Femtosecond Laser-assisted Phacoemulsification Research Articles

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.

Clinical efficacy of femtosecond laser-assisted phacoemulsification in diabetic cataract patients.

Diabetic patients with cataracts encounter specific difficulties during cataract surgery due to alterations in microcirculation, blood supply, metabolism, and the microenvironment. Traditional phacoemulsification may not fully tackle these issues, especially in instances with substantial preoperative astigmatism. The utilization of femtosecond laser-assisted phacoemulsification, in conjunction with Toric intraocular lens (IOL) implantation, offers a potentially more efficient strategy. This research seeks to evaluate the efficacy and possible complications of this approach in diabetic cataract patients. To investigate the clinical efficacy and complications of femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation in diabetic cataract patients, comparing it with traditional phacoemulsification methods. This retrospective study enrolled 120 patients with diabetes cataract from May 2019 to May 2021. The patients were divided into two groups: the control group underwent traditional phacoemulsification and Toric IOL implantation, while the treatment group received Len Sx femtosecond laser-assisted treatment. Outcome measures included naked eye vision, astigmatism, high-level ocular phase difference detection, clinical efficacy, and complication. There were no significant preoperative differences in astigmatism or naked eyesight between the two groups. However, postoperative improvements were observed in both groups, with the treatment group showing greater enhancements in naked eye vision and astigmatism six months after the procedure. High-level corneal phase difference tests also indicated significant differences in favor of the treatment group. This study suggests that femtosecond laser-assisted phacoemulsification combined with Toric IOL implantation appears to be more effective in enhancing postoperative vision in diabetic cataract patients compared to traditional methods offering valuable insights for clinical practice.

Symmetrical femtosecond laser arc incision in correcting corneal astigmatism in cataract patients.

To evaluate the effect of symmetrical arc incision correcting corneal astigmatism in femtosecond laser-assisted phacoemulsification (FLACS). This study enrolled patients with cataract combined with regular corneal astigmatism of >0.75 D, who underwent FLACS. Symmetrical arc incision was set at 8 mm diameter and 85% depth. The follow-up time was 3-24mo (4.92±3.49mo). Pentacam recorded the corneal astigmatism and higher-order aberration at pre-operation and post-operation. The changes in corneal astigmatism were analyzed by Alpins method. The correlation of astigmatism type, age, corneal horizontal diameter, corneal thickness, arc incision length, and correction index (CI) was analyzed, and the residual corneal astigmatism was compared with the residual whole eye astigmatism. Totally 79 patients (102 eyes) were enrolled, 10 patients had corneal epithelial injury, 1 patient occurred corneal epithelial hyperplasia. The corneal astigmatism was 1.23±0.38 D pre-operation, and decreased to 0.76±0.39 D post-operation (t=10.146, P=0.000). Corneal high-order aberration was 0.17±0.08 µm pre-operation and 0.24±0.11 µm post-operation (t=-5.186, P=0.000). The residual corneal astigmatism and residual whole eye astigmatism were no significant difference (t=-0.347, P=0.729). Using Alpin's method, the following were determined: target-induced astigmatism (TIA) =1.23±0.38 D, surgery-induced astigmatism (SIA) =0.77±0.45 D, difference vector (DV)=0.77±0.39 D, and CI=0.54±0.28. Age, astigmatism size, corneal horizontal diameter, corneal thickness, and arc incision length were not correlated with CI. The CI for against the rule astigmatism (ATR) was better than that for with the rule astigmatism (WTR; P=0.001). Femtosecond laser-assisted astigmatic keratotomy has better CI of ATR, but increase higher-order corneal aberration. CI is not ideal, it's not a perfect choice if we pursue ideal correction effect.

Hybrid (femtolaser) phacoemulsification: technical aspects and functional results

This article summarizes scientific and practical results of hybrid femtosecond laser-assisted phacoemulsification (HFE) including study of clinical and technical aspects of the intervention and evaluation of post-surgical functional state of the eye on the basis of clinical, morphological and biomechanical data. The HFE technology should be considered the method of choice for microinvasive phaco surgery, its main advantage being the possibility of controlled handling of such important surgical stages as anterior circular continuous capsulorhexis and nucleus fragmentation on a closed eyeball, which significantly reduces the risk of complications and decreases of effective ultrasound time.

