Abstract
The introduction of femtosecond laser-assisted cataract surgery is an alternative approach to conventional cataract surgery. Our study aimed to determine the effectiveness of femtosecond laser-assisted capsulotomy in the presence of different ophthalmic viscoelastic devices (OVDs) in the anterior chamber. Fresh porcine eyes (n = 96) underwent LDV Z8-assisted anterior capsulotomy, either in the presence of an OVD (Viscoat, Provisc, Healon, Healon GV or HPMC) or without, using 90% and 150% energies respectively. Following that, the capsule circularity, tag’s arc-length, tag-length, tag-area and rupture strength (mN) of the residual capsular bag were evaluated. We found that increasing energy from 90 to 150% across the OVD sub-groups improved the studied capsulotomy parameters. Amongst the 90% energy sub-groups, the circularity and tag-parameters were worse with Viscoat and Healon GV, which have higher refractive index and viscosity compared to the aqueous humour. Using 150% energy, Healon GV showed a significantly worse total arc-length (p = 0.01), total tag-length (p = 0.03) and total tag-area (p = 0.05) compared to the control group. We concluded that; an OVD with a refractive index similar to aqueous humour and lower viscosity, such as Healon or Provisc, as well as a higher energy setting, are recommended, to enhance the efficacy of laser capsulotomy.
Highlights
The introduction of femtosecond laser-assisted cataract surgery is an alternative approach to conventional cataract surgery
A pooled analysis showed no significant difference in the Central corneal thickness (CCT) before and after the application of femtosecond laser (FSL) across the sub-groups with 90% energy (0.81 ± 0.03 mm vs 0.82 ± 0.06 mm, p = 0.12) and 150% energy (0.81 ± 0.05 mm vs 0.83 ± 0.08 mm, p = 0.20)
In this study we have shown that, increasing the energy from 90 to 150% across the ophthalmic viscoelastic devices (OVDs) sub-groups, decreased the likelihood of an incomplete laser cut, improved the clinical grading of capsulotomy and circularity, decreased the total arc-length, total tag-length and total tag-area, in addition to reducing the risk of clinically significant tags
Summary
The introduction of femtosecond laser-assisted cataract surgery is an alternative approach to conventional cataract surgery. Some studies have suggested that the anterior capsulotomy strength, produced by certain FSL, may exceed that obtained with a manual capsulorhexis[4,7] These features maybe useful in improving the safety profile of cataract surgery in patients with pseudoexfoliation syndrome, small eyes (axial length < 21 mm), Fuchs endothelial corneal dystrophy, floppy iris syndrome, subluxated lens, hard nucleus, and patients with poor red reflex[4]. Either in FLACS or conventional phacoemulsification, a small pupil makes the surgery more difficult, due to the reduced visibility of the anterior lens capsule, lack of red reflex and limited space for intraoperative manipulation[4,9] It increases the intraoperative risk of iris trauma, retained lens matter and posterior capsule r upture[9].
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