Conventional Phacoemulsification Research Articles

Surgical stress and cytoskeletal changes in lens epithelial cells following manual and femtosecond laser-assisted capsulotomy.

To study the effect of mechanical stress on the cytoskeleton in lens epithelial cells following conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS). The cytoskeleton of the epithelial cells of the anterior lens capsules (ALC) removed by CPS and FLACS was examined by immunohistochemistry. Expression of the intermediate filament, glial fibrillary acidic protein (GFAP), and glutamine synthetase (GS) immunoreactivity were detected. In order to map the actin network of cells, fluorescently labeled phalloidin was used. The samples were examined using confocal laser scanning microscopy. GFAP expression was visible in a larger number of the epithelial cells after CPS compared to FLACS. In CPS sample's epithelial cells, GFAP immunoreactivity indicated robust morphological change. Regarding the actin filaments, the presence of tubular elements connecting epithelial cells, regular actin pattern and marked cortical network after CPS were found. Following FLACS, the actin cytoskeleton of the epithelial cells remained densely structured, and the tubular elements were undetectable, however, the above-mentioned regular actin pattern and the marked cortical network were visible. The conventional removal of the ALC induces more robust changes of the cytoskeleton of the lens epithelial cells.

Intraindividual comparison of cytokine and prostaglandin levels with and without low-energy, high-frequency femtosecond laser cataract pretreatment after single-dose topical NSAID application.

To investigate interleukin (IL)-1β, IL-6, and total prostaglandin (PG) levels in the anterior chamber in patients undergoing low pulse energy femtosecond laser-assisted cataract surgery. Forty patients undergoing immediate sequential cataract surgery received randomized low-energy femtosecond laser pretreatment in 1 eye and conventional phacoemulsification in the other. Aqueous humor was collected precisely 5 minutes after femtosecond laser pretreatment and before conventional phacoemulsification from all 80 eyes. IL-1β, IL-6, and total PG (including PGE1, PGE2; PGF1a, PGF2a) levels were analyzed using enzyme-linked immunoassay kits. One drop of ketorolac 0.5% was administered 30 minutes preoperatively. Mean concentrations of IL-1β, IL-6, and total PG were 0.87, 0.67, and 32.19 pg/mL in the femto group compared with 0.10 (P = .36), 0.78 (P = .79), and 19.66 pg/mL (P < .05) in the nonfemto group. Levels of IL-1β and IL-6 were not statistically significantly different when compared between groups. There was a small but statistically significant increase of PG levels in the femto group. There were no statistically significant correlations between levels of 1β, IL-6, or total PG and suction time or lens density (P > .05). Low pulse energy femtosecond laser pretreatment did not trigger any additional IL and only a small but statistically significant increase of PG release in the anterior chamber after a single-dose of topical nonsteroidal antiinflammatory drug administered 30 minutes before the start of cataract surgery. The findings indicated that the minor inflammatory reaction was due to the lower pulse energy concept applied by the femtosecond laser.

Visual and refractive outcomes and complications in femtosecond laser-assisted versus conventional phacoemulsification cataract surgery: findings from a randomised, controlled clinical trial

Background/aimTo compare visual and refractive outcomes, changes in intraocular pressure (IOP), and complications of femtosecond laser-assisted cataract surgery (FLACS) to conventional phacoemulsification surgery (CPS) in paired eyes from the same...

Safety and efficacy of a small-aperture capsular bag-fixated intraocular lens in eyes with severe corneal irregularities.

To implant a small-aperture intraocular lens (IOL) (IC-8) in eyes with severe corneal irregularities to reduce higher-order aberrations and provide better central visual acuity. University Hospital, LMU Munich, Germany. Prospective nonrandomized interventional case series. Eyes with severe corneal irregularities due to keratoconus, previous penetrating keratoplasty, status postradial keratotomy, or scarring after ocular trauma were enrolled. Exclusion criteria were progressive keratoconus, pseudoexfoliation, glaucoma, maculopathy, reduced endothelial cells (<1800 cells/mm), and central corneal opacity. Conventional phacoemulsification with implantation of the small-aperture IOL was performed. The primary efficacy endpoint was corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary endpoints were life quality assessment using the Visual Function Questionnaire-25 and determination of the refractive defocus curve. Seventeen eyes of 17 patients were enrolled. In all 17 patients, CDVA improved from 0.37 ± 0.09 to 0.19 ± 0.06 logarithm of the minimum angle of resolution (logMAR) 3 months postoperatively (P < .0001). Similarly, postoperative UDVA, UIVA, and UNVA improved significantly in 100%, 88%, and 88%, respectively. The defocus curve showed best results at 0.17 logMAR with a defocus of -0.5 diopter. In addition, overall life quality analyses reported less difficulty with activities under reduced optical phenomena conditions. The small-aperture IOL was a useful option in eyes with severe corneal irregularities, had a high safety index and a high satisfaction rate, and can lead to better visual quality in these cases. Further studies are needed to improve power calculation of this IOL.

