Brunescent Cataract Research Articles

Small-aperture intraocular lens implantation after multiple penetrating keratoplasties secondary to penetrating ocular trauma

Introduction: The small-aperture intraocular lens (IOL) is a recently introduced IOL that can provide favorable central visual acuity in patients with irregular corneas. This case describes a patient with multiple prior penetrating keratoplasties secondary to ocular trauma that achieved a favorable outcome with the aforementioned IOL. Patient and Clinical Findings: A 66-year-old man presented with a penetrating corneal injury that was successfully repaired but was eventually complicated by fungal keratitis requiring a therapeutic penetrating keratoplasty (PKP). The patient had a prolonged postoperative course complicated by multiple graft failures and finally stabilized after a third PKP. Through the protracted course, the patient developed a brunescent cataract, and the multiple PKPs resulted in significant irregular astigmatism. Diagnosis, Intervention, and Outcomes: The patient underwent cataract surgery in the affected eye with implantation of a small-aperture IOL 18 months after his initial injury. The patient's uncorrected distance visual acuity was 20/20 at six months post-operatively and he reported excellent quality of vision. Conclusions: This case represents the first use of the small-aperture IOL in a patient with prior PKP since its U.S. Food and Drug Administration approval. The small-aperture IOL can overcome high levels of corneal irregularities and provide favorable visual acuity in complex eyes.

A rare case of complete anterior capsular occlusion following phacoemulsification with acrylic intraocular lens and capsular tension ring implantation in pseudoexfoliation syndrome

A 72-year-old man presented with bilateral brunescent cataract with pseudoexfoliation syndrome and subtle phacodonesis. He underwent right eye phacoemulsification with a 5-mm continuous curvilinear capsulorrhexis and implantation of an acrylic hydrophilic intraocular lens (IOL) with a polymethyl methacrylate (PMMA) capsular tension ring (CTR). Six months postoperatively, anterior capsule fibrosis and complete closure of the capsulorhexis opening were noted. A neodymium: YAG (Nd: YAG) laser anterior capsulotomy was performed for visual recovery. The centripetal forces of capsular fibrosis after cataract surgery may exceed the centrifugal resistance of the standard CTR in patients with pseudoexfoliation. Such patients must be frequently monitored postoperatively. A Nd: YAG laser anterior capsulotomy is a safe and effective option to manage even thick membranous anterior capsular occlusion. This is a unique case report since anterior capsular fibrosis and complete occlusion despite CTR in situ are extremely rare (reported only once to the best of our knowledge).

Complications of manual small-incision cataract surgery.

The manual small-incision cataract surgery (MSICS) is instrumental in tackling cataract-induced blindness in developing countries, especially with a sizeable proportion being hard brunescent cataracts. MSICS has a unique set of complications related to wound construction, the creation of the capsular opening, and the technique of nuclear delivery. A poorly constructed sclero-corneal tunnel or a small capsulorhexis hampers the nuclear extraction, and the extensive intracameral maneuvers increase the chances of postoperative corneal edema and iritis. Though MSICS has been shown to have universal applicability, producing replicable visual outcomes requires a significant learning curve. This article reviews the relevant published literature on complications of MSICS utilizing the databases of PubMed, Medline, Cochrane, and Google Scholar.

Difference between both eyes in the calculation of the dioptre power of the intraocular lens in a series of 7994 patients.

To analyse the distribution of the difference between both eyes in the calculation of the dioptric power of the intraocular lens in a series of 7994 patients and the biometric variables that determine it. The data of patients between 3 and 99 years old, residents of the city of Guayaquil and neighbouring sites, who received ocular biometry by partial optical coherence interferometry between 2004 and 2020 were reviewed. Ocular biometrics, including axial length (AL), anterior chamber depth (ACD), and the mean corneal dioptre power (CD), were measured by partial coherence interferometry. Refraction without or with cycloplegia was recorded in spherical equivalent (SE). The Haigis formula from the IOL Master instrument was used to calculate the dioptric power of the intraocular lens in both eyes. Data from the bilateral optical biometry of 7994 patients were analysed. The mean and standard deviation of AL, CD, ACD and dioptre power of the IOL were 23.66 ± 1.25, 43.70 ± 1.49, 3.34 ± 0.40 and +20.46 ± 3.84, respectively. 2538 (31.7%) patients had equal dioptre power of the IOL between both eyes. 3243 (40.6%) patients had a 0.50 D difference; 1162 (14.5%), 1.0 D; 425 (5.3%), 1.5 D. 626 patients (7.8%) had a difference in IOL dioptre of 2 D or more, with a maximum of 24 D. The asymmetry of AL between OU was ≥0.4 mm in 10.49%, while that of CD reached ≥1 D in 1.9%. 92.16% of patients had a difference within 1.5 D between both eyes in the calculation of the dioptre power of the intraocular lens. In case an eye is programmed in which it is impossible to perform a reliable biometry, either due to trauma or due to white or brunescent cataract, the calculation of the intraocular lens could be done taking as a reference the biometry of the contralateral eye.

