Conventional Phacoemulsification Research Articles

Finger-Controlled Nonultrasonic Lens Extractor.

To report initial surgical experience and learning curve with a novel finger-controlled, ultrasoundless lens extractor device and provide insights for future surgical endeavors. Bascom Palmer Eye Institute (Miami, FL). Single-center, non-comparative, retrospective, consecutive case series. 61 eyes of 51 individuals with cataract. All surgeries were performed with the miCOR® 700 lens extractor (Carl Zeiss Meditec Inc, Dublin, CA) by a single experienced physician. Nuclear density was graded preoperatively. Corrected distance visual acuity (CDVA), intraocular pressure (IOP) and pachymetry were evaluated pre- and postoperatively. Surgical videos were reviewed to collect data on time for each surgical step and complications. Regression analyses assessed the learning curve, performance improvement and effects of nuclear density on surgical time and postoperative pachymetric variation. Subjects had a mean age of 72.2 ± 7.6 years. Increased surgical experience significantly reduced procedure time (P < 0.001), nuclear removal time (P = 0.018) and cortex removal time (P = 0.002). Higher nuclear density resulted in longer procedure (P < 0.001) and nuclear removal time (P < 0.001). One posterior capsular rent occurred, not attributed to the lens extractor. No thermal damage to the corneal wound was observed. Postoperative CDVA improved significantly (P < 0.001 for eyes without ocular comorbidities, P = 0.016 for eyes with ocular comorbidities). All cases of corneal edema and IOP spikes resolved within a month. The miCOR® 700 lens extractor offers an innovative, cost-effective approach to cataract surgery. Further research is needed to compare it with conventional phacoemulsification techniques.

A case series on small incision cataract surgery + PMMA IOL with primary posterior capsulorrhexis: A safe and cheaper alternative in management of pediatric cataracts

Pediatric cataracts, a significant cause of childhood blindness, present pronounced challenges in low-income countries where conventional phacoemulsification with hydrophobic foldable IOLs may be economically unfeasible. In resource-limited settings, the conventional method of employing phacoemulsification with hydrophobic foldable IOLs is often impractical. This case series explores an economically pragmatic alternative, centering on Small-incision cataract surgery (SICS) paired with rigid polymethyl methacrylate (PMMA) intraocular lenses (IOLs). This study delves into the visual outcomes of SICS with in-the-bag PMMA IOLs, Primary Posterior Capsulorrhexis (PPC), and anterior vitrectomy to mitigate Posterior Capsule Opacification (PCO) formation in the Visual Axis (VA). The evaluation, conducted at specific postoperative intervals spanning from Post-op Day 01 to the 6th month, provides a comprehensive understanding of the efficacy and safety of this approach. Findings underscore PMMA IOLs as both durable and cost-effective substitutes, with an emphasis on SICS with PPC as a reliable technique for cataract removal. This research delivers a practical solution to enhance visual outcomes, tackling the distinct challenges confronted in resource-limited settings and contributing to the broader global endeavor to alleviate preventable childhood blindness.

The Impact of Femtosecond Laser on Intraocular Pressure with Cataract Surgery in Healthy Eyes.