Comparative clinical outcomes of Tecnis toric IOL implantation in femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery.

To compare the short-term visual outcomes, residual refractive cylinder, and rotation stability after Tecnis toric intraocular lens (IOL) implantation during femtosecond laser-assisted cataract surgery (Femto phaco) and conventional phacoemulsification surgery (Conventional phaco). In a prospective cohort study, Conventional phaco and Femto phaco (anterior capsulotomy and lens fragmentation by a femtosecond laser) with Tecnis toric IOL implantation were performed in 40 eyes from 36 patients and 37 eyes from 33 patients, respectively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction were assessed during 1d, 1wk, and 1mo follow-ups. The orientation of the Tecnis Toric IOL was evaluated during 1wk and 1mo follow-ups. There were no significant differences in UDCA or CDVA between two groups at 1mo postoperatively, though relatively more subjects had UDVA values of 20/25 or better in Femto phaco group than in the Conventional group (P>0.05). A lower but not significantly lower rate of having more than 5° of IOL rotation was observed in Femto phaco group at the 1-month follow-up, while a significant lower rate of residual astigmatism of ≤1 D was observed in Femto phaco group. The Femto phaco group has significantly more subjects with the residual astigmatism of ≤1 D, but there are no significant differences in rotation stability and visual outcomes as compared with the Conventional phaco group after the application of the Tecnis toric IOL in this cohort.

Comparison between refractive outcomes of femtosecond laser-assisted cataract surgery and standard phacoemulsification

BackgroundTo compare the visual and refractive outcomes of femtosecond laser assisted cataract surgery (FLACS) using Victus platform (Technolas Bausch and Lomb (B&L), Munich, Germany) and conventional phacoemulsification cataract surgery (CPCS).MethodsA retrospective study of 100 eyes operated for cataract. FLACS was performed in 50 eyes and CPCS was done in another 50 eyes. Preoperative and 6 months postoperative visual and refractive evaluation (efficacy, safety, predictability, and surgically induced astigmatism) as well as higher-order aberrations were analyzed. Efficacy index which equals post-operative mean of uncorrected distance visual acuity (UDVA) divided by preoperative mean corrected distance visual acuity (CDVA) was calculated in both groups. Safety index equals post-operative mean of corrected distance visual acuity (CDVA) divided by preoperative mean CDVA.ResultsLogarithm of the Minimum Angle of Resolution (LogMAR), UDVA improved in both groups after surgery (p < 0.05). It was 0.23 ± 0.20 and 0.291 ± 0.311 log MAR in FLACS and CPCS groups respectively. Safety index was 1.777 in FLACS group and 1.744 in CPCS groups showing high degree of safety of both measures. Mean surgically induced astigmatism (SIA) was 0.35 ± 0.67 D and 0.901 ± 0.882 D in FLACS and CPCS groups respectively (p = 0.015). The post-operative comparison between both groups was in favor of CPCS group vs. FLACS group regarding total aberrations (0.563 ± 0.386 vs. 0.91 ± 1.20) (p = 0.03), while low order aberrations were significantly less in FLACS group vs. CPCS group (0.64 + 0.63 vs. 2.07 + 3.15) (p = 0.027). RMS high order aberration was higher in FLACS group vs. CPCS group but of no statistical significance 0.54 ± 0.96 vs. 0.328 ± 0.360 (p = 0.082).ConclusionFemtosecond laser -assisted cataract surgery was a safe and precise procedure but enhanced visual outcomes only minimally when compared to conventional cataract surgery in experienced hands. Both FLACS and manual surgeries can achieve a high efficacy, predictability and safety with slight superior outcomes in FLACS.Trial registration numberPACTR201804003256258 (date: 27 Mar 2018) Available at: https://pactr.samrc.ac.za/