Clinical evaluation of femtosecond laser-assisted phacoemulsification in the treatment of cataract with shallow anterior chamber

Clinical evaluation of femtosecond laser-assisted phacoemulsification in the treatment of cataract with shallow anterior chamber

Concentric rings after femtosecond laser-assisted phacoemulsification with Descemet's membrane endothelial keratoplasty

Concentric rings after femtosecond laser-assisted phacoemulsification with Descemet's membrane endothelial keratoplasty

Comparison of cumulative dispersed energy between conventional phacoemulsification and femtosecond laser-assisted cataract surgery with two different lens fragmentation patterns

The purpose of the study is to compare the total ultrasound power used between eyes undergoing different lens fragmentation patterns of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS). A total of 506 patient eyes underwent preoperative grading of lens opacity using the Lens Opacity Classification System III (LOCSIII). The eyes were divided into two subgroups: subgroup 1 had a LOCSIII grade of 1–3, and subgroup 2 had a LOCSIII grade of 4–6. The eyes underwent FLACS (LenSx) for clear corneal wound, capsulotomy, and lens fragmentation. Either a grid pattern or radial pattern was used for lens fragmentation. The eyes received one of the following three treatments: (1) CPS without femtosecond laser assistant, (2) FLACS with a grid pattern (FGP) lens fragment, or (3) FLACS with a quadrant pattern (FQP) lens fragment. The mean cumulative dispersed energy (CDE) for each subgroup and treatment was evaluated. The mean CDE was lower in the two FLACS groups (1.21±1.91 in FGP and 1.22±1.92 in FQP) than that in the CPG group (2.67±2.84). In subgroup 1, CDE was higher in the CPG group (1.54±1.18) as compared with the FLACS groups (0.16±0.31 in FGP and 0.74±1.17 in FQP; P<0.001). In subgroup 2, CDE was higher in the CPG (6.47±3.46) as compared with the FLACS groups (2.74±2.21 in FGP and 5.34±2.17 in FQP; P<0.001). CDE was lower in the two FLACS groups than that in the CPS group, and CDE was the lowest with FGP in both subgroups 1 and 2.

Femtosecond Laser-assisted Lens Surgery with Low-energy Pulse versus Conventional Phacoemulsification for Presbyopia Correction: An Intraindividual Study

Background: Lens surgery with multifocal IOL implantation for presbyopia correction is performed by femtosecond laser-assisted lens surgery or conventional phacoemulsification. Objective: To compare the clinical results of femtosecond laser-assisted with low-energy pulse conventional phacoemulsification lens surgery for presbyopia correction intraindividually. Methods: Charts from patients who underwent Refractive Lens Exchange (RLE) for presbyopia correction in a single center, with Femtosecond Laser-Assisted Lens Surgery (FLALS) in one eye and Conventional Phacoemulsification (CP) in the other, were retrospectively reviewed. All eyes had the same multifocal Intraocular Lens (IOL) implanted. The clinical outcomes and the results of the level of satisfaction questionnaire were compared between the two groups according to the technique employed (FLALS vs. CP) for a period of up to four years. Stability, efficacy and safety indices were also assessed. Results: This study comprised a total of 56 eyes of 28 patients randomly assigned FLALS in one eye and CP in the other. No statistically significant difference was observed between the two techniques regarding postoperative visual acuities, duration of surgical procedure, efficacy or safety indexes (p&gt;0.05). Refraction was stable in all FLALS eyes, whereas a change occurred in 2 eyes (7.1%) operated with CP upon 6 months postoperatively, but without statistical significance (p˃0.05). Satisfaction was slightly better with FLALS but not statistically significant (p=0.134). No immediate myosis or other adverse events after the femtosecond laser were registered. Conclusion: The parameters assessed showed no significant differences between the two techniques, in spite of a difference of refraction stability upon 6 months postoperatively.

