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Liang X, Luo S, Deng K, Li L. Comparison of macular changes and visual outcomes between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery for high myopic cataract patients. BMC Ophthalmol 2024; 24:212. [PMID: 38750496 PMCID: PMC11097499 DOI: 10.1186/s12886-024-03479-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND To evaluate differences in log MAR best-corrected visual acuity (BCVA) improvement and postoperative central foveal thickness (CFT) and choroidal thickness (CT) changes between conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) for high-myopia cataracts. METHODS This was a retrospective and observational study. One hundred and two eyes of 102 patients with high-myopia cataracts were examined. CPS was performed in 54 eyes, and FLACS was performed in 48 eyes. All eyes underwent logMAR BCVA, CFT and CT of three different sectors preoperatively and one week and six months postoperatively. RESULTS The logMAR BCVA improved significantly after surgery in both groups (both P < 0.001), but no difference was observed in BCVA improvement between the groups (P = 0.554). Moreover, no significant differences were reflected in the changes in CFT, nasal 1 mm CT or temporal 1 mm CT between the two groups, and only subfoveal choroidal thickness (SFCT) in the CPS group decreased significantly compared with that in the FLACS group at any postoperative time (P = 0.003 and 0.026). AL, preoperative logMAR BCVA, and CT of the three regions exhibited a notable correlation with postoperative BCVA (all P < 0.05) according to univariate logistic regression analysis. However, only the AL, preoperative logMAR BCVA and SFCT remained significant in the multivariate model. Postoperative logMAR BCVA revealed a positive correlation with AL and preoperative logMAR BCVA but a negative correlation with SFCT. CONCLUSIONS FLACS was not superior to CPS in improving BCVA but had less impact on SFCT in the treatment of high-myopia cataracts. Eyes with a longer AL, worse preoperative logMAR BCVA and thinner SFCT had a high risk of worse postoperative BCVA.
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Affiliation(s)
- Xuemei Liang
- Department of Ophthalmology, Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, 510071, PR China
- Department of Ophthalmology, Nanning Aier Eye Hospital, Nanning, China
| | - Shinan Luo
- Department of Ophthalmology, Nanning Aier Eye Hospital, Nanning, China
| | - Kaiyu Deng
- Department of Ophthalmology, Nanning Aier Eye Hospital, Nanning, China
| | - Li Li
- Department of Ophthalmology, Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, 510071, PR China.
- Department of Ophthalmology, Nanning Aier Eye Hospital, Nanning, China.
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Pichardo-Loera NS, Corredor-Ortega C, Castro-Monreal MA, Massaro-Corredor MG, Pérez-Vázquez JF, Gonzalez-Salinas R. Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: A meta-analysis of randomized controlled trials. Eur J Ophthalmol 2024:11206721241229129. [PMID: 38291620 DOI: 10.1177/11206721241229129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PURPOSE The main purpose of our study is to compare the adverse events occurrence, complications, and postoperative outcomes of Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification surgery (CPS) in adult patients undergoing cataract surgery. METHODS We conducted our research using PubMed, Scopus, and MEDLINE through EBSCOhost from 2012 to July 2022 with English and Spanish language restriction, including only Randomized Controlled Trials (RCTs). The PRISMA guidelines were observed for data abstraction, including a random-effects model for each outcome. RESULTS We analyzed 4844 eyes from 23 RCTs with some low risk of bias according to RoB 2 tool. We found statistically significant differences between the FLACS and CPS groups for the mean absolute error (MD = -0.12, 95% CI:-0.22-[-0.02], p = 0.01), the circularity of capsulorhexis (MD = 0.04, 95% CI: 0.04-0.05, p ≤ 0.00001), IOL centration (D = -0.07, 95% CI:-0.09-[-0.05], p ≤ 0.00001), CDE count (MD = -1.75, 95% CI: -2.75-[-0.74], p = 0.0006), mean phacoemulsification time (MD = -12.90, 95% CI:-20.89-[-4.92], p = 0.002), EPT (MD = -0.93, 95% CI: -1.68-[-0.019], p = 0.01) and endothelial cell density loss ((MD = -0.6, 95% CI: -1-[-0.19], p = 0.004). Also, the safety analysis showed a lower incidence of posterior capsule tear (PCT) in the FLACS group (OR =0.29, 95% CI: 0.09-1, p = 0.05). CONCLUSIONS Our results suggest that FLACS might be helpful for patients with relatively dense cataracts and low preoperative endothelial cell values.