Femtosecond laser-assisted cataract surgery leads to an increase in intraocular pressure (IOP) during the procedure and subsequent IOP reduction after surgery, with greater magnitude in eyes with higher preoperative IOP. To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) using the LDVZ8 laser on intraocular pressure (IOP) during and after surgery, and to compare the IOP-lowering effect of FLACS and conventional phacoemulsification cataract surgery (CPCS). This prospective cohort study enrolled 395 healthy eyes (395 patients) scheduled for FLACS (n=245) and CPCS (n=150). FLACS was performed using the LDVZ8 laser. During FLACS, IOP was assessed before and immediately after docking. IOP reduction during a six-month postoperative period was evaluated following FLACS and CPCS. Multivariate analyses were performed. Mean IOP increase after docking was 2.3±4.1mmHg (P<0.0001); maximum increase 17.6mmHg, peak 38mmHg. Sixty-one (61) eyes (25.1%) demonstrated an increase of ≥5mmHg and 10 (3.7%) showed an increase of ≥10mmHg; pre-docking IOP was associated with an IOP increase of ≥5mmHg (P-0.029). IOP reduction over six months post-surgery was similar for FLACS and CPCS (P>0.05),-1.33±3.12mmHg for FLACS (P<0.001) and -1.4±2.87mmHg for CPCS (P<0.001). Preoperative IOP correlated statistically significantly with IOP reduction in both FLACS (β -0.742, P<0.001) and CPCS (β -0.743, P<0.001). Although the LDVZ8 laser procedure causes an increase in IOP in some healthy eyes, a subsequent decrease in IOP is observed after FLACS. The IOP-lowering effect of FLACS is similar to CPCS, and tends to be more pronounced in eyes with higher preoperative IOP. Eyes with higher preoperative IOP are prone to IOP elevation during FLACS, a critical consideration for glaucoma patients.

Comparing the efficacy and safety between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery: systematic review and meta-analysis

To investigate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification cataract surgery (CPCS). Randomized controlled trials (RCTs) were systematically searched in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, and Wanfang. Main outcomes were visual acuity, capsulotomy parameters, effective lens position, and complications. Secondary outcomes included refractive outcomes, intraoperative parameters, and corneal parameters. In total, 41 RCTs involving 9310 eyes were included. There was a statistically significant difference in favour of FLACS over CPCS for uncorrected distance visual acuity at 12 months (mean difference [MD] -0.03; 95% CI -0.05 to -0.01); corrected distance visual acuity at 1 week (MD -0.05; 95% CI -0.07 to -0.02) and 12 months (MD -0.02; 95% CI -0.04 to -0.00); area of capsulotomy at 1 month (MD 4.04 mm2; 95% CI 3.45-4.64) and 6 months (MD 5.02 mm2; 95% CI 3.28-6.77); and intraocular lens centroid-pupil centroid distance at 1 week (MD -0.06 mm; 95% CI -0.08 to -0.05), 1 month (MD -0.07 mm; 95% CI -0.09 to -0.06), and 6 months (MD -0.06 mm; 95% CI -0.07 to -0.04). With regard to surgical complications, FLACS was less than CPCS for the incidence of decentred IOL (odds ratio 0.06; 95% CI 0.01-0.24). However, FLACS did not increase the incidence of other intraoperative or postoperative complications except subconjunctival hemorrhage. Both FLACS and CPCS are effective and safe. FLACS achieves better visual outcomes in the early postoperative period and long-term follow-up, accompanied by more accurate capsulotomy and more optimized effective lens position than CPCS. However, no difference of visual outcomes was found after middle-term follow-up.

Manually performed limbal relaxing incisions versus femtosecond laser-guided astigmatic keratotomy for correction of corneal astigmatism after phacoemulsification