Evaluation of Astigmatic Correction Using Vector Analysis after Combined Femtosecond Laser-Assisted Phacoemulsification and Intrastromal Arcuate Keratotomy.

The aim of this study was to evaluate astigmatic correction in patients with mild to moderate astigmatism after combined femtosecond laser-assisted cataract surgery (FLACS) and intrastromal arcuate keratotomy (ISAK), using vector analysis. This retrospective study included patients with corneal astigmatism of 0.5–3.0 diopters (D) who underwent FLACS and ISAK. Vector analyses of astigmatism were performed using the Alpins method, considering three vectors: target-induced astigmatism (TIA), surgically induced astigmatism (SIA), and difference vector (DV). Magnitude of error (ME), angle of error (AE), correction index (CI), and coefficient of adjustment (CA) were calculated. Subgroup analysis according to the axis of astigmatism, patient age, and white to white (WTW) diameter was conducted. In total, for the 79 eyes of 79 patients, the TIA was 1.21 ± 0.52 D, the SIA was 0.76 ± 0.53 D, and the DV was 0.86 ± 0.50 D. The ME (difference between SIA and TIA) was −0.46 ± 0.45 D, and the CI (ratio of SIA and TIA) was 0.62 ± 0.34; both these parameters demonstrated slight undercorrection. The CA (inverse of the CI) was 2.48 ± 2.61. The AE was 4.02° ± 28.7°, and the absolute AE was 21.7° ± 19.0°. In the univariate regression analyses to identify factors that affected the CI, there was a negative correlation between age and the CI (P=0.022). In conclusion, vector analysis after the combined FLACS and ISAK revealed slight undercorrection, regardless of the astigmatism meridian. The precision of the nomogram should be improved through long-term vector analysis for the results of arcuate keratotomy and through further research on the relationship between patient demographics and CI. Overall, this study has shown that FLACS and ISAK could reduce postoperative corneal astigmatism effectively and safely.

Femtosecond laser-assisted phacoemulsification of hypermature cataract in patients with lens subluxation

To develop a technique for femtosecond laser-assisted phacoemulsification of hypermature cataract in patients with degree I-II lens subluxation. Phacoemulsification of hypermature cataract with comorbid lens subluxation was performed in 78 patients (78 eyes) divided into two groups. In the 1st group (45 eyes), capsulorhexis was performed using a femtosecond laser. Patients of the 2nd group (33 eyes) underwent manual capsulorhexis. The study assessed the possible frequency of using modern methods of capsular bag fixation and complete all-in-the-bag intraocular lens (IOL) implantation, as well as the number of various types of intraoperative capsular bag ruptures. In all patients of the 1st group, capsulorhexis of the correct round shape and the required diameter was achieved, allowing the use of modern methods of fixation and centering of the capsular bag. Insignificant tear of the edge of the capsulorhexis after IOL implantation was detected only in 1 (2.2%) patient. Vitreous prolapse was noted in 1 (2.2%) case. In the 2nd group, manual technique resulted in oval capsulorhexis with a smooth edge, allowing the use of modern methods of fixation of the capsular bag only in 7 (21.2%) cases. Vitreous prolapse was noted in 4 (12.1%) cases. The complete in-the-bag IOL implantation was possible in 44 (97.8%) cases in the 1st group and only in 7 (21.2%) in the 2nd group. The use of femtosecond laser in patients with hypermature cataract and lens subluxation allows achieving capsulorhexis of ideally round shape with a smooth edge. This creates the necessary conditions for the use of modern methods of fixation of the capsular bag and provides the possibility of complete all-in-the-bag IOL implantation.