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Affiliation(s)
| | - Claudia Corredor-Ortega
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
| | | | | | | | - Roberto Gonzalez-Salinas
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
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Wang H, Chen X, Xu J, Yao K. Comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on corneal impact: A meta-analysis and systematic review. PLoS One 2023; 18:e0284181. [PMID: 37058458 PMCID: PMC10104330 DOI: 10.1371/journal.pone.0284181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/26/2023] [Indexed: 04/15/2023] Open
Abstract
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.
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Affiliation(s)
- Hanle Wang
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Xinyi Chen
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Jingjie Xu
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
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Slezak F, Thumann G, Kropp M, Cvejic Z, De Clerck EEB, Bravetti GE, Guber I, Pajic B. Comparison of Conventional and Femtosecond Laser-Assisted Cataract Surgery Regarding Macula Behavior and Thickness. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040639. [PMID: 37109597 PMCID: PMC10145739 DOI: 10.3390/medicina59040639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/05/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023]
Abstract
Background: The aim of the study was to compare macular thickness behavior and clinical outcomes after femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification conventional surgery (PCS). Methods: Macular Optical Coherence Tomography OCT was analyzed in 42 patients preoperatively, 1 day, 12 days, 4 weeks and 6 weeks postoperatively according to the 9-field Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Clinical findings were collected in both the FLACS group and the PCS group. Results: There was no significant difference in macular thickness between the FLACS and PCS groups (p > 0.05). However, from postoperative day 12 onwards, there was a significant increase in macular thickness observed in both groups (p < 0.001). In the FLACS group, a significant increase in visual acuity was observed on the first postoperative day, as compared to the PCS group (p = 0.006). Conclusions: The use of a low-energy high-frequency femtosecond laser has potentially no effect on postoperative macular thickness. In the FLACS group, visual rehabilitation was significantly faster as compared to the PCS group. No complications occurred intraoperatively in either group.
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Affiliation(s)
- Filip Slezak
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
| | - Gabriele Thumann
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Martina Kropp
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Zeljka Cvejic
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
| | - Eline Elodie Barbara De Clerck
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Giorgio Enrico Bravetti
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Ivo Guber
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Bojan Pajic
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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Medhi S, Senthil Prasad R, Pai A, Muthukrishnan GR, Mariammal A, Chitradevi R, Shekhar M. Clinical outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: A retrospective study in a tertiary eye care center in South India. Indian J Ophthalmol 2022; 70:4300-4305. [PMID: 36453333 PMCID: PMC9940570 DOI: 10.4103/ijo.ijo_802_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the clinical outcomes of femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) in terms of refractive outcomes, cumulative dissipated energy, and intraoperative complications. Methods In this retrospective study performed in a tertiary care ophthalmic hospital, we reviewed 2124 eyes that underwent FLACS or CP. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), cumulative dissipated energy (CDE), and intraoperative complications were analyzed in the study. Results Out of 2124 eyes, 873 underwent FLACS and 1251 underwent CP. The postoperative mean UCVA after one month was 0.05 ± 0.11 logMAR and 0.14 ± 0.23 logMAR for FLACS and CP, respectively (P < 0.00001). Mean CDVA one month post operation was 0.02 ± 0.07 logMAR and 0.06 ± 0.19 logMAR for FLACS and CP, respectively (P < 0.0001). The CDE for the FLACS group was 6.17 ± 3.86 (P < 0.00001) and it was 9.74 ± 6.02 for the CP group. The intraoperative complication for the FLACS group was 1.60% and the CP group was 2.39% (P < 0.00001). Conclusion The visual outcomes were better in FLACS compared to CP. The CDE was lower for the FLACS group and FLACS had significantly less intraoperative complications.
