Abstract
OBJECTIVES:To compare the amount of ultrasound energy and irrigation volume in conventional phacoemulsification cataract surgery versus femtosecond laser-assisted phacoemulsification at different nuclear-cortical cataract grades.METHOD:This was a prospective, consecutive, investigator-masked nonrandomized parallel cohort study. Patients were divided into 4 groups (Phaco1, Phaco2, Femto1 and Femto2) according to the surgical technique (conventional phacoemulsification [Group Phaco] or femtosecond laser-assisted cataract surgery [Group Femto]) and the Lens Opacity Classification System III (LOCS) grade (LOCS<11 [group 1] or LOCS≥11 [group 2]). The measured outcomes were effective phacoemulsification time (EPT), indicating the ultrasound energy, and balanced salt solution (BSS) use, indicating the irrigation volume, to indirectly estimate the damage to the corneal endothelium caused by the cataract surgery.RESULTS:A total of 160 eyes from 109 patients were included: 87 eyes in Group Phaco, 73 eyes in Group Femto, 76 eyes in group 1 and 84 eyes in group 2. The EPT mean in Femto1 was 53% less (2.73±1.88, 0.1 to 8.65) than that in Phaco1 (5.80±2.86) (p=0.00) and in Femto2 (8.38±9.32) was 33% less than that in Phaco2 (12.55±8.38) (p=0.00). No significant differences in mean LOCS grades between the Phaco1 (8.21±1.44) and Femto1 (7.90±1.90) groups (p=0.73) or between the Phaco2 (13.15±2.55) and Femto2 (12.72±2.18) groups (p=0.95) were found. There were no significant differences in the mean BSS use between the Phaco1 (55.73±12.45) and Femto1 (59.37±10.93) groups (p=0.48) or between the Phaco2 (64.34±21.00) and Femto2 (65.71±17.60) groups (p=0.47).CONCLUSIONS:Compared to conventional phacoemulsification at different nuclear-cortical cataract grades, femtosecond laser-assisted cataract surgery provides an EPT reduction but does not influence the BSS use.
Highlights
Cataracts remain the most common potentially reversible cause of blindness, with an estimated 19 million phacoemulsification surgeries performed per year and a prospective 32 million surgeries projected in 2020 [1,2,3]
There was no significant difference between the average Lens Opacity Classification System III (LOCS) grade of Group Phaco1 (8.21±1.44) and Group Femto1 (7.90±1.90, p=0.73) or between that of Group Phaco2 (13.15±2.55) and Group Femto2 (12.72±2.18, p=0.95)
Abell et al [22] showed a significant reduction in endothelial cell loss and corneal edema in the early postoperative period (1 day and 3 weeks) with the femtosecond laser. They showed no statistical evidence that the decrease in ultrasonic energy by the femtosecond laser reduced the endothelial cell loss at 6 months of surgery, except in cases where the effective phacoemulsification time (EPT) reached zero or in cases of femtosecond laser-assisted procedures without corneal incisions, showing that a large reduction in the energy used can bring benefits to the corneal endothelium
Summary
Cataracts remain the most common potentially reversible cause of blindness, with an estimated 19 million phacoemulsification surgeries performed per year and a prospective 32 million surgeries projected in 2020 [1,2,3]. Received for publication on April 2, 2019. Accepted for publication on June 24, 2019. The proper functioning of these cells maintains the transparency of the cornea and avoids stromal edema [7,8,9,10]
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