Ultrasound energy consumption and macular changes with manual and femtolaser‐assisted high‐fluidics cataract surgery: a prospective randomized comparison

Abstract

Purpose: The purpose of the study was to compare ultrasound (US) consumption and central macular thickness (CMT) and volume changes with manual and femtosecond laser (FSL)-assisted cataract nucleus workup. Methods: Sixty patients scheduled for immediate sequential bilateral surgery underwent a prospective randomized intraindividual comparison of nucleus sector fragmentation performed manually in one eye and with low-energy FSL assistance in the partner eye, followed by high-fluidics phacoaspiration with a maximum US power of 30%. Ultrasound (US) energy consumption and macular thickness and volume were compared as measured by intraoperative effective phacoemulsification time (EPT) and highresolution spectral domain optical coherence tomography pre-and 1 week, 3 weeks and 6 weeks postoperatively. Results are presented as means AE SD or medians [min; max]. Results: Fifty-two patients completed the full follow-up. For the manual and FSLassisted groups, nuclear hardness was almost identical with a mean LOCS III grade of 2.44

Prostaglandin Release After Low-Energy Femtosecond Laser-Assisted Cataract Surgery Without Anti-Inflammatory Drug Premedication

“…Sustained prostaglandin and cytokine release after antLEC injury or destruction after completion of the cataract surgery may destabilize the blood-aqueous barrier (BAB) in the postoperative course, resulting in inflammation and a potential increase of cystoid macular edema. 13,14 No increase of macular thickness or volume and no CME formation has been observed with the FSL platform used for the present study. 14 The lower energy of the single pulses must be compensated by a higher number of pulses delivered at a higher frequency resulting in a total amount of energy input comparable with regular energy pulse FSLs.…”

“…13,14 No increase of macular thickness or volume and no CME formation has been observed with the FSL platform used for the present study. 14 The lower energy of the single pulses must be compensated by a higher number of pulses delivered at a higher frequency resulting in a total amount of energy input comparable with regular energy pulse FSLs. The lower release of PGE-2 and the lack of miosis compared to regular FSLs identify the high-energy of the pulses in microjoule range, even though reduced in number compared to the low-energy pulses in nanojoule range, as the causative factor.…”

“…The sample was immediately stored at -80°C. Subsequent to the aqueous tapping the anterior chamber was filled with hydroxymethylcellulose 2% and coaxial phacoemulsification performed using high fluidic settings with minimum use of ultrasound energy as previously described 14 (easyTip2.2, OS4, Oertli Instruments, Berneck, Switzerland), followed by a coaxial cortical clean-up and implantation of an intraocular lens.…”

“…10,11,12 Cytokines may also infringe the blood-aqueous barrier and dissipate into the posterior segment with potential impact on the macula. 13,14 In the studies published so far investigating or comparing the release of inflammatory mediators into the AH after LCS with that after manual cataract surgery (MCS) the capsulotomy was performed first. 7,8,15 Capsulotomy was then followed by nucleus fragmentation.…”

Management of inflammation after the cataract surgery

“…It is yet unknown what clinical effect inflammation caused by FLACS has because it is reported that cases done with femtosecond laser does not result in greater PCME when compared with conventional phacoemulsification [26,27 ▪ ,28].…”