Combined Descemet membrane endothelial keratoplasty and extracapsular cataract extraction: management of an intraoperative challenge

Endothelial corneal transplantation (Descemet membrane endothelial keratoplasty [DMEK]) combined with cataract surgery as a triple procedure has been demonstrated to be safe and cost-effective. Where the corneal opacity is more significant, this may preclude safe phacoemulsification. This may not be apparent during preoperative assessment. An 80-year-old man with corneal decompensation secondary to herpes simplex endotheliitis and cataract underwent combined cataract extraction and DMEK. Intraoperatively, the surgical view became too poor to continue with conventional phacoemulsification. The lens was extracted by conversion to extracapsular surgery (extracapsular cataract extraction [ECCE]). Descemet membrane endothelial keratoplasty surgery was then completed without complication. Postoperatively, the graft remained attached, and by 3 months, acuity improved to 20/32 (Snellen). A poor intraoperative view during the triple procedure does not preclude a successful outcome. Corneal opacity can be overcome, avoiding full-thickness penetrating keratoplasty or discarding healthy graft tissue. Conversion to ECCE combined with DMEK is a feasible option intraoperatively that can still provide good outcomes.

Сравнение клинико-функциональных результатов фемтолазер-ассистированной экстракции катаракты и традиционной факоэмульсификации

Сравнение клинико-функциональных результатов фемтолазер-ассистированной экстракции катаракты и традиционной факоэмульсификации

Femtosecond laser-assisted cataract surgery: A review.

Review scientific literature concerning femtosecond laser-assisted cataract surgery. Following databases were searched: CENTRAL (Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 2 of 12, June 2019), Ovid MEDLINE® without Revisions (1996 to June 2019), Ovid MEDLINE® (1946 to June 2019), Ovid MEDLINE® Daily Update June 2019, MEDLINE and MEDLINE Non-Indexed Items, Embase (1980-2019), Embase (1974 to June 2019), Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to June 2019), Web of Science (all years), the metaRegister of Controlled Trials ( www.controlled-trials.com ), ClinicalTrials.gov ( www.clinicaltrial.gov ) and World Health Organization International Clinical Trials Registry Platform ( www.who.int/ictrp/search/en ). Search terms/keywords included 'Femtosecond laser' combined with 'cataract', 'cataract surgery'. Based on quality of their methodology and their originality, 121 articles were reviewed, including randomised controlled trials, cohort studies, case-controlled studies, case series, case reports and laboratory studies. Each step of the femtosecond laser-assisted cataract surgery procedure (corneal incisions, arcuate keratotomies, capsulotomy and lens fragmentation) has been discussed with relevance to published outcomes, as well as complication rates of femtosecond laser-assisted cataract surgery, and what we can learn from the larger studies/meta-analyses and the economics of femtosecond laser-assisted cataract surgery within different healthcare settings. Studies suggest that the current clinical outcomes of femtosecond laser-assisted cataract surgery are not different to conventional phacoemulsification surgery and it is not cost effective when compared with conventional phacoemulsification surgery. In its current technological form, it is a useful surgical tool in specific complex cataract scenarios, but its usage has not been shown to translate into better clinical outcomes.

Effect Of Intracameral Phenylephrine And Ketorolac 1.0%/0.3% On Intraoperative Pain And Opioid Use During Cataract Surgery.