Purpose This study aimed to evaluate the safety and efficacy of manually performed limbal relaxing incisions (LRIs) compared with femtosecond laser-guided astigmatic keratotomy (FLAK) in the management of corneal astigmatism after phacoemulsification. Patients and methods This is a prospective, comparative, randomized, interventional study that was conducted from March 2018 to September 2022. It included 56 patients (74 eyes) who had corneal astigmatism after conventional phacoemulsification. They were classified into two groups. Group A included 34 patients (41 eyes) for whom manual LRIs using a diamond knife were performed and group B included 22 patients (33 eyes) for whom FLAK was performed. The preoperative evaluation included manifest refraction, uncorrected distance visual acuity, best corrected distance visual acuity, slit lamp examination of the cornea, intraocular pressure measurement, and fundus examination. Corneal astigmatism in diopters (D) was established by corneal tomography and Scheimpflug imaging (Pentacam). Postoperative follow-up visits were scheduled on the first day, at 1 week, 1 month, and 3 months after surgery. Postoperative evaluation included a slit lamp examination for the incisions, uncorrected distance visual acuity, manifest refraction, and Pentacam to evaluate corneal astigmatism. Results The mean topographic corneal astigmatism was reduced from 3.36±1.66 D to 1.07±1.11 D, 3 months postoperatively in the LRIs group with a statistically highly significant difference (P=0.000) and from 3.66±1.82 D to 1.19±1.26 D in the FLAK group with a statistically highly significant difference (P=0.000). The mean topographic corneal astigmatism 3 months postoperatively showed a statistically nonsignificant difference between the two groups (P=0.665). Although there was no statistically significant difference between the two groups, the mean arithmetic reduction of astigmatism was higher in the FLAK group (2.47 D) than in the LRIs group (2.29 D). The surgery was uneventful in 92.68% of the cases in group A with only 7.32% showing nonserious corneal perforation, while in group B, the surgery was uneventful in 97% of the cases with only 3% showing nonserious corneal perforation with a statistically nonsignificant difference between the two groups (P=0.431). Conclusion Both manually performed LRIs and FLAK were safe, predictable, and effective methods for correcting pre-existing or surgically induced corneal astigmatism after phacoemulsification with a nonsignificant difference in visual and corneal topographic outcomes between the two methods.

Challenges in cataract surgery after penetrating keratoplasty managed using femtosecond laser: A series of 3 case reports.

Cataract surgery in patients after penetrating keratoplasty (PKP) is often challenging because of changes in corneal structure induced by PKP and primary corneal disease. Femtosecond laser-assisted cataract surgery offers several advantages over conventional phacoemulsification, and has been widely used in complicated cataract surgery. We report the use of femtosecond laser-assisted cataract surgery in 3 challenging cases after penetrating keratoplasty. Case 1 involved a patient with hard nuclear grade IV° cataract. After surgery, his corrected distance visual acuity (CDVA) improved from 20/400 to 20/25, and the endothelial cell loss (ECL) % was 12.05 % at 3 months postoperatively. The rotation of the toric IOL in Case 1 was 2°. Case 2 involved a patient with severe nuclear cataract and an endothelial cell density of 837 cells/mm2. After surgery, the CDVA improved from 20/100 to 20/40. The ECL% was 4.06% at 1 week postoperatively. Case 3 was a 91-year-old woman with a short axis length of 21.35 mm and an endothelial cell density number of 1238 cells/mm2. After surgery, the CDVA improved from light perception to 20/133, and the ECL% was 26.09% at 1 week postoperatively; ECL% was 2.67% at 1 month post-operation. The corneal grafts were transparent. Femtosecond laser-assisted cataract surgery seems to be an effective, predictable, and safe approach for challenging patients after PKP, and improves visual recovery and optimal refractive outcomes.

Effect of femtosecond laser-assisted phacoemulsification on corneal endothelium and prognosis of diabetic patients with cataract with different nuclear hardness