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Affiliation(s)
- Santana Medhi
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - R Senthil Prasad
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Aruna Pai
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - A Mariammal
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - R Chitradevi
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | - Madhu Shekhar
- Department of Cataract and IOL Services, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Haddad JS, Borges C, Daher ND, Mine A, Salomão M, Ambrósio Jr R. Correlations of Immediate Corneal Tomography Changes with Preoperative and the Elapsed Phaco Parameters. Clin Ophthalmol 2022; 16:2421-2428. [PMID: 35957658 PMCID: PMC9359794 DOI: 10.2147/opth.s363185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/19/2022] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Jorge Selem Haddad
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil
- Instituto Oftalmológico Paulista, São Paulo, SP, Brazil
- Correspondence: Jorge Selem Haddad, Instituto Oftalmológico Paulista, 35 Alameda Casa Branca, São Paulo, SP, Brazil, Tel +55 11 98999-1212, Email
| | | | | | | | - Marcella Salomão
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, SP, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, RJ, Brazil
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Pastor-Pascual F, Pastor-Pascual R, Montés-Micó R, Ruiz-Mesa R, Tañá-Rivero P. Transitional conic toric intraocular lens evaluation after femtosecond laser-assisted cataract surgery using intraoperative aberrometry. Int Ophthalmol 2021; 42:177-189. [PMID: 34424437 DOI: 10.1007/s10792-021-02012-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess refractive and visual outcomes following phacoemulsification with femtosecond laser-assisted cataract surgery (FLACS) using intraoperative aberrometry and implantation of a toric intraocular lens (IOL) in eyes with different degrees of astigmatism. METHODS One hundred two eyes of 70 patients who underwent implantation of the transitional toric 565 Precizon IOL (Ophtec BV) were enrolled. FLACS, capsular tension ring insertion, and intraoperative aberrometry were performed. Main outcome measures were refractive error, uncorrected- and corrected distance snellen decimal visual acuity values (UDVA and CDVA, respectively), and IOL rotation. Specifically, a vector analysis was carried out with J0 and J45 evaluation. Eyes were evaluated 1-year after surgery. RESULTS Overall, 94.12% (96 eyes) and 100% (102 eyes) of the eyes showed a spherical equivalent (SE) within ± 0.50D and ± 1.00D, respectively. The mean SE and refractive cylinder were - 0.06 ± 0.29D and - 0.23 ± 0.37D, respectively. Vector analysis revealed that 100% of the eyes were within ± 0.50D for the J0 and J45 cylindrical components. The mean toric axis rotation was 1.10 ± 1.71° (from 0° to 5°), 77% (79 eyes), and 100% (102 eyes) of the eyes showed UDVA and CDVA of 20/25, respectively. The postoperative mean values of monocular UDVA and CDVA were 0.88 ± 0.17 and 0.96 ± 0.07 (about 20/20), respectively. No patient required IOL realignment during the postoperative follow-up. CONCLUSIONS The present study suggests that the use of the Precizon IOL after FLACS, using intraoperative aberrometry in patients with different amounts of astigmatism, provides good visual acuity, accurate refractive outcomes, and excellent rotational stability.
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Affiliation(s)
| | | | - Robert Montés-Micó
- Oftalvist, C/Ruzafa 19, 46004, Valencia, Spain
- University of Valencia, Valencia, Spain
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Meduri A, Bergandi L, Oliverio GW, Rechichi M, Acri G, Perroni P, Silvagno F, Aragona P. The cold eye irrigation BSS solution used during phacoemulsification reduces post-surgery patients discomfort preventing the inflammation. Eur J Ophthalmol 2021; 32:11206721211018377. [PMID: 34011203 DOI: 10.1177/11206721211018377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study was to assess whether the intraoperative use of the cold eye irrigation balanced salt solution (BSS) could have a protective effect in preventing the anterior chamber flare and conjunctival hyperemia and, thus, in reducing patients discomfort after phacoemulsification. MATERIALS AND METHODS About 214 patients were enrolled and randomly divided into: patients whose eye were irrigated with BSS at ~ 20°C (Group 1) and patients whose eye were irrigated with BSS at 2.7°C (Group 2). Anterior chamber flare, visual analogue score and conjunctival hyperemia were evaluated at 1, 3, 5, and 30 days after surgery. RESULTS In patients of Group 2 the anterior chamber flare, the visual analogue score and the conjunctival hyperemia, used as parameters to evaluated clinical inflammation, at 1 day after surgery were significantly lower than those in Group 1 who received BSS solution at operating room temperature (p < 0.001), while at day 3, 5, and 30 there were not any significant differences. CONCLUSION Our study provided evidence supporting the efficacy of the treatment with cold irrigation solution on reduction of anterior chamber flare, pain and conjunctival hyperemia already at 1 day after phacoemulsification, suggesting that cooling procedure was fully effective at controlling early post-operative inflammation.