PurposeTo compare the effect of Omidria (phenylephrine and ketorolac 1.0%/0.3%) vs epinephrine on pain reduction and opioid usage during cataract surgery.Patients and methodsSixty patients at a single center underwent femtosecond laser (FLACS) or conventional phacoemulsification under topical lidocaine gel anesthesia and intracameral preservative-free lidocaine 1%. Eligible participants were prospectively assigned to receive either intracameral phenylephrine and ketorolac 1.0%/0.3% or intracameral epinephrine. All patients received standardized pre- and post-operative topical therapy. Intravenous (IV) fentanyl was administered for ocular discomfort in patients who complained of intraoperative pain. Outcome measures included both pain (measured by mean visual analog scale (VAS) pain scores from 0 (no pain) to 10 (extreme pain)) and the use of IV fentanyl during surgery. A composite endpoint identified “responders” as being patients who: (1) did not require fentanyl and (2) experienced no to minimal pain (VAS score ≤ 3).ResultsForty-one patients were in the phenylephrine and ketorolac 1.0%/0.3% (study) group and 19 were in the epinephrine (control) group. Mean VAS pain scores were significantly (48.9%) lower in the study group than the control group (2.3 vs 4.5; P < 0.0001). The proportion of patients with VAS scores ≤ 3 was significantly greater in the study group (85.0%) than the control group (31.6%) (P < 0.0001). A smaller proportion of patients required intraoperative fentanyl in the study group compared to the control group (9.8% vs 42.1%; P = 0.006). For the composite endpoint, patients receiving phenylephrine and ketorolac 1.0%/0.3% were 94% less likely to require fentanyl or to have moderate-to-severe pain (pain VAS ≥ 4; OR, 0.06; 95% CI 0.02–0.24) than patients receiving epinephrine.ConclusionOur results suggest that the routine use of intracameral phenylephrine and ketorolac 1.0%/0.3% during cataract surgery can significantly reduce patient pain as well as the need for opioids.

Comparison of lens anterior capsular changes between femtosecond laser-assisted phacoemulsification and conventional phacoemulsification for cataract patients with diabetes

Objective To compare the anterior capsule opacification and contraction of lens following femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract patients with diabetes. Methods A non-randomized control study was carried out.Eighty-five eyes of 85 cataract patients with diabetes were included from March 2015 to August 2016 in Xiamen Eye Center.The patients were divided into 2 groups based on the different surgeries.Forty-three eyes of 43 patients in the femtosecond laser group received femtosecond laser-assisted phacoemulsification and completed the 5.3 mm capsulorhexis using the Alcon LenSx femtosecond laser platform.Forty-two eyes of 42 patients in the conventional surgery group underwent conventional phacoemulsification group and performed 5.3 mm continuous circular capsulorhexis under the guidance of Alcon VERION.Anterior capsule opacification (ACO) was graded according to Werner's method.The area of anterior capsular opening was calculated by using Image Pro Plus 6 software.The number of eyes in different grades of ACO and anterior capsule opening area between two groups were compared at 1 month, 3 months and 6 months after operation. Results Initial anterior capsular opening area was not significantly different between the femtosecond laser group and the conventional phacoemulsification group (t=0.003, P=0.958). The anterior capsule opening area in the two groups among different time-points after operations was significantly different (Fgroup=73.602, P<0.001; Ftime=378.895, P<0.001), and anterior capsule opening areas were smaller in the conventional phacoemulsification group than those in the femtosecond laser group at various time points after operation (all at P<0.001). At 1 month after suigery, grade Ⅰ of the ACO was found in 29 eyes (67.4%) in the femtosecond laser group and 26 eyes (61.9%) in the conventional phacoemulsification group, and there was no significant difference between two groups (P=0.133). At 3 months after surgery, the incidence rate of grade Ⅱ of ACO was 11.6% (5/43) in the femtosecond laser group, which was lower than than that in the conventional phacoemulsification group(66.7%, 28/42), showing a significant difference between them (P<0.001). At the 6th month after operation, the incidence rate of grade Ⅲ of ACO in the femtosecond laser group was 14.0%(6/43), which was lower than that in the conventional phacoemulsification group(73.8%, 31/42), with a significant difference between them (P<0.001). Conclusions Femtosecond laser-assisted cataract surgery for cataract is a good choose patients with diabetes mellitus because of reducing the occurrence of ACO and the contraction of anterior capsule. Key words: Cataract/surgery; Diabetic mellitus; Laser/therapy use; femtosecond laser-assisted phacoemulsification; Anterior capsular membrane, lens

Intra and post-operative complications observed with femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a systematic review and meta-analysis