Objective: To assess the impact of femtosecond laser-assisted phacoemulsification on corneal endothelial characteristics and prognosis among patients with type 2 diabetes and age-related cataracts, considering varying nuclear hardness. Methods: This non-randomized controlled trial involved 161 patients (161 eyes) with type 2 diabetes undergoing cataract extraction at Weifang Eye Hospital between March 2020 and December 2022. The cohort comprised 73 males and 88 females, with an average age of (65.9±5.23) years. Based on patient preference, 101 individuals underwent conventional phacoemulsification (group A), while 60 chose femtosecond laser-assisted phacoemulsification (group B). Patients were further stratified based on Emery-Little grade of lens nuclei into A1/B1 (grade Ⅰ and Ⅱ), A2/B2 (grade Ⅲ), and A3/B3 (grade Ⅳ) subgroups. The study compared effective phacoemulsification time (EPT), cumulative energy release of phacoemulsification (CDE), central corneal thickness (CCT), endothelial cell density (ECD), coefficient of variation (CV), and hexagon cell ratio (HEX) before and after surgery at 1 day, 1 week, 1 month, and 3 months. Results: The intraoperative EPT of patients in groups A and B were (6.52±4.93) and (5.63±4.31)s, respectively, and the CDE were 11.57%±5.21% and 10.68%±6.02%, respectively. The differences between them were not statistically significant (all P>0.05).There were no significant differences in EPT and CDE between groups A1 and B1 (all P>0.05), and there were statistically significant differences between groups A2 and B2, A3 and B3 (all P<0.05).The postoperative CCT was increased in both groups.There were no statistically significant differences in CCT between A1 and B1 groups at different time after surgery (all P>0.05), and there were statistically significant differences in CCT between A2 and B2, A3 and B3 groups at 1 day and 1 week after surgery (all P<0.05), and group B was significantly lower than group A.There was no significant difference between 1 month and 3 months after surgery (P>0.05).ECD was reduced in both groups.There was no statistically significant difference in ECD at different time of operation between A1 and B1 groups (all P>0.05), while there was statistically significant difference in ECD at 1 day, 1 week, 1 month and 3 months after operation in A2 and B2, A3 and B3 groups (all P<0.05). Group B was significantly better than group A. There was no significant difference in coefficient of variation and HEX between the two groups at different time after surgery (P>0.05). Conclusion: Femtosecond laser-assisted phacoemulsification demonstrates benefits in preserving corneal endothelial cells, reducing early postoperative corneal edema, and minimizing corneal injury in type 2 diabetes patients with cataracts of high nuclear hardness.

Comparison of clinical outcomes between femtosecond laser-assisted cataract surgery versus conventional phacoemulsification in vitrectomized eyes - A prospective interventional study.

To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes. A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 ( n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 ( n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT). Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period ( P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively. FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS.

Comparison of macular changes and visual outcomes between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery for high myopic cataract patients

BackgroundTo evaluate differences in log MAR best-corrected visual acuity (BCVA) improvement and postoperative central foveal thickness (CFT) and choroidal thickness (CT) changes between conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) for high-myopia cataracts.MethodsThis was a retrospective and observational study. One hundred and two eyes of 102 patients with high-myopia cataracts were examined. CPS was performed in 54 eyes, and FLACS was performed in 48 eyes. All eyes underwent logMAR BCVA, CFT and CT of three different sectors preoperatively and one week and six months postoperatively.ResultsThe logMAR BCVA improved significantly after surgery in both groups (both P < 0.001), but no difference was observed in BCVA improvement between the groups (P = 0.554). Moreover, no significant differences were reflected in the changes in CFT, nasal 1 mm CT or temporal 1 mm CT between the two groups, and only subfoveal choroidal thickness (SFCT) in the CPS group decreased significantly compared with that in the FLACS group at any postoperative time (P = 0.003 and 0.026). AL, preoperative logMAR BCVA, and CT of the three regions exhibited a notable correlation with postoperative BCVA (all P < 0.05) according to univariate logistic regression analysis. However, only the AL, preoperative logMAR BCVA and SFCT remained significant in the multivariate model. Postoperative logMAR BCVA revealed a positive correlation with AL and preoperative logMAR BCVA but a negative correlation with SFCT.ConclusionsFLACS was not superior to CPS in improving BCVA but had less impact on SFCT in the treatment of high-myopia cataracts. Eyes with a longer AL, worse preoperative logMAR BCVA and thinner SFCT had a high risk of worse postoperative BCVA.

Comparison of corneal endothelial cell loss in FLACS: impact on endothelial cells in different regions.