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Affiliation(s)
- Alessandro Meduri
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | | | - Giovanni William Oliverio
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | - Miguel Rechichi
- Centro Polispecialistico Mediterraneo, Sellia Marina, Catanzaro, Italy
| | - Giuseppe Acri
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
| | - Pietro Perroni
- Department of Ophthalmology, Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, Milano, Italy
| | | | - Pasquale Aragona
- Biomedical, Dental and Morphological and Functional Images Sciences Department, University of Messina, Messina, Italy
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Pohlmann D, Pilger D, Bertelmann E, von Sonnleithner C. Corneal higher-order aberrations after cataract surgery: Manual phacoemulsification versus femtosecond-laser assisted technique. Eur J Ophthalmol 2021; 31:2955-2961. [PMID: 33499651 PMCID: PMC8606799 DOI: 10.1177/1120672121990611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare and evaluate corneal higher-order aberrations (c-HOA) between conventional manual phacoemulsification (Phaco), femtosecond laser-assisted cataract surgery (FLACS), and femtosecond laser-assisted cataract surgery with astigmatic keratotomy (FSAK). Methods: In this retrospective single center study, 53 healthy individuals with cataract (73 eyes) underwent phacoemulsification with implantation of an intraocular lens. Three groups were formed: group A, Phaco (n = 27 eyes of 21 patients); group B, FLACS (n = 25 eyes of 15 patients); group C, FSAK (n = 21 eyes of 17 patients). An iTrace aberrometer (Tracey Technologies, Houston, TX, USA) was used to perform aberrometry with a pupil scan size of 5.0 mm. We used ANOVA analysis and the paired sample t-test for statistical analysis. Results: There was no difference in total c-HOA between the groups prior to surgery (F(2,66) = 2.2, p = 0.128), but some evidence for a difference between the groups after surgery (F(2,65) = 3.87, p = 0.025). After surgery, total c-HOA increased in all groups, but the greatest increase occurred FSAK. Conclusion: Manual phacoemulsification and femtosecond laser-assisted cataract surgery seem to have less impact on corneal higher-order aberrations than the combination of femtosecond laser-assisted cataract surgery with astigmatic keratotomy.
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Affiliation(s)
- Dominika Pohlmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pilger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eckart Bertelmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph von Sonnleithner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Charles Crozafon P, Bouchet C, Zignani M, Griner R, Foster SD, Zou M, Dhariwal M. Comparison of real-world treatment outcomes of femtosecond laser-assisted cataract surgery and phacoemulsification cataract surgery: A retrospective, observational study from an outpatient clinic in France. Eur J Ophthalmol 2020; 31:1809-1816. [PMID: 32452248 DOI: 10.1177/1120672120925766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study compared real-world safety and efficacy outcomes of cataract surgery performed with LenSx femtosecond laser-assisted cataract surgery or manual phacoemulsification cataract surgery procedures. METHODS A retrospective observational study used data from anonymised electronic medical records to compare mean cumulative dissipated energy, the proportion of eyes reaching emmetropia, mean change in best-corrected distance visual acuity and the proportion of eyes with post-surgical complications, including corneal oedema and posterior capsule opacification. Results were adjusted for multiple comparisons for primary and secondary objectives. RESULTS Data from 811 phacoemulsification cataract surgery and 496 femtosecond laser-assisted cataract surgery procedures were analysed. Mean cumulative dissipated energy was significantly lower for femtosecond laser-assisted cataract surgery (6.5 percent-seconds) than for phacoemulsification cataract surgery (14.3 percent-seconds; p < 0.0001) procedures. More femtosecond laser-assisted cataract surgery (81.2%) procedures achieved emmetropia (⩽ 0.5 dioptre) than did phacoemulsification cataract surgery (73.5%) procedures, although this difference was not statistically significant. Mean change in best-corrected distance visual acuity and the proportion of eyes with corneal oedema, posterior capsule opacification or other complications were not significantly different between cohorts when adjusted for multiple comparisons. CONCLUSIONS In this single-centre, single-surgeon retrospective electronic medical record database study using divide and conquer technique, femtosecond laser-assisted cataract surgery was associated with significantly lower cumulative dissipated energy when compared to manual phacoemulsification cataract surgery. This supports the hypothesis that femtosecond laser-assisted cataract surgery involves less mechanical trauma, which might lead to more consistent refractive and safety outcomes than manual phacoemulsification cataract surgery, though such outcomes were found to be comparable in this study.