Analysis of postoperative intraocular pathologies in patients with mature cataracts.

To examine the prevalence and risk factors of intraocular pathologies after mature cataract surgery. The medical records of 115 patients (115 eyes) diagnosed with brunescent or white cataracts, who underwent surgery at a single primary center between January 2018 and August 2021 were retrospectively reviewed. Dense cataracts precluded preoperative fundus examination in all eyes; however, patients with fundus examination results within 3 months after cataract surgery were included. Logistic regression analyses were performed to identify factors associated with intraocular pathologies. Intraocular pathologies were observed in 37 eyes (32.2%) 11.8 ± 13.9 days postoperatively. The most common abnormalities were drusen (6.1%), myopic degeneration (5.2%) and diabetic retinopathy (4.3%). Intraocular pathology in the fellow eye was associated with posterior segment pathology in mature cataract eyes (odds ratio, 47.72; P < 0.001). The prevalence of each intraocular pathology found after mature cataract surgery was unremarkable. This study provides clinically useful evidence for clinicians to explain the risk of posterior segment pathology in patients with mature cataracts.

Diferencia entre ambos ojos en el cálculo del poder dióptrico del lente intraocular en una serie de 7.994 pacientes

PurposeTo analyse the distribution of the difference between both eyes in the calculation of the dioptric power of the intraocular lens in a series of 7994 patients and the biometric variables that determine it. MethodsThe data of patients between 3 and 99years old, residents of the city of Guayaquil and neighbouring sites, who received ocular biometry by partial optical coherence interferometry between 2004 and 2020 were reviewed. Ocular biometrics, including axial length (AL), anterior chamber depth (ACD), and the mean corneal dioptre power (CD), were measured by partial coherence interferometry. Refraction without or with cycloplegia was recorded in spherical equivalent (SE). The Haigis formula from the IOL Master instrument was used to calculate the dioptric power of the intraocular lens in both eyes. ResultsData from the bilateral optical biometry of 7994 patients were analysed. The mean and standard deviation of AL, CD, ACD and dioptre power of the IOL were 23.66±1.25, 43.70±1.49, 3.34±0.40 and +20.46±3.84, respectively. 2538 (31.7%) patients had equal dioptre power of the IOL between both eyes. 3243 (40.6%) patients had a 0.50D difference; 1162 (14.5%), 1.0D; 425 (5.3%), 1.5D. 626 patients (7.8%) had a difference in IOL dioptre of 2D or more, with a maximum of 24D. The asymmetry of AL between OU was ≥0.4mm in 10.49%, while that of CD reached ≥1D in 1.9%. Conclusions92.16% of patients had a difference within 1.5D between both eyes in the calculation of the dioptre power of the intraocular lens. In case an eye is programmed in which it is impossible to perform a reliable biometry, either due to trauma or due to white or brunescent cataract, the calculation of the intraocular lens could be done taking as a reference the biometry of the contralateral eye.

THE ANALYSIS OF a-CRYSTALLINE PROTEIN IN WHITE AND BRUNESCENT CATARACT

Objectives: The objectives of the study were to determine the difference of concentration and expression of α-crystalline protein in white and brunescent cataract lenses. Methods: The design of this study is cross-sectional comparative. The subject was cataract patients who underwent cataract surgery in Puskesmas Pariaman, West Sumatra, Indonesia. Lens examination was carried out at the Microbiology Laboratory of FK Unand from July 2019 to February 2020. The samples consisted of 36 subjects who met the inclusion criteria. ELISA examination was used to determine the concentration of α-crystalline protein and Western Blot examination was performed to see the expression of the α-crystalline protein in all subjects. Results: The difference in the concentration of α-crystalline protein in white cataract and brunescent cataract was not statistically significant, with p=0.129 (p&gt;0.05). The result of Western blot examination was normal expression of α-crystalline protein in white cataract and under expression of α-crystalline protein in brunescent cataracts. Conclusion: The expression of α-crystalline protein appeared to be different between white and brunescent cataract lenses. In brunescent cataract, under expression of α-crystalline proteins was related to the decrease of chaperone activity. This change occurred allegedly because of photochemical reaction that happened inside the lens.

