Laboratory results indicate that microcoaxial phacoemulsification through a 2.2 mm incision offers fluidic-, thermal-, and incision-related benefits over sleeveless bimanual microphacoemulsification. Moreover, a full-sized single-piece acrylic IOL could be safely implanted without enlarging the 2.2 mm incision.
Mr. Injev is an employee of Alcon Laboratories. Dr. Miller is a consultant to and investigator for Alcon Laboratories. Ms. Nejad has no financial or proprietary interest in any material or method mentioned.
Purpose: To compare the effects of femtosecond laser assisted cataract surgery (FLACS) and manual phacoemulsification on cumulative dissipated energy (CDE), torsional amplitude, and endothelial cell density (ECD). Patients and Methods: This prospective, randomized study was conducted at Oka Eye Clinic (Fukuoka, Japan). Surgeries were performed using FLACS (with LenSx) or conventional technique in adults ≥20 years with grade 2-4 cataracts. Visits included preoperative, surgery day, and 5 postoperative visits (days 1, 4-10, 20-40, 60-120, and 150-210). Primary endpoint was CDE. Secondary endpoints included ECD percent change at day 150-210 versus preoperative visit and average torsional amplitude on surgery day. Exploratory endpoints included central corneal thickness and corrected distance visual acuity (CDVA). Superiority of FLACS to conventional technique was evaluated using t-tests based on a mixed model for repeated measures. Results: Full analysis set included 53 eyes per group. Mean cataract grade was 2.92±0.58 in FLACS and 2.94±0.57 in conventional group. FLACS versus conventional method had significantly lower mean CDE (0.213±0.334 versus 1.718±0.898%-seconds, respectively; P<0.0001), demonstrating superiority of FLACS. Low endothelial cell loss (ECL) was achieved with both FLACS and conventional methods (1.5±5.6% and 2.7±5.2%; P=0.260). Torsional amplitude was significantly lower for FLACS versus conventional method (19.6 ±16.0% versus 31.1±6.6%; P<0.0001). Central corneal thickness was comparable for both methods at all visits except day 1; CDVA was comparable for both methods at all postoperative visits. Conclusion: FLACS achieved significantly lower CDE compared with the conventional surgical method (P<0.0001). Low ECL was achieved with both FLACS (1.5%) and conventional (2.7%) methods.
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