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Affiliation(s)
| | | | | | - Ray Griner
- IQVIA Real-World and Analytics Solutions, London, UK
| | | | - Ming Zou
- IQVIA Real-World and Analytics Solutions, London, UK
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An Alternative Approach to Cataract Surgery Using BSS Temperature of 2.7 °C. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The aim of this study is to evaluate the difference in the number of endothelial cells after cataract operations with phacoemulsification by using a balanced salt solution (BSS) at standard temperature (about 20 °C) and at 2.7 °C. Two groups, comprising 214 individuals in total, participated in this study; patients were operated on using BSS bottle at about 20 °C and 2.7 °C in the first and second groups, respectively. All operations were conducted by the same surgeon and in similar conditions. One month after the operations, endothelial cells in the two groups were checked. For patients in Group 2, an important reduction in the loss of endothelial cells was observed.
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Visual performance and positional stability of a capsulorhexis-fixated extended depth-of-focus intraocular lens. J Cataract Refract Surg 2020; 46:179-187. [DOI: 10.1097/j.jcrs.0000000000000044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Reñones de Abajo J, Estévez Jorge B, González Martín JM, Carreras Díaz H, Loro Ferrer JF, Antón López A. Effect of femtosecond laser-assisted lens surgery on the optic nerve head and the macula. Int J Ophthalmol 2019; 12:961-966. [PMID: 31236353 DOI: 10.18240/ijo.2019.06.13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/22/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effect of femtosecond laser-assisted lens surgery (FLALS; cataract surgery or refractive lens exchange) on the structure of the optic nerve head and the macula. METHODS This prospective longitudinal study included healthy eyes undergoing FLALS. Eyes with glaucoma or any other ocular disease that could alter optical coherence tomography results were excluded. Retinal nerve fiber layer (RNFL), Bruch's membrane opening-minimum rim width (BMO-MRW) and macular thickness (MT) were measured preoperatively, 1 and 6mo after surgery using spectral-domain optical coherence tomography (SD-OCT). Changes between preoperative and postoperative values were evaluated. RESULTS A total of 87 eyes of 46 patients were included in this study. Preoperative RNFL, BMO-MRW and MT in microns (µm) were 100.77±10.39, 330.31±49.99 and 276.30±33.39, respectively. Postoperative RNFL, BMO-MRW and MT were 104.74±11.55, 348.32±54.05 and 279.83±22.65 1mo after surgery and 102.93±11.17, 343.11±53.4 and 278.90±22.19 6mo after surgery, respectively; which equals an increase of 3.93%, 5.45% and 1.27%, respectively, 1mo after surgery, and 2.14%, 3.87% and 0.94% 6mo after surgery. The differences between the preoperative and the postoperative RNFL and BMO-MRW values were statistically significant (P<0.001). Regarding MT values, there were not statistically significant differences (P=0.26). CONCLUSION Our study suggests that FLALS does not have a negative impact on the structural status of the optic nerve head in healthy eyes, assessed by SD-OCT. There is a slight increase in the values of RNFL, BMO-MRW and MT 1mo and 6mo after surgery.
