Femtosecond laser–assisted cataract surgery in eyes with shallow anterior chamber depth: comparison with conventional phacoemulsification

Abstract

Purpose: To compare the postoperative outcomes between femtosecond laser–assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with shallow anterior chamber depth (ACD). Setting: Eye Clinic, NEUROFARBA Department, University of Florence, Italy. Design: Prospective case series. Methods: Forty eyes of 40 patients with senile cataract and true ACD less than 2.00 mm underwent FLACS (femto group, n = 20) or manual phacoemulsification (phacoemulsification group, n = 20). Preoperatively and 1 week and 1 month and 6 months postoperatively, central corneal thickness (CCT) and endothelial cell density were evaluated; basal epithelial cell (BEC) and Langerhans dendritic cell (LDC) densities and keratocyte activation were assessed using in vivo corneal confocal microscopy. Intraoperative parameters such as cumulative dissipated energy (CDE) and ultrasound (US) power were recorded. Results: Endothelial cell loss (ECL) was significantly lower in the femto group at all timepoints (P ≤ .001). In the phacoemulsification group, the CCT was significantly higher 1 week (P < .001) and 1 month (P < .001) postoperatively than preoperatively; conversely, in the femto group, it was higher only after 1 week (P < .001). BECs and LDCs significantly increased at 1 postoperative week (P < .001), returning to preoperative values after 1 month in both groups. Keratocyte activation remained significantly higher at 1 postoperative month only in the phacoemulsification group (P = .005). CDE and US power were lower in the femto group (P = .017 and P = .001, respectively); they were correlated with ECL (r = 0.662, P = .000; r = 0.389, P = .013). Conclusions: In eyes with shallow ACD, FLACS was a safe and an effective technique, significantly reducing the postoperative ECL and corneal inflammation compared with conventional phacoemulsification.

Adverse events associated with femtosecond laser–assisted cataract surgery reported to the MAUDE database

“…Although numerous studies have assessed FLACS outcomes and reported adverse events, the advantage of the MAUDE database is its inclusion of ophthalmologists from a wide range of backgrounds and practice settings. [1][2][3][4][5][6][7][8][11][12][13][14] The FDA MAUDE database represents the single largest publicly available repository of complications related to FLACS in the United States, reflecting this diversity of realworld surgeon experience with both conventional phacoemulsification and FLACS.…”

“…5 Among the possible advantages of FLACS, it has been shown to reduce endothelial cell loss in eyes with shallow anterior chambers, Fuchs dystrophy, and dense cataracts. [6][7][8] In the present work, we report on the landscape of complications associated with FLACS that are reported in the FDA's Manufacturer and User Facility Device Experience (MAUDE) database and the number of complications reported per year over the past decade. As a repository for adverse event reports, the MAUDE database serves as one of the FDA's tools for postmarketing surveillance of medical devices.…”

The Latest Evidence with Regards to Femtosecond Laser-Assisted Cataract Surgery and Its Use Post 2020

“… 8 A recent prospective study has shown that FLACS is safer in eyes with shallow anterior chambers of less than 2mm. 18 …”

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

“…Despite the scarcity of evidence regarding its efects on the ONH, the number of publications stating that FLACS is especially useful in certain conditions related to glaucoma keeps increasing [6,7]. Tese conditions include pseudoexfoliation, narrow anterior chamber, angle closure, nanophthalmos, and phacomorphic glaucoma [6][7][8][9][10][11].…”