Clinical Outcomes after Phacoemulsification in Brunescent Cataract

Purpose To compare the clinical outcomes after phacoemulsification in a brunescent cataract group and a control cataract group. Methods Using slit-lamp microscopy, the Lens Opacities Classification System III was applied to classify brunescent cataract from “other” types based on nuclear opalescence and nuclear color cut-off levels of 5 and 5, respectively. From December 2016 to December 2019, 33 eyes of 33 brunescent cataract patients who underwent cataract surgery were included in the brunescent cataract group; 33 eyes of 33 other cataract patients with similar conditions were included as the control group. The corneal endothelial cell density and best-corrected visual acuity were compared between the two groups. Results In the three cases of posterior capsular rupture that developed in the brunescent cataract group, the intraocular lens was implanted at the ciliary sulcus, and in two cases, total vitrectomy was performed. In the one case of posterior capsular rupture in the control group, the intraocular lens was implanted at the ciliary sulcus, and total vitrectomy was performed. There were no significant differences in best-corrected visual acuity between the two groups at 1 week, 1 month, 3 months, or 6 months postoperatively. The mean corneal endothelial cell density loss measured at 1 month after surgery was significantly higher in the brunescent cataract group. Conclusions Phacoemulsification in the brunescent cataract group showed good clinical results in terms of visual acuity and mean corneal endothelial cell density loss compared with the control cataract group, when performed by an experienced surgeon. Keywords: Brunescent cataract; Clinical outcomes; Complications; Phacoemulsification

Return of phacoemulsification after emergency status related to COVID-19: experience of a tertiary referral center.

To present a protocol of priority criteria for phacoemulsification after the backlog due to severe acute respiratory syndrome coronavirus (SARS-CoV)-2 pandemic status. Ophthalmology department of Centro Hospitalar e Universitário do Porto (CHUP), Oporto, Portugal. Cross-sectional, nonrandomized, retrospective study. Data of all patients waiting for cataract surgery were analyzed at the beginning of May 2020, after 2 months without performing elective surgery. The waiting time since surgical inscription was considered an independent and overriding factor. In addition, higher priority was given to patients with white or brunescent cataracts and patients with low visual acuity: corrected distance visual acuity (CDVA) of 20/200 or less in binocular patients or CDVA of 20/63 or less in monocular patients. Criteria of medium priority included patients who remained with anisometropia and patients with glaucoma or low to moderate risk for chronic angle closure. Data of scheduled surgeries in the following months were then analyzed. A total of 717 patients were waiting for phacoemulsification. One hundred ninety-one patients (26.64%) were on the waiting list more than 4.5 months; the medium waiting time was 3.51 ± 1.57 months. According to both priority criteria and waiting time, 348 (48.6%) were categorized as priority cases. A total of 158 patients (22.0%) met the highest priority; 61 patients (8.5%) met the medium priority criteria. In 129 patients (18.0%), priority was considered based solely on higher waiting time. This algorithm allowed surgeons to operate on all priority cases within the first 3 months. The presented protocol showed to be effective, providing a timely surgical opportunity for priority cases.

Endoscopy-assisted pars plana lensectomy for brunescent cataracts in eyes with microcornea with microphthalmos

ABSTRACT Purpose Conventional cataract surgeries can be a challenge in eyes with microcorneas due to difficult manipulation in a crowded anterior chamber (AC) and can lead to a high occurrence of corneal edema and an increased rate of complications. Similarly, in cases of dense brunescent cataracts even a lensectomy through posterior approach may prove to be difficult because of inadequate visualization. An endoscopyassisted pars plana lensectomy can help in obviating these difficulties. This study aims to describe the surgical technique of endoscopy-assisted pars plana lensectomy in eyes with brunescent cataract, microcornea, and microphthalmos. Methods Retrospective review of two cases where endoscopy-assisted pars plana vitrectomy and lensectomy was performed for patients with dense cataract and microcornea and microphthalmos. Result Complete clearance of the cataract was achieved without having to resort to a sclerocorneal incision. Postoperatively the cornea was clear and there was no postoperative corneal edema. Conclusion Endoscopy-assisted pars plana lensectomy can help in overcoming the challenges of conventional anterior and posterior approaches of cataract extraction in cases of microcornea with reduced intraoperative and postoperative complications.

