Comparing Outcomes of Phacoemulsification With Femtosecond Laser–Assisted Cataract Surgery in Patients With Fuchs Endothelial Dystrophy

Abstract

To compare the outcome in patients with Fuchs endothelial dystrophy (FED) who underwent standard phacoemulsification vs femtosecond laser-assisted cataract surgery (FLACS) in the treatment of visually significant cataracts. Retrospective, comparative, interventional case series. Patient or Study Population: Between April 2013 and December 2016, 140 FED eyes with cataracts of all densities were included. Seventy-two eyes underwent phacoemulsification and 68 eyes underwent FLACS. Intervention or Observation Procedures: Automated noncontact specular microscopy was performed at baseline and postoperatively over a mean of 17.91 ± 10.47months. Parameters collected include visual acuity, slit-lamp examination findings, and intraoperative findings. Pachymetry, endothelial cell density (ECD), and coefficient of variance (COV) were compared. Phacoemulsification had significantly greater postoperative median loss of ECD of 229.0 cells/mm2 (14.2%) compared to FLACS ECD of 133.0 cells/mm2 (6.5%) (U= 1343.0, Z= -2.241, P=.025). Mean loss of ECD was 346.524 ± 420.472 cells/mm2 and 119.964 ± 434.882 cells/mm2 for phacoemulsification and FLACS, respectively (P= .005). Mean percentage loss of ECD was 15.3% ± 17.5% for phacoemulsification and 4.4% ± 25.0% for FLACS (P= .006). Eyes that underwent phacoemulsification had 10.7% ± 15.4% mean ECD loss in the mild cataract group, and in the moderate/hard cataract group 19.5% ± 18.0%, P= .045. Eyes that underwent FLACS had 0.9% ± 22.5% mean ECD loss in the mild cataract group, and 8.2% ± 26.3% in the moderate/hard cataract group, P= .291. Comparison between procedures of mean ECD loss for moderate/hard cataracts was significant (P= .043). FLACS is shown to be superior to phacoemulsification in reducing postoperative endothelial cell loss in FED patients, which translates to a lower risk of corneal decompensation, especially in patients with moderate/hard cataract densities.