To compare changes in corneal endothelial parameters after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) in different corneal regions. Chang Gung Memorial Hospital, Linkou, Taiwan. Single-center, retrospective. Before and 1, 3, and 6 months postoperatively, specular microscopy was performed to measure endothelial cell density (ECD), corneal thickness, hexagonal cell rate (Hex), and coefficient of variation (CoV). Position 1 referred to the central cornea, position 2 was nearest to the main wound, and position 3 was at the peripheral zone diagonal to the main wound. This study analyzed 96 eyes in the FLACS group and 110 eyes in the CPS group. Preoperatively, position 1 had lower ECD and CoV and higher Hex compared with the peripheral regions. FLACS patients had a significantly less phacoemulsification time and cumulative dissipated energy. At 1 month, FLACS patients showed a significantly smaller increase in corneal thickness at positions 1 and 2. At 3 months, FLACS patients had lower endothelial cell loss (ECL) at positions 1 and 3. ECL remained lower in FLACS patients at 6 months. The highest ECL was observed at position 2 in both groups and was progressive up to 6 months. After phacoemulsification, ECL varied in different corneal regions. At 3 months, the FLACS group exhibited significantly less ECL at the central cornea; however, the continued ECL at 6 months near the main wound suggested ongoing endothelial remodeling in the region.

Comparison of low-energy FLACS and conventional cataract surgery: meta-analysis and systematic review.

To systematically compare the effectiveness of conventional phacoemulsification surgery (CPS) and low-energy femtosecond laser-assisted cataract surgery (FLACS) in patients with cataract. Cataract surgery is a common procedure, and comparing different techniques such as CPS and low-energy FLACS is crucial for optimizing patient outcomes. The PubMed, Web of Science, MEDLINE, EMBASE, and Cochrane library databases were searched for clinical trials. Outcomes of procedure time, effective phacoemulsification time, balanced salt solution usage, cumulative dissipated energy, mean change of corrected distance visual acuity, endothelial cells reduction, central corneal thickness (CCT), and aqueous cytokine level were evaluated. The effect measures were weighted mean differences with 95% CI. The protocol was registered at the Prospective Register for Systematic Reviews (registration number CRD42023420173). 11 studies were included in this meta-analysis, of which 1680 eyes were analyzed (637 eyes in the low-energy FLACS group and 1043 eyes in the CPS group). Low-energy FLACS demonstrated significantly fewer reductions in endothelial cell count at 6 months ( P < .001) compared with CPS. It also exhibited a shorter effective phacoemulsification time ( P < .001) and less balanced salt solution usage ( P < .001). However, there were no differences in cumulative dissipated energy, corrected distance visual acuity, CCT changes, or aqueous cytokine levels between the 2 groups. Both low-energy FLACS and CPS are effective in treating cataracts, but low-energy FLACS may offer advantages such as reduced phacoemulsification time and less endothelial cell loss.

Femtosecond laser-assisted cataract surgery for complex cataracts - A review.

Since its inception in 2009, femtosecond laser-assisted cataract surgery (FLACS) has become an alternative to conventional phacoemulsification cataract surgery (CPCS). Clinical studies were unable to demonstrate superior visual outcomes, but revealed reduced endothelial cell loss. More recently, the cost-effectiveness of FLACS over CPCS in routine cataract surgeries has been challenged. However, the unique abilities of FLACS to customize anterior capsulotomies precisely, soften and fragment the nucleus without capsular bag stress, and create corneal incisions may have special utility in complex cataract and less-common scenarios. In this article, we review the unique role of FLACS in complex cataract surgeries and how it could play a role to improve the safety and predictability of nonroutine cataract surgery.

Incidence and analysis of intraoperative complications in femtosecond laser-assisted cataract surgery: a large-scale cohort study to establish the learning curve

AimsTo assess the safety of femtosecond laser-assisted cataract surgery (FLACS) based on surgical parameters and intraoperative complications analysis and to determine the length of the learning curve for FLACS.MethodsA prospective...

Effects of Different Capsulotomy and Fragmentation Energy Levels on the Generation of Oxidative Stress Following Femtosecond Laser-Assisted Cataract Surgery.

