Abstract
Purpose To evaluate capsulotomy shape and posterior capsule opacification (PCO) during an 18-month follow-up for bimanual femtosecond laser-assisted cataract surgery (FLACS). Methods 74 eyes operated by a well-trained surgeon with bimanual FLACS technique using low-energy LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) were included in the study. The follow-up period was 18 ± 2 months. Another 91 eyes, which underwent standard bimanual microincision cataract surgery (B-MICS), served as a control group. In all cases, a BunnyLens AF (Hanita Lenses, Israel) intraocular lens was implanted in the bag. A digital image of the capsule with slit-lamp retroillumination was performed in all patients at 18 months of follow-up. Image analysis software (ImageJ) was used to evaluate the shape of the capsulotomy in terms of diameter, area, and circularity. PCO score was evaluated using EPCO 2000 software. Best corrected visual acuity (BCVA) and endothelial cell count (ECC) were evaluated before and after surgery at 1 and 18 ± 2 months. Results At 18 months, mean capsulotomy diameter was 5.34 ± 0.21 mm while capsulorhexis was 5.87 ± 0.37 mm (p < 0.001) and the deviation area from baseline was 1.13 ± 1.76 mm2 in FLACS and 2.67 ± 1.69 mm2 in B-MICS (p < 0.001). Capsulotomy circularity was 0.94 ± 0.04 while capsulorhexis was 0.83 ± 0.07 (p < 0.001). EPCO score was 0.050 ± 0.081 in the FLACS group and 0.122 ± 0.239 in the B-MICS group (p=0.03). The mean BCVA improvement was significant in both groups, without a significant difference at 18 months. We noticed a statistically significant difference in endothelial cell loss at 18 months (FLACS 12.4% and B-MICS 18.1%; p=0.017). Conclusions Bimanual FLACS is a safe and effective technique, as determined in a long-term follow-up. Capsulotomy shape presented higher stability and circularity in the FLACS group over the 18-month observation period. FLACS resulted in lower PCO scores and endothelial cell loss at 18 months in comparison to B-MICS standard technique.
Highlights
Age-related cataract is the second cause of moderate-tosevere vision impairment among the global population after uncorrected refractive errors. e strong impact of cataract in the public health justifies ophthalmological community interest in increasing precision and safety in cataract surgery [1].In recent years, the use of a femtosecond laser has been introduced to assist the surgeon during cataract surgery
Even though femtosecond laser-assisted cataract surgery (FLACS) does not seem to show any significant difference with respect to refractive and visual outcomes when compared to standard phacoemulsification, recent studies showed better accuracy and reproducibility in the execution of corneal incisions, highly precise anterior capsulotomies, and nucleus fragmentation/liquefaction associated with a lower phacoemulsification energy and limited manipulation inside the eye [2,3,4,5]
With the introduction of femtosecond laser technology, cataract surgery is experiencing a period of change and scientific fervor. e femtosecond laser does assist and facilitate cataract surgery and standardizes some crucial steps: allowing precise and reproducible corneal microincisions, perfectly circular and centered anterior capsulotomies, and lens fragmentation, leading to a reduction in ultrasound energy
Summary
Age-related cataract is the second cause of moderate-tosevere vision impairment among the global population after uncorrected refractive errors. e strong impact of cataract in the public health justifies ophthalmological community interest in increasing precision and safety in cataract surgery [1].In recent years, the use of a femtosecond laser has been introduced to assist the surgeon during cataract surgery. Even though femtosecond laser-assisted cataract surgery (FLACS) does not seem to show any significant difference with respect to refractive and visual outcomes when compared to standard phacoemulsification, recent studies showed better accuracy and reproducibility in the execution of corneal incisions, highly precise anterior capsulotomies, and nucleus fragmentation/liquefaction associated with a lower phacoemulsification energy and limited manipulation inside the eye [2,3,4,5]. Journal of Ophthalmology frequency and low energy [6] It allows overlapping of very small laser spots creating a precise cut with minor gas bubbles and inflammation comparing to other femtolaser machines. It is entirely mobile, and its small dimensions allow surgeons to carry out the whole surgical operation in the same operating room, avoiding questionable patient transfer. Bimanual microincision cataract surgery (B-MICS) is a variant of traditional coaxial phacoemulsification characterized by its incisional microinvasiveness (1.4 mm incisions) [7, 8]. e increased stability of the anterior chamber, the separation of the aspiration and the infusion probe together with the small instrument size, and greater visibility of the surgical field make it a safe and effective technique to be used in combination with a femtosecond laser [9,10,11]
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