Efficacy of preoperative nonsteroidal anti-inflammatory drug and the re-dilation technique in minimizing miosis after femtosecond laser in cataract surgery.

Bruna Vieira Ventura,Laura Portela Rabello,Fernanda Silvestre,Marcelo Carvalho Ventura

doi:10.5935/0004-2749.20190025

Abstract

To assess the efficacy of using a nonste-roidal anti-inflammatory drug preoperatively and of applying the re-dilation technique when necessary to minimize pupil size variation when comparing the degree of mydriasis before femtosecond laser pretreatment with that at the beginning of phacoemulsification. This retrospective study included patients who underwent cataract surgery using the LenSx (Alcon Laboratories, Inc., Fort Worth, TX). Our routine dilating regimen with flurbiprofen, tropicamide, and phenylephrine was used. The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment. The technique consists of overcoming pupillary contraction by instilling tropicamide and phenylephrine before phacoemulsification. Pupil size was assessed before femtosecond laser application and at the beginning of phacoemulsification. Seventy-five eyes (70 patients) were included. Nine (12%) eyes underwent the re-dilation technique. There was no significant difference in mean pupillary diameter and mean pupillary area between the two studied surgical time points (p=0.412 and 0.437, respectively). The overall pupillary area constriction was 2.4 mm2. Immediately before opening the wounds for phacoemulsification, none of the eyes presented with a pupillary diameter <5 mm, and 61 (85.3%) eyes had a pupillary diameter >6 mm. Preoperative administration of nonsteroidal anti-inflammatory drug and the re-dilation technique resulted in no significant pupil size variation in eyes that were pretreated with the femtosecond laser, when comparing the measurements made before the laser application and at the beginning of phacoemulsification. This approach can avoid the need to proceed with cataract extraction with a constricted pupil.

Highlights

Femtosecond laser in cataract surgery is useful for both routine and challenging cases[1,2,3]
The re-dilation technique was applied on eyes that manifested with a pupillary diameter that was smaller than the programmed capsulotomy diameter after laser pretreatment
Diakonis et al[7] compared three laser platforms with regard to pupil size alteration in femtosecond laser-assis ted cataract surgery (FLACS). They found that the LenSx (Alcon Laboratories, Inc., Fort Worth, TX); the Catalys Precision Laser System (OptiMedica, Abbott Medical Optics, Santa Ana, CA); and the Victus (Bausch & Lomb, Inc., Rochester, NY) significantly decreased the pupillary diameter, with the LenSx inducing the highest degree of miosis, followed by the Catalys and, the Victus

Summary

Introduction

Femtosecond laser in cataract surgery is useful for both routine and challenging cases[1,2,3]. Previous studies reported pu pil size reduction after laser pretreatment in up to 32% of cases[4]. Diakonis et al[7] compared three laser platforms with regard to pupil size alteration in femtosecond laser-assis ted cataract surgery (FLACS). They found that the LenSx (Alcon Laboratories, Inc., Fort Worth, TX); the Catalys Precision Laser System (OptiMedica, Abbott Medical Optics, Santa Ana, CA); and the Victus (Bausch & Lomb, Inc., Rochester, NY) significantly decreased the pupillary diameter, with the LenSx inducing the highest degree of miosis, followed by the Catalys and, the Victus. Mo reover, the degree of miosis correlated with age, time for lens fragmentation, and time for the creation of the main incision

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