Improved Femtosecond Laser-Assisted Phacoemulsification of Hard Nucleus Cataract

Purpose: The development and clinical study of improved femtosecond laser-assisted phacoemulsification (PE) technology of hard nucleus cataract.Patients and methods. Improved femtosecond laser-assisted PE of hard nucleus cataract performed in 83 patients (93 eyes) (1st group), known femtosecond laser-assisted PE technique performed in 72 patients (78 eyes) (2nd group), torsional PE performed in 81 patients (89 eyes) (3rd group). The degree of intraoperative myosis, effective ultrasound time, corneal endothelial cell loss were evaluated in all groups.Results. Femtosecond laser-assisted PE is an effective technique for hard nucleus cataract removal, which can significantly reduce the energy ultrasonic load on the eye tissue. The proposed method for the instillation of prostaglandin synthesis inhibitors and the observance of the minimum possible interval between the first and second stages of the operation can prevent significant intraoperative narrowing of the pupil. A significant narrowing of the pupil by more than 2 mm after the femtolaser stage was noted in 7 (7.5 %) cases in the 1st group of patients, in 15 (16.9 %) cases in the 2nd group, in 5 (6.4 %) cases in the 3rd group. The results of the study has shown a significant decrease in the effective ultrasound time for a femtosecond laser-assisted PE compared with a torsional PE. The effective ultrasound time was in the 1st group (improved technology of femtosecond laser-assisted PE) — 3.81 ± 0.75, in the 2nd group (known technology of the femtosecond laser-assisted PE) — 5.23 ± 1.07 s (p &lt; 0.05), in the 3rd group (OZil technology) — 8.67 ± 1.83 s (p &lt; 0.05). The decrease in the effective ultrasound time has become a determining factor in reducing the loss of corneal endothelial cells in both femtosecond laser-assisted PE technologies compared to torsional PE. The average loss of corneal endothelial cells 3 months after surgery was 8.7 ± 1.8 % in the 1st group, 10.3 ± 2.1% in the 2nd group, 13.5 ± 2.7 % (p &lt; 0.05) in the 3rd group of patients.Conclusion. The proposed improved technology contributes to the solution of some problems that characterize femtosecond laser-assisted PE, and also helps to reduce the effective ultrasound time and the loss of corneal endothelial cells.

Результаты фемтолазерной факоэмульсификации с имплантацией мультифокальной ИОЛ

Результаты фемтолазерной факоэмульсификации с имплантацией мультифокальной ИОЛ

Современные возможности фемтолазерной факоэмульсификации перезрелой катаракты

Современные возможности фемтолазерной факоэмульсификации перезрелой катаракты

Comparison of Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification in Shallow Anterior Chambers and Glaucoma.

Purpose To compare femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification in shallow anterior chamber cataract patients with glaucoma or zonulysis. Methods This was a single-center retrospective review of cataract surgeries in shallow anterior chamber and glaucoma patients between January 2016 and December 2018 in which a LenSx femtosecond laser was used. The outcome measures included pre- and postoperative uncorrected and corrected distance visual acuity (UDVA and CDVA), intraocular pressure (IOP), endothelial cell density (ECD), endothelial cell loss (ECL), and object scatter index (OSI). Results One hundred and six eyes of 106 patients with a mean anterior chamber depth of 1.54 ± 0.51 mm were included in this study. Among them, 26 (23.2%) had zonulysis and 18 eyes had capsular tension ring implantation in general. The percentage of capsular tension ring implantation was statistically significantly lower in the FLACS group (P = 0.027). The UDVA, CDVA, ECD, and IOP were not statistically significant between the two groups at all time points. The postoperative ECL and OSI of the FLACS group was better than those of the conventional group (P < 0.01). Conclusions FLACS can reduce ECL and improve visual quality compared to the conventional phacoemulsification in shallow anterior chamber patients. Also, it has the trend of reducing the use of capsular tension rings in subluxated cataracts. It is an ideal choice for patients with complicated cataract such as with shallow anterior chambers, glaucoma, and zonulysis.