BackgroundIn this analysis, we aimed to systematically compare the complications which were associated with femtosecond laser-assisted cataract surgery (FLACS) versus the conventional phacoemulsification surgery (CPE).MethodsCommonly used search databases, specifically MEDLINE, Cochrane Central, EMBASE, and http://www.clinicaltrials.gov were carefully searched for English publications comparing FLACS versus CPE. The selected endpoints which were assessed included incomplete capsulotomy, anterior capsulotomy tag, anterior capsule tear, posterior capsule tear, injury to the descemet’s membrane, zonular dialysis, vitreous loss, macular or corneal edema, and elevated intra-ocular pressure. Statistical analysis was carried out by the latest version of the RevMan software (version 5.3) and represented by risk ratios (RR) with 95% confidence intervals (CI).ResultsA total number of 7156 participants were included. Three thousand five hundred and fifty four (3554) participants were assigned to the FLACS group. The risks for incomplete capsulotomy, anterior capsulotomy tag, and anterior capsular tear were significantly higher with FLACS (RR: 22.42, 95% CI: 4.53–110.82; P = 0.0001), (RR: 33.07, 95% CI: 6.53–167.56; P = 0.0001) and (RR: 4.74, 95% CI: 2.59–8.68; P = 0.00001) respectively. The risks for macular/corneal edema (RR: 2.05, 95% CI: 1.18–3.55; P = 0.01) and elevated intra-ocular pressure (RR: 3.24, 95% CI: 1.55–6.78; P = 0.002) were also significantly higher with FLACS. However, the risks for impaired descemet’s membrane (RR: 0.95, 95% CI: 0.61–1.47; P = 0.80), zonular dialysis (RR: 0.40, 95% CI: 0.06–2.72; P = 0.35), vitreous loss (RR: 0.09, 95% CI: 0.01–1.63; P = 0.10) and posterior capsular tear (RR: 1.45, 95% CI: 0.23–9.16; P = 0.69) were not significantly different.ConclusionsThe current results showed that FLACS did not improve intra/post-operative complications in comparison to CPE. Further larger studies should confirm this hypothesis.

Presbyopic lens exchange (PRELEX) cataract surgery outcomes with implantation of a rotationally asymmetric refractive multifocal intraocular lens: femtosecond laser-assisted versus manual phacoemulsification.

To compare the visual and refractive outcomes obtained with the implantation of a rotationally asymmetric refractive multifocal IOL after femtosecond laser-assisted cataract surgery (FLACS) and conventional lens extraction (CLE). A total of 78 eyes of 58 patients that had undergone conventional phacoemulsification (36 eyes, CLE group) or FLACS (37 eyes, FLACS group) with the implantation of the toric multifocal IOL LU-313 MF30T (Oculentis, Germany) were enrolled in this retrospective study. Mean age was 57.0years at the time of surgery, ranging from 44 to 69years. Visual and refractive outcomes were evaluated during a 12-month follow-up. Likewise, contrast sensitivity was assessed at the end of the follow-up. Significant improvements were observed in both groups in uncorrected distance (UDVA) and near visual acuity (UNVA) at 1month postoperatively (p < 0.001). Differences between groups in these parameters as well as in sphere and cylinder did not reach statistical significance during the whole follow-up (p ≥ 0.079), except for UNVA only at 12months postoperatively (p = 0.018). Concerning corrected near visual acuity, only significant differences between groups were found preoperatively (p = 0.020). Furthermore, only a minimal but significant difference between groups was found at 12months postoperatively in contrast sensitivity for the spatial frequency of 18 cycles/° (p = 0.029). The rotationally asymmetric toric multifocal IOL LU-313 MF 30T provides good visual rehabilitation for near and distance vision after presbyopic lens extraction in eyes with preexisting astigmatism, independently whether the cataract surgery is performed with the FLACS or conventional technique.

Comparison of changes in corneal endothelial cell density and central corneal thickness between conventional and femtosecond laser-assisted cataract surgery: a randomised, controlled clinical trial

Background/AimTo identify changes in endothelial cell density (ECD) and central corneal thickness (CCT) in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification surgery (CPS).MethodsThis is an intraindividual...

