Standard manual capsulorhexis / Ultrasound phacoemulsification compared to femtosecond laser-assisted capsulorhexis and lens fragmentation in clear cornea small incision cataract surgery

Abstract

BackgroundFemtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures. We decided to perform a comparative study to standard manual incision phacoemulsification surgery.MethodsThis is a single-center, single-intervention, and prospective comparative data evaluation of 133 consecutive cases subjected to cataract surgery. Group-A (Phaco), manual capsulorhexis & ultrasound phacoemulsification (n = 66); Group-B femtosecond-laser assisted capsulorhexis and lens fragmentation (n = 67), employing the LenSx laser (Alcon Surgical, Ft. Worth, TX). All cases were evaluated for refraction, visual acuity, keratometry, tomography, pachymetry, endothelial cell counts, intraocular pressure, and type of intraocular lens (IOL) implanted. The groups were matched for age, gender, pre-operative vision metrics, and cataract grade, and were followed up to 1 year.ResultsIn group-A post-operative uncorrected distance visual acuity (UDVA) was 20/20 or better in 61.5 % and 20/25 or better in 78.5 % of the eyes. The femtosecond laser group-B had improved outcomes (p = 0.075 and p = 0.042, respectively): post-operative UDVA was 20/20 or better in 62.7 % of the eyes and 20/25 or better in 85.1 %.Linear regression scatterplots of achieved versus attempted spherical equivalent had excellent regression coefficients (r2 = 0.983 in group-A and 0.979 in group-B). There were 75.2 % cases in group-A and 80.6 % in group-B (p = 0.8732) within ±0.50 D of targeted refractive equivalent. Slight trend of under-correction was noted in group-A. Average residual manifest cylinder in the toric subgroup-A was -0.50 D (95 % Limit-of-Agreement (LoA) = -0.78 D), and in toric subgroup-B -0.45 D (LoA = -0.45 D).ConclusionsMean spherical equivalent refraction and visual acuity are comparable with laser cataract surgery compared with manual capsulorhexis & ultrasound phacoemulsification. Improved astigmatism correction may be among the benefits of femtosecond laser–assisted cataract surgery. Transient corneal edema may be a first day transient disadvantage in femtosecond laser–assisted cataract surgery.

An Alternative Approach to Cataract Surgery Using BSS Temperature of 2.7 °C

“…Surgical damage to the endothelium can have severe consequences on functional outcome and on the consequent recovery of the patient [7]. For this reason, for many years, technological research has been devoted to reducing this loss, for example by using fewer ultrasounds, thanks to femtosecond lasers [10][11][12][13]. Joussen et al [14] used a cold irrigation temperature solution during phacoemulsification.…”

Contralateral eye comparison of the phacoemulsification metrics, patient experience and clinical outcomes in patients undergoing bilateral cataract surgery with two commonly used femtosecond laser systems

“…This has led to a shift in thinking about cataract surgery, from the correction of pathology and restoration of prior visual status to a refractive procedure that can provide the patient with a better uncorrected vision than previously enjoyed. 2 …”

Outcomes study between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery using an active fluidics system

“… 6 – 9 The previous fragmentation of the nucleus also allows for less use of ultrasound energy, reducing risk of structural damage. 7 , 8 , 10 – 13 …”

“… 21 In addition, there is great bias involving surgeons still in learning curve of the technique and studies comprising different surgeons and phaco machines. 7 , 9 – 13 …”