Abstract
BackgroundFemtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures. We decided to perform a comparative study to standard manual incision phacoemulsification surgery.MethodsThis is a single-center, single-intervention, and prospective comparative data evaluation of 133 consecutive cases subjected to cataract surgery. Group-A (Phaco), manual capsulorhexis & ultrasound phacoemulsification (n = 66); Group-B femtosecond-laser assisted capsulorhexis and lens fragmentation (n = 67), employing the LenSx laser (Alcon Surgical, Ft. Worth, TX). All cases were evaluated for refraction, visual acuity, keratometry, tomography, pachymetry, endothelial cell counts, intraocular pressure, and type of intraocular lens (IOL) implanted. The groups were matched for age, gender, pre-operative vision metrics, and cataract grade, and were followed up to 1 year.ResultsIn group-A post-operative uncorrected distance visual acuity (UDVA) was 20/20 or better in 61.5 % and 20/25 or better in 78.5 % of the eyes. The femtosecond laser group-B had improved outcomes (p = 0.075 and p = 0.042, respectively): post-operative UDVA was 20/20 or better in 62.7 % of the eyes and 20/25 or better in 85.1 %.Linear regression scatterplots of achieved versus attempted spherical equivalent had excellent regression coefficients (r2 = 0.983 in group-A and 0.979 in group-B). There were 75.2 % cases in group-A and 80.6 % in group-B (p = 0.8732) within ±0.50 D of targeted refractive equivalent. Slight trend of under-correction was noted in group-A. Average residual manifest cylinder in the toric subgroup-A was -0.50 D (95 % Limit-of-Agreement (LoA) = -0.78 D), and in toric subgroup-B -0.45 D (LoA = -0.45 D).ConclusionsMean spherical equivalent refraction and visual acuity are comparable with laser cataract surgery compared with manual capsulorhexis & ultrasound phacoemulsification. Improved astigmatism correction may be among the benefits of femtosecond laser–assisted cataract surgery. Transient corneal edema may be a first day transient disadvantage in femtosecond laser–assisted cataract surgery.
Highlights
Femtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures
In a benchmark study [15], researchers concluded that refractive outcomes in cataract surgery for normal eyes should be within ±0.50 D for 55 %, and within ±1.00 D for 85 % of the cases
Toric intraocuLar lens (IOL) evaluation We further evaluated the refractive outcomes of the subgroups within each group in which toric IOLs were implanted
Summary
Femtosecond-laser assisted clear cornea cataract surgery may hold promise in safer and more effective procedures. Poor wound integrity and subclinical wound leaks from clear-cornea incisions have been associated with an increased rate of endophthalmitis [2,3,4,5]. Continuous evolution and refinement in cataract surgery has led to increased accuracy and satisfactory refractive results. In a benchmark study [15], researchers concluded that refractive outcomes in cataract surgery for normal eyes should be within ±0.50 D for 55 %, and within ±1.00 D for 85 % of the cases. Effective IOL position (ELP) variability has been identified among parameters responsible for the inconsistency of refractive outcomes [16]
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