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Affiliation(s)
- Josefina Reñones de Abajo
- Eurocanarias Oftalmológica, Las Palmas de Gran Canaria 35004, Spain.,Universidad de Las Palmas de Gran Canaria (ULPGC), Las Palmas de Gran Canaria 35001, Spain
| | | | - Jesús María González Martín
- Department of Research, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria 35019, Spain
| | | | | | - Alfonso Antón López
- Universidad Internacional de Cataluña (UIC), Barcelona 08195, Spain.,Institut Català de Retina (ICR), Barcelona 08017, Spain.,Parc de salut Mar, Barcelona 08024, Spain
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14
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Masuda Y, Igarashi T, Oki K, Kobayashi M, Takahashi H, Nakano T. Free radical production by femtosecond laser lens irradiation in porcine eyes. J Cataract Refract Surg 2019; 45:1168-1171. [PMID: 31126782 DOI: 10.1016/j.jcrs.2019.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the relationship between the generation of free radicals and femtosecond laser lens irradiation. SETTING AMO Laboratory, Tokyo, Japan. DESIGN Ex vivo studies. METHODS Hydroxyphenyl fluorescein (HPF) was injected into the anterior chamber of fresh 6-month-old porcine cadaver eyes (N = 31). After laser irradiation, a plate reader was used to measure the fluorescence of the aqueous humor samples. Relative fluorescence units (RFU) were calculated by subtracting the average control value from the measured values of all the samples. Experiment 1: After determining the RFU in the 7 laser-irradiated eyes, the relationship with the amount of laser energy was then assessed. Experiment 2: To clarify the issue regarding the degree of attenuation of the fluorescence intensity, HPF was simultaneously injected into 2 eyes, with 1 eye irradiated and the other eye used as a control. After dividing the RFU of the laser-irradiated eye by the control RFU, the laser irradiation-control RFU ratio was calculated, and the relationship with the laser irradiation energy amount then assessed. RESULTS There was a significant correlation between the femtosecond laser lens irradiation energy and the RFU in the aqueous humor (P < .05, analysis of variance). CONCLUSIONS Femtosecond laser lens irradiation increases the quantity of free radicals in the aqueous humor, with the extent of the increase dependent on the amount of laser energy. These results suggest that excessive laser irradiation during femtosecond laser-assisted cataract surgery might cause corneal endothelial damage because of the free radicals created during the procedure.
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Affiliation(s)
- Yoichiro Masuda
- Department of Ophthalmology, Jikei University, School of Medicine, Tokyo, Japan.
| | - Tsutomu Igarashi
- Department of Ophthalmology, Nippon Medical School, Tokyo, Japan
| | | | - Maika Kobayashi
- Department of Ophthalmology, Nippon Medical School, Tokyo, Japan
| | | | - Tadashi Nakano
- Department of Ophthalmology, Jikei University, School of Medicine, Tokyo, Japan
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15
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Solomon KD, Sandoval HP, Potvin R. Correcting astigmatism at the time of cataract surgery: Toric IOLs and corneal relaxing incisions planned with an image-guidance system and intraoperative aberrometer versus manual planning and surgery. J Cataract Refract Surg 2019; 45:569-575. [PMID: 30902431 DOI: 10.1016/j.jcrs.2018.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/16/2018] [Accepted: 12/02/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the outcomes of the combination of an image-guided system and intraoperative aberrometer with the surgeon's standard of care in correcting astigmatism using toric intraocular lenses (IOLs) or corneal incisions. SETTING Single site in United States. DESIGN Prospective case series. METHODS Contralateral eyes of patients having uncomplicated bilateral cataract surgery and astigmatism correction were randomly assigned to Group A or Group B. Group A received the surgeon's preferred standard of care. Group B had preoperative planning using an image-guidance system (VERION), intraoperative aberrometry (ORA System with VerifEye+), and femtosecond laser-assisted cataract surgery. The primary endpoint was the residual refractive astigmatism at 3 months. RESULTS Thirty-eight eyes were treated with toric IOLs and 40 eyes with corneal astigmatic incisions. On average, toric IOLs resulted in almost 0.25 diopter (D) less cylinder than corneal astigmatic incisions (P < .01), with no difference between groups (P = .41). There was no statistically significant difference in the mean spherical equivalent refraction by group (P = .51). At 3 months, the IOL in 4 eyes (11%) (2 in Group A and Group B each) was more than 10 degrees of absolute orientation from the intended orientation. The mean keratometry was 0.16 D higher with the image-guided system compared with optical biometry (Lenstar). The vector difference between the 2 measurements was 0.5 D or lower in all eyes. CONCLUSIONS The combined use of an image-guided system and intraoperative aberrometer did not significantly improve outcomes compared with the surgeon's standard of care. Based on keratometry, there was good agreement in corneal astigmatism measurements between the image-guided system and the optical biometer.
