Changes in Ganglion Cell Complex and Peripapillary Retinal Nerve Fiber Layer after Femtosecond Laser-Assisted Cataract Surgery Compared to Manual Phacoemulsification in Patients Receiving a Trifocal Intraocular Lens

Abstract

Introduction. During femtosecond laser-assisted cataract surgery (FLACS), there is a significant increase in intraocular pressure, which might lead to ganglion cell damage. We aimed to determine whether there were differences in the changes produced in the ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (pRNFL) thickness, as evaluated with optical coherence tomography (OCT), between phacoemulsification and FLACS, after implantation of a trifocal intraocular lens (IOL). Methods. Patients with no coexistent pathologies undergoing cataract surgery with implantation of a PanOptix IOL were explored with the Cirrus-OCT before and three months after surgery. GCC values were obtained from the built-in software. The differences between pre- and postoperative GCC and pRNFL thicknesses after phacoemulsification were compared to differences after FLACS. Results. A total of 171 eyes were included, 74 undergoing FLACS and 97 phacoemulsification. For both groups, there was a statistically significant increase in GCC values after cataract surgery, except for the inferior and inferonasal sectors. There were no statistically significant differences between FLACS and phacoemulsification. Mean change in average GCC and minimum GCC were 1.08 ± 1.40 µm (range −1 to +6 µm) and 1.69 ± 2.54 µm (range −3 to +11 µm) after FLACS and 0.99 ± 1.67 µm (range −5 to +6 µm) and 2.02 ± 3.54 µm (−6 to +18 µm) after phacoemulsification. These values are similar to those previously reported after phacoemulsification with monofocal IOL implantation. No significant changes after surgery were detected for the pRNFL, with no differences between groups. Discussion. There were no differences in the changes produced by FLACS and phacoemulsification in either GCC or pRNFL values. Although mean change was small, the range of variation was wide. Therefore, it is necessary to establish a new baseline for GCC and pRNFL thicknesses after cataract surgery in order to monitor any subsequent changes.

Effect of Femtosecond Laser Cataract Surgery on Peripapillary Retinal Nerve Fiber Layer Thickness

“…The sample size of our CPCS group is close to many of the other studies in the literature on the effect of CPCS on pRNFL. 10,[13][14][15][16][17] Moreover, CPCS generated a similar variance of change within the average pRNFL in this study as in the study by Sánchez-Sánchez et al 7 Therefore, there is evidence to support the validity of our CPCS group. Nevertheless, the significant difference in sample size between groups limits the possibility of establishing accurate comparisons.…”

“…This observation is compatible with our finding. Like us and as in the previous study, Sánchez-Sánchez et al, 7 via Cirrus HD-OCT showed an increase in average pRNFL thickness, 3 months after FLACS using LenSx laser, and a trifocal IOL implantation, in 74 eyes. Direct comparison with that study is limited by dissimilar OCT devices and IOL types.…”

“…10,[13][14][15][16][17] While these studies addressed the mean pRNFL thickness measurements, we focused on the change in pRNFL thickness, therefore our post-FLACS findings cannot be compared with those after CPCS in the literature. Sánchez-Sánchez et al 7 compared the average pRNFL thickness after FLACS to that after CPCS and found that no significant changes were detected after surgery, with no differences between groups. They reported a 10 μm variance of change within the average pRNFL for both surgeries.…”

“…Optical coherence tomography (OCT) is a well-recognized method of analyzing the in vivo optic nerve architecture, quantified by measuring the peripapillary retinal nerve fiber layer (pRNFL) thickness 5. We are aware of only 2 studies reporting the effect of FLACS using LenSx laser with soft lens interface (SoftFit) on pRNFL thickness measurements via OCT in healthy eyes 6,7. One study showed an increase in pRNFL thickness measurements,6 while the other demonstrated no change in pRNFL thickness values, after surgery 7.…”

Effect of Conventional Cataract Surgery and Femtosecond Laser‐Assisted Cataract Surgery on Bruch’s Membrane Opening‐Minimum Rim Width, Retinal Nerve Fiber Layer, and Macular Thickness

“…The aim of this study was to evaluate and compare the changes in BMO-MRW, RNFL, and MT one month and six months after cataract surgery, in CCS and FLACS. Some studies have shown that FLACS does not lead to more macular thickening than CCS [ 12 – 16 ], but there is a paucity of evidence regarding the effects of CCS and FLACS on the ONH [ 23 , 24 ]. In the present study, the postoperative behaviour of BMO-MRW, RNFL, and MT was very similar in both groups.…”