Femtosecond Laser-Assisted Facoemulsification of Hypermature Cataract

Aim. The development and clinical study of optimized femtosecond laser-assisted phacoemulsification (PE) technology of hypermature cataract. Patients and methods. Femtosecond laser-assisted PE of hypermature cataract was performed in 72 patients (72 eyes). The 1st group included 45 patients (45 eyes) who underwent a femtolaser capsulorexis with a pulse power of 6,700 nanojoules (optimized technique for femtosecond laser-assisted РE). The 2nd group included 27 patients (27 eyes) who underwent a femtolaser capsulorexis with a pulse power of 7000 nanojoules. Results. The use of a femtosecond laser to perform anterior capsulorexis in case of PE hypermature cataract is a technique that allows to obtain capsulorexis of an ideal round shape with high diameter accuracy, which is not possible with manual capsulorexis in patients with hypermature cataract. In the 2nd group, radial tear of the edge of capsulorhexis was noted in 2 (7.4 %) cases. In the postoperative period, in all cases in the 1st group, the periphery of the IOL optics was covered with a smooth edge of capsulorhexis of a regular round shape around the entire circumference. In the 2nd group, in 2 (7.4 %) cases, the exit of the edge of the IOL optics from under the edge of the capsulorexis was noted due to its radial tear with the shift of the IOL optics anteriorly, which can negatively affect the accuracy of the refractive result of IOL implantation. Visual acuity without correction and with maximum correction did not have significant differences in both groups and depended on the state of the neuroreceptor apparatus. The average loss of corneal endothelial cells in the 1st group was 5.7 ± 1.4 % and 8.7 ± 1.8 % in the 2nd group (p < 0.05). Conclusion. The use of a femtosecond laser to perform anterior capsulorhexis in PE of hypermature cataract is an effective surgical technique for the treatment of hypermature cataracts, which ensures a fully in-the-bag position of the IOL in the postoperative period . Optimization of the energy parameters of a femtosecond laser helps prevent capsulorexis edge tears in patients with hypermature cataract .

Energy load and state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification

To compare the intraoperative energy load and postoperative state of corneal endothelium in hybrid (femtosecond laser-assisted) and torsional phacoemulsification. The study analyzed surgical outcomes of 603 patients (714 eyes) divided into 3 groups: 225 patients (267 eyes) underwent modified femtosecond laser-assisted phacoemulsification (1st group), 237 patients (278 eyes) underwent standard femtosecond laser-assisted phacoemulsification (2nd group), and 141 patients (169 eyes) who underwent torsional phacoemulsification (3rd group). The follow-up period lasted up to 2 years. In patients with grade II lens density (here and further - L. Buratto classification is used), effective ultrasound time was 0.56±0.11 s in the 1st group, 0.83±0.17 s in the 2nd group, and 2.78 ± 0.51 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade III lens density effective ultrasound time was 2.04±0.37 s in the 1st group, 2.97±0.53 s in the 2nd group, and 4.59±0.91 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, effective ultrasound time was 3.95±0.81 s in the 1st group, 5.11±1.03 s in the 2nd group, and 8.37±1.73 s in the 3rd group (p(1-2)<0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade II lens density, loss of endothelial cells was 3.3±1.1% in the 1st group, 3.7±1.2% in the 2nd group, and 4.3±1.2% in the 3rd group (p(1-2)>0.05; p(1- 3)<0.05; p(2-3)<0.05). In patients with grade III lens density, loss of endothelial cells was 5.1±1.4% in the 1st group, 5.7±1.5% in the 2nd group, 7.2±1.7% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2-3)<0.05). In patients with grade IV lens density, loss of endothelial cells was 8.9±2.1% in the 1st group, 10.1±2.3% in the 2nd group, and 13.3±2.5% in the 3rd group (p(1-2)>0.05; p(1-3)<0.05; p(2- -3)<0.05). Both techniques of femtosecond laser-assisted phacoemulsification significantly reduce the effective ultrasound time (p<0.05) and the degree of corneal endothelial cells loss (p<0.05) compared with torsional phacoemulsification.

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.

Сравнительный анализ стабильности положения заднекамерных интраокулярных линз в послеоперационном периоде факоэмульсификации с фемтосекундным сопровождением при инволюционном подвывихе хрусталика первой степени

Сравнительный анализ стабильности положения заднекамерных интраокулярных линз в послеоперационном периоде факоэмульсификации с фемтосекундным сопровождением при инволюционном подвывихе хрусталика первой степени

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.