. Immunocytochemistry indicated significantly higher number of cells containing p53 protein in the manual CCC group than following FLAC. Bcl-2 and cyclin D1 gene expression levels were slightly lower following manual CCC than after FLAC, but the difference was not significant.

CONCLUSION

Manually removed ALC shows slightly, but not significantly larger damage due to the mechanical stretching and pulling of the capsule than those removed using FLAC.

Femtosecond laser-assisted cataract surgery for the white cataract

Aim

To report the capsulotomy and lens fragmentation outcomes of white cataracts managed with the femtosecond laser (FL).

Methods

Outcomes of a prospective, observational consecutive case series of white cataracts (June 2012–November 2016) that underwent FL-assisted cataract surgery (FLACS) (Victus, Bausch+Lomb, Munich, Germany) at the Singapore National Eye Centre were audited. Data collected: patient demographics, type of white cataract, levelness of docking, anterior capsule position following laser, completeness of capsulotomy and fragmentation, best-corrected visual acuity (BCVA) at 1 month, intraoperative complications. Outcome measures: capsulotomy integrity, fragmentation capability and BCVA at 1 month.

Results

58 eyes of 54 patients underwent FLACS. White cataract types included dry white (24 eyes), intumescent (28 eyes) and Morgagnian (6 eyes). Docking was level in 22 eyes (38.6%). Following FL, the anterior capsule level dropped in 20 eyes (34.5%). Incomplete capsulotomies occurred in 10 eyes (17.2%). Lens fragmentation attempted in 38 eyes was effective or partially effective in 31 eyes (81.6%). No anterior or posterior capsule tears occurred. LogMAR BCVA at 1 month was 0.073 (SD 0.09). Risk factors for incomplete capsulotomy were Morgagnian cataract and lens thickness (multiple logistic regression, p<0.01 and p=0.03, respectively).

Conclusion

The main complication of FLACS in white cataracts was incomplete capsulotomy (17.2%), significantly associated with Morgagnian cataracts and increased lens thickness. Lens fragmentation was effected in four-fifths of white cataracts but should be avoided in Morgagnian cataracts due to possible overlap of the lens fragmentation plan and the anterior capsule.