Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery

Nejima, Ryohei; Terada, Yukiko; Mori, Yosai; Ogata, Mitsuaki; Minami, Keiichiro

doi:10.1007/s10384-015-0383-3

Cited by 21 publications

(13 citation statements)

References 23 publications

(39 reference statements)

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“…The latest development in cataract surgery is the application of the femtosecond laser to create tailor-made corneal incisions,[ 1 2 ] fashion perfectly centered and calibrated capsulorhexis,[ 1 3 4 5 6 ] and assist with fragmenting the nucleus. [ 1 7 8 ] Additional benefits include reduced ultrasound energy[ 9 10 ] during emulsification with resultant endothelial protection and creation of customized arcuate incisions[ 11 12 13 ] to neutralize any astigmatism that may compromise visual quality. Femtosecond laser-assisted cataract surgery (FLACS) is being adopted widely for the precision, it offers compared to conventional techniques, which are surgeon dependent.…”

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confidence: 99%

Learning curve of femtosecond laser-assisted cataract surgery: Experience of surgeons new to femtosecond laser platform

Christy

Nath

Mouttapa

et al. 2017

Indian J Ophthalmol

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Purpose:The purpose of this study is to assess the learning curve in the initial 100 cases of cataract surgery performed using femtosecond laser-assisted cataract surgery (FLACS) by experienced cataract surgeons without prior experience in femtosecond laser platform.Methods:This study was conducted at tertiary care eye hospital, South India. This was a prospective interventional study. The first 100 consecutive eyes undergoing FLACS were studied to understand docking time, number of docking attempts, problems encountered during docking, and complications attributable to docking. Phacoemulsification performed after femtosecond laser was also studied for complications, need for additional instrumentation, and total time required for surgery. Comparison was also made between two operating surgeons.Results:Successful docking was recorded in 70% eyes at the first attempt. Mean time taken for successful docking was 9.3 ± 6.4 min (median = 6 min, interquartile range (IQR) = 5–10 min, range = 4–35 min). When surgeries were divided into quartiles, docking time reduced significantly from 16.2 ± 7.9 min in the first quartile to 6.2 ± 2.7 min in the fourth quartile (P < 0.001). Phacoemulsification postdocking required 12.9 ± 6.2 min (median = 10 min, IQR = 9–17.5 min). Six eyes showed anterior capsular tags, one had radial extension of capsulorhexis, and two eyes showed pupillary miosis after femtosecond laser application. At 6 weeks, 79% eyes attained uncorrected vision of 20/20, and all eyes had best-corrected vision of 20/20.Conclusion:Approximately 25–30 cases were required before obtaining reproducible results with FLACS, irrespective of cataract surgical experience, suggesting that training programs must offer a minimum 25 surgeries. Very few complications occurred during the learning curve, making it patient friendly.

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confidence: 99%

Learning curve of femtosecond laser-assisted cataract surgery: Experience of surgeons new to femtosecond laser platform

Christy

Nath

Mouttapa

et al. 2017

Indian J Ophthalmol

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“…Overall incision depth of penetrating femtosecond laser arcuate incisions has been reported as a factor contributing to effectiveness, with deeper incisions with less uncut posterior cornea providing more astigmatic correction. 14 Additionally, these IS incisions may cause architectural changes of the cornea, due to wound repair or other factors. Subsequently, the architectural changes of the cornea may have potential impact on the deviation between the actual location of IS incisions and the planned parameters.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Femtosecond Laser Intrastromal Incision Location Using Optical Coherence Tomography

et al. 2017

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Purpose Using optical coherence tomography (OCT) to evaluate the femtosecond laser intrastromal (IS) incisions made during cataract surgery to reduce corneal astigmatism. Design Retrospective case series. Subjects 77 eyes of 77 patients were included. Methods Paired IS incisions were created using the Catalys femtosecond laser (Abbott Medical Optics, Inc.). The planned IS incision parameters were 20% uncut anterior, 20% uncut posterior, midpoint depth of 50%, and 90° side cut angle. OCT scans were obtained three weeks or more postoperatively to assess these four parameters, and actual values were compared to intended values. Main Outcome Measures Percentages of uncut anterior and posterior tissue, midpoint depth, and degrees of side cut angle. Results The mean values were 17.2% ± 5.8% (range 7.2% to 36.9%) for uncut anterior, 32.5% ± 8.8% (range 6.0% to 57.9%) for uncut posterior, and 42.3% ± 6.6% (range 25.5% to 65.4%) for midpoint depth, which were all significantly different from the planned parameters (all P<0.05). The mean side cut angle was 88.5° ± 5.6° (range 71° to 114°) and was significantly different from the planned side cut angle of 90° (P<0.05). In 50 eyes that had paired IS incisions scanned by the OCT, there was no correlation between the paired incisions for midpoint depth and side cut angle (correlation coefficient r = −0.063 and −0.067, respectively, P>0.05). Conclusions The IS incision midpoint depth was significantly more anterior than the planned depth of 50%. The location of paired IS incisions in each eye were not correlated. Further improvements are needed to ensure the precise location of the IS incisions made with this device.

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“…A recent report describes paired symmetric arcuate incisions used for the treatment of an average of 2.8 diopters of astigmatism after phacoemulsification [15]. Results at 1 month showed improved uncorrected vision and reduction of astigmatism to an average of 0.91 diopters, despite astigmatism overcorrection in 6-8 eyes due to deeper than planned incisions (by an average of 60 microns).…”

Section: Femtosecond Astigmatic Keratotomy In the Setting Of Cataractmentioning

confidence: 93%

Femtosecond laser-assisted keratotomy

Vickers

Gupta²

2016

Current Opinion in Ophthalmology

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Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery

Abstract: The FSL-AK effectively reduced corneal astigmatism and improved the UDVA, although it was demonstrated that the deeper incisions led to overcorrection.

Cited by 21 publications

References 23 publications

Learning curve of femtosecond laser-assisted cataract surgery: Experience of surgeons new to femtosecond laser platform

Learning curve of femtosecond laser-assisted cataract surgery: Experience of surgeons new to femtosecond laser platform

Evaluation of Femtosecond Laser Intrastromal Incision Location Using Optical Coherence Tomography

Femtosecond laser-assisted keratotomy

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