Changes in aqueous oxidative stress, prostaglandins, and cytokines: Comparisons of low-energy femtosecond laser–assisted cataract surgery versus conventional phacoemulsification

Liu, Yu‐Chi; Setiawan, Melina; Ang, Marcus; Yam, Gary Hin Fai; Mehta, Jodhbir S.

doi:10.1016/j.jcrs.2018.09.022

Cited by 38 publications

(70 citation statements)

References 24 publications

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“…It is well demonstrated that FLACS procedures performed with high-energy lasers are associated with higher prostaglandin and cytokine concentrations and higher rates of anterior capsule damage [ 34 ], whereas reduced inflammation could also decrease the risk of PCO induction, and Liu et al found only low amounts of interleukin (IL)-1 α and −1 β in the anterior chamber aqueous humour of patients who underwent FLACS with the low-energy Z8 [ 35 ]. The IL-1 α of 0.5 ± 0.2 pg/ml was only slightly higher compared to manual surgery (0.05 ± 0.05 pg/ml), and the IL-1 β showed almost similar values for the FLACS and manual surgery: 0.5 ± 0.3 pg/ml and 0.5 ± 0.4 pg/ml respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Verdina

Peppoloni

Barbieri

et al. 2020

Journal of Ophthalmology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Verdina

Peppoloni

Barbieri

et al. 2020

Journal of Ophthalmology

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“…Femtosecond lasers have been applied to the field of refractive surgery 16 , cataract surgery 17 and corneal transplantation 18,19 , providing reproducible, accurate and reliable capsulotomy 20 , corneal flaps, stromal lenticules 21 , or corneal grafts 18,19 . In order to attempt to transfer these favorable characteristics of femtosecond lasers to pterygium surgery, recently, we described a new technique, in which a low-energy, high-frequency femtosecond laser (Z8 LDV, Ziemer Ophthalmic Systems AG, Port, Switzerland) was used to prepare CAGs in pterygium surgery 22,23 .…”

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confidence: 99%

Femtosecond Laser-assisted Preparation of Conjunctival Autograft for Pterygium Surgery

Liu

Tan

et al. 2020

Sci Rep

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Femtosecond laser-assisted conjunctival autografts (CAG) preparation was recently proposed. This study reports the outcomes of the first clinical trial on the use of laser to prepare CAG in pterygium surgery, and to compare the outcomes with those of manual technique. Forty eyes undergoing primary pterygium excision with laser-assisted CAG transplantation were prospectively included (L group). Two historical matched cohorts whose cAGs were prepared manually were compared (n = 78 eyes by the same experienced surgeon, M group; n = 78 eyes by trainees; TM group). We found the laser-created CAGs had only 11 μm deviation from the targeted thickness. The best-corrected visual acuity improved, and the astigmatism significantly decreased after surgery, with comparable efficacy across 3 groups. The 1-year recurrence rate was 2.5%, 3.8% and 7.7% in the L, M and TM groups, respectively (P = 0.12). There was no significant difference between the L and M groups in the complication rate (5.0% and 1.3%, respectively), surgical time (19.4 ± 5.1 and 19.1 ± 6.2 minutes, respectively), and postoperative discomfort scores (0.1 ± 0.3 and 0.2 ± 0.3, respectively), but these outcomes were significantly less favorable in the TM group. The results of this first comparative clinical trial suggest that femtosecond laser-assisted CAG preparation can be considered as an alternative technique for CAGs preparation.

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“…The introduction of femtosecond laser-assisted cataract surgery made it possible to evaluate the release of inflammatory mediators into the AC immediately after the application of the laser and before phacoemulsification. In a comparative study, Liu et al 66 reported that femtosecond laser treatment induced significantly higher humour aqueous levels of pro-inflammatory cytokines and PGE2 compared to standard phacoemulsification. Furthermore, the postoperative flare was higher, although not significantly, in the femtosecond-assisted group than in the standard phacoemulsification group; however, in this study, no analysis of the macula thickness was conducted.Harvesting aqueous humour remains a controversial procedure in prospective clinical trials on cataract surgery, as it would be unethical to obtain consecutive samples in the same patients during follow-up due to the invasiveness of the procedure.…”

Section: Aqueous Humor Sample Analysismentioning

confidence: 99%

<p>Measuring Anterior Chamber Inflammation After Cataract Surgery: A Review of the Literature Focusing on the Correlation with Cystoid Macular Edema</p>

Maria¹,

Iannetta²,

Cimino³

et al. 2020

OPTH

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Cystoid macular edema (CME) is an infrequent, though potentially visually impairing, complication after uneventful cataract surgery. Rupture of the blood-aqueous barrier, with leakage of serum proteins into the aqueous humour, is the main pathogenic factor. However, only a few studies investigated the potential correlation between anterior chamber (AC) inflammation and the risk of cystoid macular changes occurring after surgery. This review aims to identify evidence of a correlation between AC inflammation and the risk of pseudophakic CME. One hundred eighty-seven prospective trials investigating AC inflammation after uncomplicated cataract surgery were identified. Methods of analysis of AC inflammation and the frequency of macular changes were recorded. In the majority (51%) of the studies, inflammation was assessed by clinical grading, followed by laser flare and cell photometry (LFCP) (42%) and aqueous humour sample (4%). Few studies (4%) adopted a combined LFCP and aqueous sample or clinical grading analysis. Sixteen (9%) studies investigated AC inflammation and macular changes by OCT (7%) or fluorescein angiography (2%). Correlation between the amount of postoperative AC inflammation and frequency of CME was documented in 7 studies, not confirmed in 2 studies, and not examined in the other 7. LFCP, more than the other methods of analysis, correlated with the frequency of CME postoperatively. Investigation of the relationship between AC inflammation and the risk of CME changes requires the adoption of quantitative methods of analysis of the inflammatory response after surgery. For this purpose, due to the low level of inflammation in the AC after uncomplicated cataract surgery, LFCP, more than subjective clinical grading, seems a more sensitive and reproducible method of measurement. Inflammation assessment after cataract surgery has a potential role in predicting the risk of CME development and may help to titrate the duration and intensity of treatment in relation to the surgical inflammatory response.

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Changes in aqueous oxidative stress, prostaglandins, and cytokines: Comparisons of low-energy femtosecond laser–assisted cataract surgery versus conventional phacoemulsification

Cited by 38 publications

References 24 publications

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

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

Femtosecond Laser-assisted Preparation of Conjunctival Autograft for Pterygium Surgery

<p>Measuring Anterior Chamber Inflammation After Cataract Surgery: A Review of the Literature Focusing on the Correlation with Cystoid Macular Edema</p>

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