Effect of lens thickness and nuclear density on the amount of laser fragmentation energy delivered during femtosecond laser–assisted cataract surgery

Aly, Mohamed; Shams, Abdelrhman; Fouad, Yousef A; Hamza, Ismail

doi:10.1016/j.jcrs.2018.11.014

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…We calculated the minimal sample size required in FLACS and QCP by conservative G*Power software version 3.1.9.2, Type I error (Alpha, 0.05) and Type II error (Beta, 0.80). With reference to two original articles, Hida et al and Aly et al, 21,22 we found that the minimum sample size of the FLACS group must not be less than 40 (in our paper = 117) and in QCP must not be less than 40 (in our paper = 133).…”

Section: Methodssupporting

confidence: 48%

Femtosecond Laser-Assisted Cataract Surgery in Soft and Hard Nuclear Cataracts: A Comparison of Effective Phacoemulsification Time

Assaf¹,

Aly²,

Zaki³

et al. 2021

OPTH

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Purpose To compare effective phacoemulsification time (EFX) in femtosecond laser-assisted cataract surgery (FLACS) versus traditional quick chop phacoemulsification (QCP) in senile nuclear cataracts with different densities focusing on soft and hard ones. Patients and Methods A prospective non-randomized comparative study was carried out in Al Watany Eye Hospital and Ain Shams University Hospital, Cairo, Egypt; 250 eyes with senile nuclear cataract (NC) were included and classified into two main groups, FLACS and QCP groups. Each of them was stratified according to nuclear density into three subgroups, subgroups I (Soft NC), II (Medium NC), and III (Hard NC). Sextans-softened fragmentation pattern was performed in the FLACS group. Total EFX utilized for nucleus disassembly and removal was recorded by the completion of each surgery. Results A total of 117 eyes were included in the FLACS group and 133 eyes in the QCP group. No significant difference in EFX was observed between the two groups ( P = 0.228). Regarding subgroups, EFX showed no statistically significant difference between FLACS and QCP ( P = 0.283) in soft NC. For hard NC, a trend to lower values of EFX in FLACS compared with QCP was found, but without statistically significant difference ( P = 0.122). Only in medium NC were significantly lower values obtained in FLACS compared with QCP ( P < 0.0001). Conclusion When compared with QCP technique, FLACS can be used for advantages aside from EFX reduction, including astigmatic keratotomies, accurate sizing, and centration of capsulotomies especially in hard and soft nuclear cataracts. Significant reduction of total EFX with FLACS is most prominent only in medium-density nuclear cataracts.

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Section: Methodssupporting

confidence: 48%

Femtosecond Laser-Assisted Cataract Surgery in Soft and Hard Nuclear Cataracts: A Comparison of Effective Phacoemulsification Time

Assaf¹,

Aly²,

Zaki³

et al. 2021

OPTH

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“…This study also showed that the LT was weakly correlated with CDE ( r = 0.226, p = 0.040). However, Mohamed’s study indicated that laser fragmentation energy and total laser time had a strong positive correlation with LT ( r = 0.53, P < 0 0.001; r = 0.31, P < 0.001) [ 28 ]. We believe that there are two reasons to explain this difference.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative quantitative crystalline lens nuclear opacities analysis based on crystalline lenSx platform

Zhang,

Zhang

et al. 2024

BMC Ophthalmol

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Purpose The main objective is to quantify the lens nuclear opacity using spectral-domain optical coherence tomography (SD-OCT) and to evaluate its association with Lens Opacities Classification System III (LOCS-III) system, lens thickness (LT), and surgical parameters. The secondary objective is to assess the diagnostic model performance for hard nuclear cataract. Methods This study included 70 eyes of 57 adults with cataract, with 49 (70%) and 21 (30%) in training and validation cohort, respectively. Correlations of the average nuclear density (AND) /maximum nuclear density (MND) with LOCS-III scores, LT, and surgical parameters were analyzed. Univariate and multivariate logistic regression analysis, receiver operating characteristic curves and calibration curves were performed for the diagnostic of hard nuclear cataract. Results The pre-operative uncorrected distance visual acuity (UDVA), intraocular pressure (IOP), mean axial length (AL), and LT were 1.20 ± 0.47 log MAR, 15.50 ± 2.87 mmHg, 27.34 ± 3.77 mm and 4.32 ± 0.45 mm, respectively. The average nuclear opalescence (NO) and nuclear colour (NC) scores were 3.61 ± 0.94 and 3.50 ± 0.91 (ranging from 1.00 to 6.90), respectively. The average AND and MND were 137.94 ± 17.01 and 230.01 ± 8.91, respectively. NC and NO scores both significantly correlated with the AND (rNC = 0.733, p = 0.000; rNO = 0.755, p = 0.000) and MND (rNC = 0.643, p = 0.000; rNO = 0.634, p = 0.000). In the training cohort, the area under the curve (AUC) of the model was 0.769 (P < 0.001, 95%CI 0.620–0.919), which had a good degree of differentiation (Fig. 2a). The calibration curve showed good agreement between predicted and actual probability. Conclusion The nuclear density measurement on SD-OCT images can serve as an objective and reliable indicator for quantifying nuclear density.

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“…provide greater anatomical detail of the tissues, which was previously often thought to be difficult. The realtime in vivo changes along the lens, 8,9 laser dissection depths and paths, 10 laser parameter variations with lens thickness and density, 11 identification of Berger space, laser capsulotomy details 12,13 and others have been observed more pragmatically until now. 14 Thus, these constructive observations broaden the scope of ASOCT in lenticular diseases.…”

Section: Early Cataractsmentioning

confidence: 99%

The Emerging Role of Anterior Segment Optical Coherence Tomography in Cataract Surgery: Current Role and Future Perspectives

Pujari¹,

Sharma²

2021

OPTH

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Modern-day cataract surgery has achieved equivalence with refractive surgery, thus requiring surgeons to perform all possible pre-emptive exercises to mitigate intraoperative complications. In this direction, we possess a tremendous amount of technology to understand the preoperative status of the lens. Anterior segment optical coherence tomography (ASOCT) is one such tool, which has played a distinctive role in imaging various forms of cataracts. In this review, we critically analyse the practical role of ASOCT in the preoperative and intraoperative periods from a cataract surgeon’s perspective. After a thorough literature assessment, it was substantiated that the cross-sectional imaging ability of ASOCT can demonstrate delicate anatomical and pathological lenticular changes in a visually and clinically comprehensible way. The objective grading of immature cataracts to intralenticular and posterior capsular details in mature/white, posterior polar, traumatic and other forms of cataracts paves the way for various practical innovations as and when required. Hence, preoperative more than intraoperative ASOCT-derived lenticular knowledge is of immense help in careful surgical planning, with improved complication rates.

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Effect of lens thickness and nuclear density on the amount of laser fragmentation energy delivered during femtosecond laser–assisted cataract surgery

Cited by 6 publications

References 20 publications

Femtosecond Laser-Assisted Cataract Surgery in Soft and Hard Nuclear Cataracts: A Comparison of Effective Phacoemulsification Time

Femtosecond Laser-Assisted Cataract Surgery in Soft and Hard Nuclear Cataracts: A Comparison of Effective Phacoemulsification Time

Intraoperative quantitative crystalline lens nuclear opacities analysis based on crystalline lenSx platform

The Emerging Role of Anterior Segment Optical Coherence Tomography in Cataract Surgery: Current Role and Future Perspectives

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