Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review

Abstract

PurposeThe aim of the study was to determine whether femtosecond-assisted laser cataract surgery (FLACS) reduces the posterior capsular complication (PCC) rate compared to manual cataract surgery when performed by an experienced surgeon.Patients and methodsWe reviewed 2,021 consecutive FLACS procedures between 1 June 2012 and 30 August 2017. All cases of posterior capsular rupture (PCR) with or without vitreous prolapse or zonular dialysis (ZD) that prevented an in-the-bag placement of the intraocular lens were included. Risk factors were noted and outcomes documented.ResultsSix eyes of 2,021 (0.3%) who underwent FLACS had either a PCR or ZD. One eye (0.25%) of 403 eyes that had manual cataract surgery had a PCR. There was no significant difference in outcomes. Risk factors included advanced age, dense nuclei, pseudoexfoliation and small pupil. Only a single case in the FLACS series may have been directly attributed to the FLACS procedure.ConclusionThis study provides evidence that there is no significant difference in the PCC rate between FLACS and manual cataract surgery in the hand of an experienced surgeon who performs >350 cases annually. This low rate of complications may be achieved by less experienced surgeons adopting FLACS.

Safety of office-based lens surgery: U.S. multicenter study

“…Several studies reporting collectively on nearly 1.3 million cataract surgeries have found rates of posterior capsular tear or vitreous loss ranging from 0.19% to 6.7%. 9,11,20–41 As such, the rate of unplanned vitrectomy reported in this study is similar to or lower than that reported in the literature. Likewise, the incidence of retinal complications for which the patient had to be referred to a retina surgeon (0.072%) was also lower than the literature-reported incidence of retinal detachment/retinal tear (0.18% to 1.4%).…”

Accelerated Corneal Endothelial Cell Loss after Phacoemulsification in Patients with Mildly Low Endothelial Cell Density

“…The prevalence of posterior capsular rupture varies according to different surgeons. Ocular risk factors include hard nucleus, shallow anterior chamber, previous ocular surgery, or concurrent ocular surgery [ 4 , 39 ]. In our results, only two cases in total (one case in group A and one case in group C) were found with posterior capsular rupture during the operation.…”

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

“…The low PCC rate in FLACS found in these recent RCTs validates the fact that the capsular rupture rate is less than 1% in almost every FLACS series where more than 1000 patients were enrolled. These range from 0.27% (n=1105), 35 0.30% (n=2021), 24 0.31% (n=1300), 2 0.43% (n=1852) 29 and 0.77% (n=3371). 34 Posterior capsular rupture rates were also reported to be less common in eyes operated on by residents (0% vs 3.0%) 36 and (0% vs 3.1%) 37 or in operations on vitrectomized eyes (0% vs 12%).…”

“…Improved surgical technique and software upgrades has also reduced the PCR from 7% to 0.3%. 24 The RCT reported by Roberts et al required surgeons to have completed 30 FLACS cases before the trail began. 6 The FACT study required the participants to have undergone 10 supervised FLACS procedures.…”