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Affiliation(s)
- Kerry D Solomon
- Carolina Eyecare Physicians, LLC, Mount Pleasant, South Carolina, USA.
| | - Helga P Sandoval
- Carolina Eyecare Physicians, LLC, Mount Pleasant, South Carolina, USA
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16
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Zhang X, Yu Y, Zhang G, Zhou Y, Zhao G, Chen M, Wang Y, Zhu S, Zhang H, Yao K. Performance of femtosecond laser-assisted cataract surgery in Chinese patients with cataract: a prospective, multicenter, registry study. BMC Ophthalmol 2019; 19:77. [PMID: 30871533 PMCID: PMC6417229 DOI: 10.1186/s12886-019-1079-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 03/01/2019] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Xiaobo Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinhui Yu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | - Yanwen Zhou
- Cataract, Shenyang Aier Eye Hospital, Shenyang, China
| | - Guangyu Zhao
- Cataract, Fuzhou Southeast Ophthalmology Hospital, Fuzhou, China
| | - Maosheng Chen
- Cataract, Chongqing Aier Ophthalmology Hospital, Chongqing, China
| | - Yong Wang
- Cataract, Wuhan Aier Eye Hospital, Wuhan, China
| | - Siquan Zhu
- Ophthalmology, Beijing Tongren Hospital, Beijing, China
| | - Hong Zhang
- Cataract, Ophthalmology Hospital of Tianjin Medical College, Tianjin, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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17
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Wang L, Li P, Guo X. Comparison of diathermic high-frequency capsulorhexis and continuous curvilinear capsulorrhexis in white cataract surgery. Int J Ophthalmol 2018; 11:1317-1321. [PMID: 30140635 DOI: 10.18240/ijo.2018.08.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/30/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the corneal endothelial cell counts pre- and post-operation, ultrastructure of anterior lens capsule and surgical completion after diathermic high-frequency capsulorhexis (DHC) and continuous curvilinear capsulorrhexis (CCC) applied in phacoemulsification (PHACO) of white cataract surgery. METHODS Sixty-six eyes of 66 patients (33 males and 33 females) with cataract aged between 60 and 80y (mean 72.5±5.5) were recruited and undergone the surgery from June 2014 to November 2016. Anterior lens capsule, derived from two kinds of capsulorhexis, were randomly divided into two groups according to random number table. The ultrastructure of the capsule edge and its closer tissue were observed by transmission electron microscopy (TEM) and optical microscopy respectively. The surgical completion conditions and corneal endothelial cell counts were analyzed pre- and post-operation after two capsulorhexis. RESULTS The capsule derived from CCC had smooth edge, well-organized cellular structure and the cells filling into the cutting edge under TEM and optical microscopy. The capsule derived from DHC had an approximate 60 banded area of cell degeneration and necrosis, with dentiform prominences at the edge of the capsule, and no cell structure was observed at this area. The corneal endothelial cell counts of both groups were slightly declined 1wk post-operation compared with that of pre-operation. There was no statistical difference between the two groups (t=1.63, P>0.05). CONCLUSION DHC shows good clinical value in white mature and hypermature cataract surgery.
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Affiliation(s)
- Li Wang
- Department of Ophthalmology, Department of Medical and Research Technology Xi'an Medical University, Xi'an 710021, Shaanxi Province, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Peng Li
- Department of Ophthalmology, the 451st Hospital of the PLA, Xi'an 710054, Shaanxi Province, China
| | - Xiong Guo
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
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18
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Khodabakhsh AJ, Hofbauer J. Contralateral eye comparison of the phacoemulsification metrics, patient experience and clinical outcomes in patients undergoing bilateral cataract surgery with two commonly used femtosecond laser systems. Clin Ophthalmol 2018; 12:1391-1398. [PMID: 30122892 PMCID: PMC6087026 DOI: 10.2147/opth.s164513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the study was to compare phacometrics, patient experience factors and clinical outcomes in patients undergoing bilateral laser-assisted cataract surgery using two common femtosecond laser platforms. Setting This study was conducted in Beverly Hills Institute of Ophthalmology, Beverly Hills, California, USA. Study design This was a prospective, comparative, contralateral eye study. Methods Femtosecond laser-assisted cataract surgery was performed in the first eye of 50 patients with bilateral cataract (mean age 69.9 ± 8.61 years) using either the Catalys (Johnson & Johnson Vision) or the LenSx (Alcon Laboratories, Inc.) laser system. The fellow eye was treated with the laser not used in the first eye. The primary outcome measures included overall procedural times, and the secondary outcome measures included patient experience with the two laser systems. Results There were no statistical differences between the two groups in terms of patient interface preparation time and number of docking attempts as well as effective phaco time, average phaco power, total ultrasound time and nucleus removal time. However, the LenSx group demonstrated a significantly longer cortex removal time and higher perception of pressure and vision loss (p < 0.001) compared to the Catalys group. A significantly higher number of Catalys eyes achieved complete capsulotomy (p < 0.001). The ease of cortex removal was also better in the Catalys group. Postoperative visual acuity, keratometry, endothelial cell count and intraocular pressure were comparable in the two groups. Conclusion With similar phacometric and clinical outcomes, both laser platforms were efficient, safe and effective during cataract surgery; however, the Catalys group demonstrated superior outcomes in terms of the patient experience, completeness of capsulotomy and ease of cortex removal.