This study was conducted to evaluate the effects of different capsulotomy and fragmentation energy levels on the production of oxidative free radicals following femtosecond laser-assisted cataract surgery (FLACS) with a low-energy platform. The experimental study included 60 porcine eyes (12 groups). In each group, capsulotomies with 90% or 150% energy, and fragmentations with 90%, 100%, or 150% energy or 150% with high spot density, respectively, were performed. Control samples were obtained from non-lasered eyes at the beginning (five eyes) and end (five eyes) of the experiment. In the clinical study, 104 eyes were divided into 5 groups, and they received conventional phacoemulsification (20 eyes), FLACS with 90% capsulotomy and 100% fragmentation energy levels without NSAIDs (16 eyes), FLACS with 90% (26 eyes) or 150% (22 eyes) capsulotomy energy levels, respectively, with a 100% fragmentation energy level and NSAIDs, and FLACS with 90% capsulotomy and 150% fragmentation energy levels and NSAIDs (20 eyes). Aqueous samples were analyzed for their malondialdehyde (MDA) and superoxide dismutase (SOD) levels. In the experimental study, there were no significant differences in the MDA and SOD levels between the groups with different capsulotomy energy levels. An increase in the fragmentation energy from 100% to 150% led to significantly higher MDA levels in the groups with both 90% (p = 0.04) and 150% capsulotomy energy levels (p = 0.03), respectively. However, increased laser spot densities did not result in significant changes in MDA or SOD levels. In the clinical study, all four of the FLACS groups showed higher MDA levels than the conventional group. Similarly, the increase in the fragmentation energy from 100% to 150% resulted in significantly elevated levels of MDA and SOD, respectively. Although increasing the FSL capsulotomy energy level may not have increased free radicals, higher fragmentation energy levels increased the generation of aqueous free radicals. However, fragmentation with high spot density did not generate additional oxidative stress. Increased spot density did not generate additional oxidative stress, and this can be helpful for dense cataracts.

Comparative study of FLACS vs conventional phacoemulsification for cataract patients with high myopia.

To compare the short-term changes in cornea, retina, and choroid of femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification (CPS) in high myopia patients with cataract. Affiliated Hospital of Nantong University, Jiangsu Province, China. Prospective single-center study. Demographics, ocular clinical features, ultrasound power, absolute phacoemulsification time, and effective phacoemulsification time were recorded for each patient. Endothelial cell density (ECD), central corneal thickness (CCT), corrected distance visual acuity (CDVA), intraocular pressure (IOP), center foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and choroidal vascularity index (CVI) were evaluated preoperatively and at 1 week, 1 month, and 3 months postoperatively. Intraoperative parameters and intraoperative/postoperative complications were recorded. 97 eyes (46 eyes and 51 eyes in the FLACS and CPS groups, respectively) were included and analyzed. Effective phacoemulsification time was lower in the FLACS group compared with the CPS group ( P < .05). The increase in CCT was significantly lower in the FLACS group compared with the CPS group at 1 week and 1 month ( P < .05). CDVA and IOP were similar in both groups at the final visit ( P > .05). The ECD decreased was lower among CPS patients compared with FLACS patients. CFT, SFCT, and CVI increase in both groups but were increased more in the CPS group with high myopia patients. No serious complications occurred in either group. FLACS is a more safety and effective in cataract patients with high myopia. It has advantages in effectively reducing EPT and promoting faster recovery of the cornea, macular, and choroidal thickness.

Update on Femtosecond Laser-Assisted Cataract Surgery: A Review.

The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.

Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts.

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above). Nethradhama Superspeciality Eye Hospital, Bangalore, India. Prospective, randomized, comparative study. 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively. The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group ( P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL ( P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) ( P < .001). 3 eyes in the CPS group had wound burns of varying severity. FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts. CTRI/2021/12/038887.

