Comparative evaluation of femtosecond laser–assisted cataract surgery and conventional phacoemulsification in eyes with a shallow anterior chamber

Abstract

To compare intraoperative performance and postoperative outcomes between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with a shallow anterior chamber (AC). Iladevi Cataract & IOL Research Centre, India. Prospective randomized masked clinical study. Patients undergoing cataract surgery with a shallow AC (<2.5mm) were randomized to have FLACS (Group 1, n=91) or conventional phacoemulsification (Group 2, n=91). Patients were followed up at 1day, 1week, and at 1, 3, and 6months. The primary outcome measure was central corneal thickness (CCT). The secondary outcome measures were corneal clarity, AC cells and flare, endothelial cell density (ECD), coefficient of variance, hexagonality, and uncorrected distance visual acuity (UDVA) at 1week. The study comprised 182 eyes (91 in each group) The cumulative dissipative energy was lower in the FLACS group (P<.05). The mean CCT was significantly lower with FLACS (540.40μm+49.40 [SD] vs 556+12.5μm, P=.03) at 1day and 1week (535.5+44.3μm vs 551+40.8μm, P=.04), with fewer eyes having higher than grade 2 AC cells and flare with FLACS (85% vs 72%, P=.056) at 1day and 1week (15% vs 28%, P=.03). At 1week, the UDVA was better with FLACS (0.089±0.31 logarithm of the minimum angle of resolution [logMAR] vs 0.178±0.65 logMAR, P=.042). At 6months, the reduction in ECD was lower in the FLACS group; however, the difference was not statistically significant. In eyes with shallow ACs, compared with conventional phacoemulsification, FLACS maintained clearer corneas, showed less increase in CCT, lower AC inflammation, and better UDVA in the early postoperative period.