Comparative evaluation of femtosecond laser–assisted cataract surgery and conventional phacoemulsification in eyes with a shallow anterior chamber

To compare intraoperative performance and postoperative outcomes between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in eyes with a shallow anterior chamber (AC). Iladevi Cataract & IOL Research Centre, India. Prospective randomized masked clinical study. Patients undergoing cataract surgery with a shallow AC (<2.5mm) were randomized to have FLACS (Group 1, n=91) or conventional phacoemulsification (Group 2, n=91). Patients were followed up at 1day, 1week, and at 1, 3, and 6months. The primary outcome measure was central corneal thickness (CCT). The secondary outcome measures were corneal clarity, AC cells and flare, endothelial cell density (ECD), coefficient of variance, hexagonality, and uncorrected distance visual acuity (UDVA) at 1week. The study comprised 182 eyes (91 in each group) The cumulative dissipative energy was lower in the FLACS group (P<.05). The mean CCT was significantly lower with FLACS (540.40μm+49.40 [SD] vs 556+12.5μm, P=.03) at 1day and 1week (535.5+44.3μm vs 551+40.8μm, P=.04), with fewer eyes having higher than grade 2 AC cells and flare with FLACS (85% vs 72%, P=.056) at 1day and 1week (15% vs 28%, P=.03). At 1week, the UDVA was better with FLACS (0.089±0.31 logarithm of the minimum angle of resolution [logMAR] vs 0.178±0.65 logMAR, P=.042). At 6months, the reduction in ECD was lower in the FLACS group; however, the difference was not statistically significant. In eyes with shallow ACs, compared with conventional phacoemulsification, FLACS maintained clearer corneas, showed less increase in CCT, lower AC inflammation, and better UDVA in the early postoperative period.

Central corneal thickness changes following manual small incision cataract surgery versus phacoemulsification for white cataract

Aim: To assess the central corneal thickness (CCT) and endothelial cell loss after manual small-incision cataract surgery and phacoemulsification in patients with white cataract. Material and methods: This is a comparative, prospective, non-randomized study on 42 patients with white cataract, who underwent cataract surgery. The patients were divided into manual small-incision cataract surgery (21 eyes, MSICS group) and phacoemulsification cataract surgery group (21 eyes, phaco group). The endothelial cell density (ECD), central cornea thickness (CCT), and corrected distance visual acuity (CDVA) were evaluated at 1 day, 1 week, 4 weeks, and 3 months postoperatively. The results of 20 cases of nuclear sclerosis grade II-III (LOCS III) who underwent phacoemulsification by the same surgeon were also compared. Propensity scoring was used to adjust for confounding by selection bias. Results: The CCT increased after surgery in both groups. The thickness was greater in the phaco group on first day postoperatively (73 µ increase in MSICS group and 138 µ in phaco group, p=0.008) and it returned to preoperative levels 1 month postoperatively. The endothelial cell loss was lower in the MSICS group at 3 months postoperatively (11.8% in MSICS group and 15.8% in phaco group, p=0.111). The CDVA was not different in both groups at 1 week and 4 weeks postoperatively (p>0.05). Conclusions: Manual small-incision cataract surgery for white cataract provided less central corneal thickness changes compared to conventional phacoemulsification. Abbreviations: CCT = central corneal thickness; ECD = endothelial cell density; CDVA = corrected distance visual acuity; APT = absolute phacoemulsification time; EPT = effective phacoemulsification time; MSICS = Manual small-incision cataract surgery in white cataract; Phaco II = Phacoemulsification in white cataract; Phaco I = phacoemulsification in NS 2 + Cataract; Phaco = Phacoemulsification in white cataract; APACRS = Asia-Pacific Association of Cataract and Refractive Surgeons.

Lens capsule-related complications of femtosecond laser–assisted capsulotomy versus manual capsulorhexis for white cataracts

Comparison of lens capsule-related complications resulting from femtosecond laser-assisted capsulotomy and manual capsulorhexis in patients with white cataracts. Eye Center, Second Affiliated Hospital, Zhejiang Medical School, Hangzhou, China. Prospective consecutive nonrandomized comparative cohort study. Selected patients were divided into a femtosecond laser-assisted cataract surgery group (FLACS group) and a conventional phacoemulsification cataract surgery group (CPCS group). Each case was recorded as either a type I or type II white cataract. Here, type I was characterized by the presence of a liquefied cortex, whereastype II had a solid cortex. Five experienced phacoemulsification surgeons conducted all surgeries. Lens capsule-related events, including anterior capsule tears, posterior capsule ruptures (PCRs), incomplete capsulotomies, and irregular capsulorhexes were recorded; surgical parameters, postoperative visual acuities, and intraocular lens (IOL) decentrations were evaluated. The study comprised 132 eyes of 132 patients (66 in each group). Anterior capsule tears were significantly more common in the CPCS group than the FLACS group (12.1% versus 0%). All 8 cases of anterior capsule tears were type I cases. Six FLACS cases developed incomplete capsulotomies, four of which were type I cases. The incidences of PCRs and vitreous loss were the same. Capsulotomy produced better circularity index and diameter stability than capsulorhexis. IOLs were better centered in the FLACS group than the CPCS group. The mean ultrasound power, absolute phaco time, effective phaco time, and postoperative visual acuities were similar in both groups. Compared with CPCS, FLACS decreased the risk for anterior capsule tears in white cataracts, especially in type I cases. However, it did not reduce the incidence of PCR. Incomplete capsulotomy during FLACS could happen in white cataracts. Using FLACS on white cataracts enabled more precise capsulotomies and better-centered IOLs.