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Affiliation(s)
| | - John Hofbauer
- Beverly Hills Institute of Ophthalmology, Beverly Hills, CA, USA,
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19
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Lawless M, Levitz L, Hodge C. Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes? Indian J Ophthalmol 2017; 65:1314-1322. [PMID: 29208811 PMCID: PMC5742959 DOI: 10.4103/ijo.ijo_736_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Femtosecond laser-assisted cataract surgery (FLACS) was introduced in 2009 and has increasingly been incorporated into surgical practice. The automation of three key aspects of cataract surgery was expected to deliver a significant improvement in both refractive and safety outcomes. The published literature has not yet shown consistent refractive improvement above conventional techniques. The purpose of this paper is to review current FLACS refractive outcomes and explore factors that may have contributed to the current findings and whether future improvements are possible.
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Affiliation(s)
- Michael Lawless
- Vision Eye Institute; Department of Ophthalmology, Sydney Medical School, Save Sight Institute, University of Sydney, Australia
| | | | - Chris Hodge
- Vision Eye Institute; Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia
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20
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Hida WT, Tzelikis PF, Vilar C, Chaves MAPD, Motta AFP, Carricondo PC, Ventura BV, Ambrosio R, Nosé W, Alves MR. Outcomes study between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery using an active fluidics system. Clin Ophthalmol 2017; 11:1735-1739. [PMID: 29026283 PMCID: PMC5627560 DOI: 10.2147/opth.s136136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose The purpose of this study was to compare intraoperative parameters between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification using Centurion® Vision System with Active Fluidics. Setting This study was performed at Brasília Ophthalmologic Hospital, Brasília, Federal District, Brazil. Patients and methods This was a prospective randomized comparative study. Patients with the diagnosis of cataract and surgical extraction programmed were divided into two groups: conventional phacoemulsification and FLACS. Intraoperative data were collected and submitted for statistical analysis. Results A total of 400 eyes were enrolled, 200 in each group. There were no surgical complications. Groups were statistically equivalent in age and nucleus density. Cumulative dissipated energy and torsional time were significantly reduced in the FLACS group. Conventional surgery had less fluid usage, total case time and aspiration (ASP) time. Conclusion FLACS with Active Fluidics System can reduce the ultrasound energy use during cataract surgery, in spite of increasing case time, fluid usage and ASP time.
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Affiliation(s)
- Wilson Takashi Hida
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo.,Department of Ophthalmology of São Paulo Federal University (UNIFESP) School of Medicine, São Paulo
| | - Patrick Frenzel Tzelikis
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo
| | - César Vilar
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District
| | - Mario Augusto Pereira Dias Chaves
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,ProVisão Hospital, João Pessoa, Paraíba
| | - Antônio Francisco Pimenta Motta
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo
| | - Pedro Carlos Carricondo
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo
| | - Bruna Vieira Ventura
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo Federal University (UNIFESP) School of Medicine, São Paulo.,Pernanbuco Eye Hospital (HOPE), Recife, Pernambuco, Brazil
| | - Renato Ambrosio
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo
| | - Walton Nosé
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo Federal University (UNIFESP) School of Medicine, São Paulo
| | - Milton Ruiz Alves
- Department of Cataract of Brasília Ophthalmology Hospital (HOB), Brasília, Federal District.,Renato Ambrosio Research Center (CEORA), Brasília, Federal District.,Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP), São Paulo
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