Femtofakoemulsyfikacja zaćmy – 10 lat doświadczeń

Femtosecond laser-assisted cataract surgery is a procedure known for more than a decade. The review compares this surgical technique with conventional cataract phacoemulsification – the most frequently performed operation of this type. The review took into account metanalysis, clinical trials and reports from the last 10 years to evaluate several aspects, including intraoperative parameters, surgical complications and advantages for patients. Femtosecond laser-assisted cataract surgery is the method with less effective phacoemulsification time, cumulative dissipate energy and better intraocular lens centration. Reduction of aberrations in presbyopia correcting intraocular lens is also noticeable. Best uncorrected and corrected visual acuity and postoperative predicted refraction are similar in both groups of patients. Surgical complications are comparable as well. Noteworthy is the fact that patients with hard nuclear cataracts have smaller endothelial cell loss. The results for low and medium severity of cataracts are mostly the same in laser-assisted surgery versus phacoemulsification. Femtosecond laser-assisted cataract surgery is a new solution for patients with low endothelial density or endothelial dystrophy, especially in advanced cataracts. The procedure is also recommended for surgery with presbyopia-correcting lens implantation due to better centration and smaller ocular aberrations. This whole new surgical technique requires greater financial outlay but provides some improvements in cataract surgery

Cataract Grade and Pupil: Comparison Between Conventional Phacoemulsification and Low-Energy Femtosecond Laser Assisted Cataract Surgery.

This study presents a comparison of pupil changes according to cataract grade between low-energy femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification (CP) in the same patient. Data from surgical records from patients submitted to cataract surgery with CP in one eye and FLACS in the other were retrospectively reviewed. The inclusion criterion was both eyes of the same patient having the same cataract grade in accordance with Lens Opacity Classification System (LOCS) III. Total pupil variation (TPV) was measured after recorded images, with intraindividual comparison between techniques, according to cataract grade (≤3 and >3), age and cumulative dissipated energy (CDE). The study included a total of 124 eyes of 62 patients (mean age 72.65 ± 7.64 years). Analysis showed a statistically significant difference in TPV between techniques in the grade ≤3 cataract group (0.08 ± 0.22 mm²; p=0.034), with less pupil narrowing with FLACS, but not in the grade >3 group (0.01 ± 0.23 mm²; p=0.849). Regarding CDE, a significant difference (p<0.001) was found between techniques in both softer and harder cataracts, with lower values for FLACS. Correlation between CDE and TPV was significant for CP (p=0.021) but not for FLACS (p=0.922). TPV was significantly lower in older patients (age >74 years) for both techniques (p<0.001). There was a statistically significant difference between techniques (although of mild clinical relevance), with less reduction of pupil area with FLACS in softer cataracts (grade ≤3), as compared to CP. Higher levels of CDE are associated with more pupil narrowing in CP.

Safety and efficacy of cataract surgery performed with a low-energy femtosecond laser compared with conventional phacoemulsification in Chinese patients: a randomized clinical trial

BackgroundTo compare the safety and efficacy of femtosecond laser-assisted cataract surgery (FLACS) performed with the low-energy FEMTO LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) laser compared with conventional phacoemulsification (CP) in Chinese patients.MethodsThis prospective, multicenter, interventional study included 126 patients who were randomized (1:1) to undergo either FLACS or CP followed by intraocular lens (IOL) implantation between January 2019 and April 2020. The primary endpoint included the comparison of the endothelial cell loss (ECL) between the two groups at 3 months. Secondary endpoints included the comparison of cumulative dissipated energy (CDE), change in central corneal thickness (CCT) from baseline, and postoperative uncorrected and corrected distance visual acuities (UDVA and CDVA) in the two groups.ResultsAt all postoperative time points, the FLACS group was found to be non-inferior to CP for the mean ECL (− 409.3 versus − 436.9 cells/mm2 at 3 months) and mean CDE (4.1 versus 4.5 percent-seconds). The increase in CCT was significantly lower in the FLACS group compared with the CP group at Day 7 (4.9 versus 9.2 µm; P = 0.04); however, the difference was not statistically significant at 1 and 3 months. Postoperatively, mean UDVA and CDVA were comparable between the two groups. No intraoperative complications occurred.ConclusionsCataract surgery performed with a low-energy femtosecond laser was non-inferior to CP; however, the FLACS group had a statistically significantly lower increase in CCT at Day 7 compared with CP.Trial registration This trial is registered at ClinicalTrials.gov on May 15, 2019, with trial registration number: NCT03953053.