Outcomes of coaxial microincision cataract surgery versus conventional phacoemulsification surgery

Aim: To compare surgical parameters and visual outcomes of coaxial microincision cataract surgery (MICS) with standard phacoemulsification.&#x0D; Methods: A prospective randomized study was conducted on 60 eyes of 60 patients with age-related uncomplicated cataract who underwent: standard phacoemulsification surgery (30 eyes) i.e., Group 1, or coaxial MICS (30 eyes) i.e., Group 2. Intraoperative parameters were mean effective phacoemulsification power (EPP), effective phacoemulsification time (EPT), and total volume of balanced salt solution (BSS) used. Best-corrected visual acuity (BCVA) and surgically induced astigmatism (SIA) were evaluated pre- and postoperatively.&#x0D; Results: Mean BCVA at 6 weeks was 0.04 ± 0.07 in Group 1 and 0.05 ± 0.08 in Group 2. No significant difference was observed in SIA between the two groups. Mean EPT was 29.80 ± 3.67 seconds in Group 1 and 31.93 ± 4.08 seconds in Group 2. The mean total EPP in Group 1 was 35.77 ± 5.17%, whereas it was 33.70 ± 3.05% in Group 2. There was a significant statistical difference between mean EPP and EPT in the two groups. Mean total BSS volume used in Group 1 was 128.83 ± 19.81 ml, whereas it was 139.33 ± 13.57 ml in Group 2.&#x0D; Conclusion: Although EPT and BSS volume used were significantly higher in coaxial MICS, the postoperative results of the two techniques were comparable.

Ultrasound power and irrigation volume in different lens opacity grades: comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification

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.

Comparison of clinical and functional results of conventional and femtosecond laser-assisted cataract phacoemulsification

To perform a comparative analysis of ultrasound and hydrodynamic parameters, and the outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). This prospective cohort study included 246 eyes. The first group consisted of 138 patients who underwent FLACS, second group - 108 patients after CPCS. Total ultrasound time was 95.36±47.93 and 113.3±97.71 seconds (p=0.04) in the 1st and the 2nd groups, respectively. The duration of torsional ultrasound was 84.72±50.03 seconds in 1st group (p=0.04) and 113.3±97.71 seconds in the 2nd group (p=0.04). Aspiration time was 208.3±95.86 seconds in the 1st group (p=0.04) and 258.43±158.81 seconds in the 2nd group (p=0.04). On the 3-4th day after the surgery, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were significantly better in the 1st group - 0.62±0.21 (LogMAR 0.20±0.19) and 0.53±0.15 (LogMAR 0.30±0.21) (p=0.01), respectively, compared to the 2nd group with UDVA of 0.75±0.18 (LogMAR 0.10±0.16) and CDVA of 0.69±0.19 (LogMAR 0.20±0.15) (p=0.04). Central corneal thickness (CCT) was 573.41±33.12 and 632.43±58.30 μm in the 1st and 2nd groups, respectively (p=0.020). At 1 month post-op there were no statistically significant differences in UDVA (p=0.17), CDVA (p=0.40) or CCT (p=0.50) between the groups. Compared with CPCS, total ultrasound time (p=0.04), torsional ultrasound time (p=0.04) and aspiration time (p=0.04) were significantly lower in the FLACS group. CCT was significantly lower (p=0.02), while UDVA (p=0.04) and CDVA (p=0.01) were significantly higher in the FLACS group in the early post-operative period (3-4 days after surgery). There were no statistically significant differences in the parameters between the groups 1 month after the surgery.