Phacoemulsification versus manual-small incision cataract surgery for brunescent cataracts: A retrospective analysis

Background: Brunescent cataracts are associated with higher incidence of ocular comorbidities which predispose to intraoperative and postoperative complications. Objectives: To compare the surgical outcomes of Phacoemulsification (PE) and Manual Small Incision Cataract Surgery (MSICS) in Brunescent cataracts. Patients and Methods: Retrospective observational study of patients who underwent either MSICS or phacoemulsification for brunescent cataracts over a 1-year period were reviewed for complication rates and visual outcomes. Multiple logistic regression analysis using Stata software (version 11.0, Stata Corp LP) performed to find factors associated with surgical complications. P

Pearls for Addressing Brunescent Cataracts

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Pars-plana vitrectomy with phacofragmentation for hyperdense cataracts in eyes with severe microcornea and chorio-retinal coloboma: A novel approach.

Purpose:To report the outcomes of pars-plana approach for the management of brunescent cataract in eyes with severe microcornea and associated chorio-retinal coloboma.Methods:This was a retrospective, single center, interventional case series performed in a tertiary eyecare center in central Medical records of consecutive cases of microcornea with coloboma who underwent pars-plana vitrectomy with phacofragmentation (PF) between January 2015 and December 2017 were reviewed.Results:The study group comprised of 30 eyes of 30 patients, of which 18 (60%) were males and 12 (40%) were females. The mean age of the patients was 41.9 years (range of 17–70 years). The mean corneal diameter was 6.7 mm with a range of 4–8 mm and all the eyes had dense cataract with nuclear sclerosis of grade 4 or more. The mean preoperative visual acuity was 1.97 (+/-0.067) Log MAR and the mean postoperative vision at 1 month was 1.6 (+/-0.39) Log MAR. Postoperatively, 21 patients (70%) gained ambulatory vision. The visual gain in all the patients was maintained over a mean follow-up period of 15.5 months.Conclusion:Pars-plana vitrectomy with PF can be considered in eyes with severe microcornea and brunescent cataracts, where cataract surgery through the limbal (anterior) approach is not only difficult but at times impossible due to anatomical restraints.

A Simple, Novel Approach to Capsulorhexis Formation in the Setting of A Mature Cataract and Miotic Pupil.

PurposeTo report a simple, effective technique for surgeons creating a capsulorhexis in patients with pupillary miosis and a dense, mature cataract.MethodsA single center, two-year retrospective chart review examined 1408 phacoemulsification cataract surgeries. The criteria for inclusion involved a dense, mature cataract and a pupil that was unresponsive to pharmacologic dilation preoperatively. A standardized technique was used for all cases consisting of a 1mm corneal paracentesis and 2.4mm temporal clear corneal incision. Synecholysis was performed if present, followed by the insertion of a 6.25mm malyugin ring under cohesive viscoelastic. The cohesive viscoelastic was removed via the irrigation aspiration tip. The paracentesis was sealed with a small amount of viscoelastic and an air bubble was placed in the anterior chamber. The anterior capsule was then painted with trypan blue. The air bubble and trypan blue were then replaced by a dispersive viscoelastic. Curvolinear capsulorrhexis was performed followed by standard phacoemulsion.ResultsNine patients ranging from 76 ± 12 years (mean ± standard deviation) met the criteria with a 4+ NS (n=5), white mature (n=3), or deep brunescent (n=1) cataract and 3mm pupil preoperatively. Pupillary miosis was caused by posterior synechia in 44.5% of the cases followed by pharmacologic interactions from tamsulosin and donepezil in 22.25% of cases respectively. One case involved idiopathic miosis likely from aging. Capsulorhexis formation was successful in all cases with no capsular tear, vitreous loss, or conversion to extracapsular cataract extraction (ECCE). However, one case had cortex retention requiring a second procedure for removal.ConclusionDense, mature cataracts and small pupils both compromise the view for the surgeon and may be significant risk factors for training ophthalmologists. Thus, good visualization of the anterior capsule and peripheral nucleus with our simple technique facilitates a reliable capsulorhexis, potentially limiting the risk of complications for ophthalmic surgeons.

Precision pulse capsulotomy in challenging cataract surgery cases.

