Clinical outcomes of femtosecond laser–assisted cataract surgery versus conventional phacoemulsification: A retrospective study in a tertiary eye care center in South India

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.

Application of Femtosecond Laser in Challenging Cataract Cases

“…FLACS has also been reported to reduce optical aberrations and improve optical quality and patient satisfaction 32–34 . Several studies have reported that FLACS showed better visual outcomes than conventional cataract surgery, particularly in cases with implantation of an extended-depth-of-focus IOL 16,34,35 . However, other studies failed to demonstrate any significant difference in visual and refractive outcomes between FLACS and conventional cataract surgery 5,36–39 .…”

“…[32][33][34] Several studies have reported that FLACS showed better visual outcomes than conventional cataract surgery, particularly in cases with implantation of an extended-depth-of-focus IOL. 16,34,35 However, other studies failed to demonstrate any significant difference in visual and refractive outcomes between FLACS and conventional cataract surgery. 5,[36][37][38][39] Metaanalysis studies revealed that FLACS did not show significant difference for visual and refractive outcomes, whereas it was associated with a higher rate of complications, such as incomplete capsulotomy, anterior capsular tear, and posterior capsular rupture.…”

Intraoperative Iridectomy in Femto-Laser Assisted Smaller-Incision New Generation Implantable Miniature Telescope

“…The main advantage of SING IMT™, if compared with the first generations IMT™, is the new device design and technique, allowing small corneal wound, the preloaded device, as well as the shorter surgery time. Further advantages expected from the use of FLACS could not be evaluated because we did not use assisted nuclear fragmentation and it is clearly known that the reduction of postoperative ECD loss is mainly due to a reduced cumulative dissipated energy during laser-assisted phacoemulsification [ 19 ]. However, the possibility of setting pre-operatively some anatomical parameters (e.g., the diameter of the capsulorhexis) increases surgical repeatability, predictability, shape accuration and strength of capsulorhexis, as well as reducing the risk of complications, compared to the manual procedure [ 20 ].…”

Femtosecond Laser Applications in Ophthalmic Surgery

“…In white, complete, or intumescent cataracts, studies have found that adjustment of femtosecond laser capsulotomy distance by reducing pre-anterior capsule and increasing postanterior distance may decrease the incidence of incomplete capsulotomies. [16][17][18] The femtosecond laser allows nucleus fragmentation can be performed through various cutting patterns including cubes, sections, or grooves depending on surgeon preference and density of the cataract. As complications in cataract surgery including posterior capsule tear can frequently arise during nuclear disassembly, nuclear pre-cutting and nuclear softening with the femtosecond laser reduces the ultrasound energy required.…”