PurposeTo evaluate the use of the precision pulse capsulotomy (PPC) device for challenging cataract surgery cases.Patients and methodsThis single-center retrospective case series study comprised of 43 eyes (from 35 patients) that were challenging cataract surgery cases with poorly dilated pupils, anterior subcapsular opacity, white cataract, brunescent cataract, and corneal opacity. This was conducted at the Busan Sungmo Eye Hospital (Busan, Republic of Korea) to assess the performance of the PPC device through a 2.2-mm clear corneal incision width, followed by the phacoemulsification technique and intracapsular intraocular lens fixation. The main outcome measurement was the anterior capsulotomy performance of the PPC device and the development of intraoperative complications. At postoperative 2 months, visual acuity, endothelial cell count, and refractive error were measured.ResultsNo cases of anterior capsule tears or tags occurred. All 43 eyes received circular, 360-degree, free-floating, and appropriately sized anterior capsulotomies. During 2 months of follow up, no postoperative complications occurred in association with the PPC device.ConclusionThe PPC device facilitated the creation of a precise, round, appropriately sized anterior capsulotomy in challenging cataract surgery cases. Further investigations are required to understand the long-term safety and efficacy of the PPC device.

Phacoemulsification of Hard Nuclei on a Single-Piece Foldable Acrylic Intraocular Lens

Objectives: We describe a technique for phacoemulsification of hard (brunescent and white) cataract after implantation of a foldable acrylic posterior chamber IOL (PCIOL) between the hard nucleus and the posterior capsule. This new technique was compared with the standard phacoemulsification. Methods: Interventional randomized case series of 64 eyes of 56 patients with senile mature white or hard brunescent cataract. The first 32 eyes were randomized for standard phacoemulsification using stop and chop technique and one-piece foldable acrylic PCIOL (soft haptics). The second 32 eyes were randomized for the same type of PCIOL implanted between the hard nucleus and the posterior capsule before starting phacoemulsification “the implant pre-phaco” group. Results: In each group 2 eyes developed transient corneal edema. Iris phaco-burn developed in 2 eyes of the standard phacoemulsification group and one eye of the “implant pre-phaco” group. Posterior capsule rupture (PCR) with vitreous prolapse occurred in 3 eyes of the standard phacoemulsification group. In the “implant pre-phaco” group one eye developed PCR with no vitreous prolapse. The difference in PCR between the 2 groups was not statistically significant but the vitreous prolapse in the AC was significantly higher in the standard phacoemulsification group. IOL decentration or dropped lens fragments did not occur in either group. Conclusion: The IOL behind the hard nucleus acts as barrier shield that covers and protects the posterior capsule and the anterior vitreous face. This could make phacoemulsification of hard cataracts safer.

Supervised resident manual small-incision cataract surgery outcomes at large urban United States residency training program

To examine the outcomes of resident-performed manual small-incision cataract surgery (SICS) in an urban academic setting. Parkland Memorial Hospital, Dallas, Texas, USA. Retrospective case series. Manual SICS was used only in selected cases for which phacoemulsification was expected to be difficult, namely for mature or brunescent cataracts, traumatic cataracts, and pseudoexfoliation syndrome or other causes of zonular weakness. All manual SICS cases performed by resident physicians as the primary surgeon over a 5-year period were reviewed. Postoperative visual acuity, intraoperative complications, and early postoperative complications were the main outcomes measured. For the 52 cases identified, the mean preoperative visual acuity was 2.165 logarithm of the minimum angle of resolution (logMAR)±0.141 (SD) (95% confidence interval) (slightly better than had motion acuity), improving to 0.278±0.131 logMAR (Snellen 20/38) corrected visual acuity postoperatively. Of the 52 cases, the most frequent intraoperative complications were iris prolapse (5 cases [9.6%]) and zonular dialysis (4 cases [7.7%]), with vitreous loss occurring in 1 case (1.9%). The most frequent postoperative complications were cystoid macular edema (3 cases [5.8%]), retained ophthalmic viscosurgical device (2 cases [3.8%]), intraocular lens displacement (2 cases [3.8%]), and microhyphema (2 cases [3.8%]). Although the more advanced wound construction in manual SICS might be challenging to surgeons unfamiliar with the technique, it was a safe and efficacious technique in the hands of learning residents. With several advantages over phacoemulsification, such as cost and ability to remove very dense nuclei, manual SICS will play a valuable role in modern cataract surgery.

Femtosecond laser–assisted cataract surgery in complex cases

To describe the use of the femtosecond laser in complex cataract cases. Department of Ophthalmology, University of Colorado, Aurora, Colorado, USA. Retrospective case series. This was a single-center retrospective review of consecutive complex cataract surgery cases in which the Lensx femtosecond laser was used between October 2012 and February 2015. Complex cases were defined as white cataracts, dense brunescent cataracts, or cataracts in which zonulopathy was identified preoperatively. Outcome measures included an assessment of the capsulotomy, surgical complications, and postoperative corrected distance visual acuity (CDVA). Thirty-four eyes of 34 patients were included in this study; 27 had white cataract, 3 had dense brunescent cataract, and 6 had zonulopathy (2 of these also had white cataract). Three patients had an incomplete capsulotomy, and 3 had small radial tears in the anterior capsule. Four patients (11.7%) developed posterior capsule tears during phacoemulsification; 1 of these subsequently had pars plana vitrectomy for a retained lens fragment. Twenty-eight (97%) of 29 patients had a postoperative CDVA of 20/40 or better. Three patients were identified with comorbidities that limited postoperative CDVA. One patient developed postoperative cystoid macular edema. The femtosecond laser was useful in the surgical approach to patients with complex cataracts, especially for the creation of the capsulotomy. None of the authors has a financial or proprietary interest in any material or method mentioned.

The Royal College of Ophthalmologists' National Ophthalmology Database Study of cataract surgery: report 2, relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture.

To describe the relationships of axial length with ocular copathology, preoperative visual acuity, and posterior capsule rupture rates in patients undergoing cataract surgery.DesignThe Royal College of Ophthalmologists' National Ophthalmology Database (NOD) study. Anonymised data on 180 114 eyes from 127 685 patients undergoing cataract surgery between August 2006 and November 2010 were collected prospectively from 28 sites. Data parameters included: demographics, biometry, ocular copathology, visual acuity measurements, and surgical complications including posterior capsule rupture, or vitreous loss or both (PCR). Consultant surgeons performed a higher proportion of operations on eyes whose axial length were at the extremes. Glaucoma and age related macular degeneration were more common in eyes with shorter axial lengths, whilst previous vitrectomy was associated with longer axial lengths. Eyes with brunescent or white cataracts or amblyopia were more common at both axial length extremes. Preoperative visual acuities were similar for eyes with axial length measurements up to approximately 28 mm and worse for eyes with longer axial length measurements. PCR rates showed little change with axial length (overall mean 1.95%, 95% CI: 1.89 to 2.01%), except for a borderline increase in eyes with axial length <20.0 mm where rates were 3.6% (95% CI: 2.0 to 6.3%). The likelihood of PCR in eyes with axial length <20.0 mm was 1.88 times higher than those of ≥20.0 mm (P=0.0373). Rates of ocular comorbidities vary by axial length. PCR rates in eyes with very short or long axial lengths were lower than expected.

Femtosecond laser–assisted compared with standard cataract surgery for removal of advanced cataracts

To compare effective phacoemulsification time (EPT) for the removal of brunescent cataracts treated with femtosecond laser-assisted cataract surgery with standard cataract phacoemulsification techniques. Ruhr University Eye Hospital, Bochum, Germany. Comparative prospective case study. The Lens Opacities Classification System III (LOCS III) grading system was used to measure eyes divided into 4 groups having cataract surgery. Groups 1 and 2 contained eyes with LOCS III grade nuclear opalescence (NO) 3 cataracts treated with standard cataract surgery and femtosecond laser-assisted cataract surgery, respectively. Groups 3 and 4 contained brunescent cataracts, LOCS III grades NO5, treated with standard cataract surgery and femtosecond laser-assisted cataract surgery, respectively. There were 240 eyes, with 60 eyes in each group. The EPT in Group 1 ranged from 0.46 to 3.10 (mean 1.38); the EPT in all eyes in Group 2 was 0 (P < .001). The EPT in Groups 3 and 4 was 2.12 to 19.29 (mean 6.85) and 0 to 6.75 (mean 1.35), respectively (P < .001). A comparison between EPT in Groups 1 and 4 showed that EPT in Group 4 was also lower than in Group 1 (P = .013). Groups 4 and 1 were the most statistically similar of all groups compared, suggesting that EPT for a femtosecond laser-treated grade 5 cataract was most similar to that of a standard-treated grade 3 cataract. Femtosecond laser pretreatment for brunescent cataracts allowed for a significant reduction in EPT compared with manual standard phacoemulsification techniques. Drs. Hatch, Talamo, and Dick are consultants to Abbott Medical Optics, Inc. Dr. Schultz has no financial or proprietary interest in any material or method mentioned.