Manual Cataract Surgery Research Articles

Long-term impact of low-energy femtosecond laser and manual cataract surgery on macular layer thickness: A prospective randomized study.

To evaluate change in retinal layers 18 months after femtosecond laser-assisted cataract surgery (LCS) and manual cataract surgery (MCS) in a representative age-related cataract population using artificial intelligence (AI)-based automated retinal layer segmentation. This was a prospective, randomized and intraindividual-controlled study including 60 patients at the Medical University of Vienna, Austria. Bilateral same-day LCS and MCS were performed in a randomized sequence. To provide insight into the development of cystoid macular oedema (CME), retinal layer thickness was measured pre-operatively and up to 18 months post-operatively in the central 1 mm, 3 mm and 6 mm. Fifty-six patients completed all follow-up visits. LCS compared to MCS did not impact any of the investigated retinal layers at any follow-up visit (p > 0.05). For the central 1 mm, a significant increase in total retinal thickness (TRT) was seen after 1 week followed by an elevated plateau thereafter. For the 3 mm and 6 mm, TRT increased only after 3 weeks and 6 weeks and decreased again until 18 months. TRT remained significantly increased compared to pre-operative thickness (p < 0.001). Visual acuity remained unaffected by the macular thickening and no case of CME was observed. Inner nuclear layer (INL) and outer nuclear layer (ONL) were the main causative layers for the total TRT increase. Photoreceptors (PR) declined 1 week after surgery but regained pre-operative values 18 months after surgery. Low-energy femtosecond laser pre-treatment did not influence thickness of the retinal layers in any topographic zone compared to manual high fluidic phacoemulsification. TRT did not return to pre-operative values 18 months after surgery. The causative layers for subclinical development of CME were successfully identified.

Anterior chamber cytokine production and postoperative macular edema in patients with diabetes undergoing FLACS.

To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery (MCS) on proinflammatory cytokine expression in patients with diabetes vs nondiabetic patients. Outpatient surgical center in Vaughan, Ontario, Canada. Prospective cohort study. Patients with diabetes and nondiabetic patients undergoing noncomplicated MCS or FLACS were assigned into 4 cohorts: MCS nondiabetic (n = 30), FLACS nondiabetic (n = 42), MCS diabetic (n = 40), and FLACS diabetic (n = 40). Aqueous humor inflammatory mediator concentrations were evaluated at MCS onset and after femtosecond laser treatment. The presence of cystoid macular edema, anterior chamber (AC) inflammation, central retinal thickness, macular volume, and retinal microvascular changes (through optical coherence tomography angiography) were evaluated preoperatively and on postoperative day 1, week 1, month 1 (POM1), and month 3 (POM3). Patients with diabetes receiving FLACS had a higher concentration of interleukin (IL)-7, IL-13, and interferon-induced protein-10 than MCS diabetic patients; they also demonstrated higher levels of vascular endothelial growth factor and lower levels of interferon (IFN)-γ, granulocyte colony-stimulating factor, and IFN-α2 compared with MCS nondiabetic patients. Macular volume appeared to be significantly higher in MCS diabetic vs MCS non-diabetic patients at POM1 and between FLACS diabetic vs FLACS nondiabetic patients at POM3. There were no other significant differences between the cohorts for any parameter. FLACS use in patients with diabetes demonstrated some differences in AC cytokine expression compared with non-diabetic FLACS or diabetic patients undergoing MCS; however, there was no increase in clinical inflammatory biomarkers. FLACS seems to be a safe technique to use in patients with diabetes.

Corneal Edema after Cataract Surgery.

This systematic review investigates the prevalence and underlying causes of corneal edema following cataract surgery employing manual phacoemulsification. A comprehensive search encompassing databases such as PubMed, Embase, ProQuest, Cochrane Library, and Scopus was conducted, focusing on variables encompassing cataract surgery and corneal edema. Two independent reviewers systematically extracted pertinent data from 103 articles, consisting of 62 theoretical studies and 41 clinical trials. These studies delved into various aspects related to corneal edema after cataract surgery, including endothelial cell loss, pachymetry measurements, visual performance, surgical techniques, supplies, medications, and assessments of endothelial and epithelial barriers. This review, encompassing an extensive analysis of 3060 records, revealed significant correlations between corneal edema and endothelial cell loss during phacoemulsification surgery. Factors such as patient age, cataract grade, and mechanical stress were identified as contributors to endothelial cell loss. Furthermore, pachymetry and optical coherence tomography emerged as valuable diagnostic tools for assessing corneal edema. In conclusion, this systematic review underscores the link between corneal edema and endothelial cell loss in manual phacoemulsification cataract surgery. It highlights the relevance of factors like patient demographics and diagnostic modalities. However, further research is essential to unravel the complexities of refractive changes and the underlying mechanisms.

CO227 An Updated Umbrella Review Comparing the Safety and Effectiveness of Femtosecond Laser-Assisted Cataract Surgery with Manual Cataract Surgery

Femtosecond laser-assisted cataract surgery (FLACS) automates several steps of manual cataract surgery (MCS) which may provide advantages in clinical effectiveness and safety outcomes. A narrative umbrella review of systematic reviews and meta-analyses (MAs) was conducted to summarize the totality of evidence available for such outcomes.

Comparison of pain perception in patients undergoing manual cataract surgery versus refractive laser-assisted cataract surgery

ObjectifsMesurer la perception de la douleur pendant la chirurgie manuelle de la cataracte comparativement à la chirurgie de la cataracte au laser femtoseconde (CCLF) de même que la perception de la douleur chez des patients qui font l'objet d'une anesthésie à 2 moments différents de la CCLF. Nous avons également évalué les facteurs liés à la perception de la douleur dans ces différents groupes. NatureÉtude comparative de cohorte prospective portant sur une démarche chirurgicale choisie par les patients. ParticipantsPatients devant subir une chirurgie de la cataracte bilatérale séquentielle retardée dans un centre de chirurgie ambulatoire en Ontario. MéthodesLes patients ont été répartis en 3 groupes : une cohorte devant subir une chirurgie manuelle de la cataracte (n = 30) et 2 cohortes devant subir une CCLF, dont l'une soumise à une neuroleptanalgésie tout juste avant le drapage opératoire en vue de la phacoémulsification (cohorte CCLF standard; n = 38) et l'autre, à une neuroleptanalgésie avant le recours au laser femtoseconde (cohorte CCLF hâtive; n = 35). Les paramètres de mesure comprenaient les scores de douleur sur une échelle visuelle analogique au jour postopératoire 0 et à la semaine postopératoire 1. Au nombre des paramètres secondaires, citons les scores d'anxiété, les scores de coopération de la part des patients selon le chirurgien ou l'anesthésiologiste, les variables oculaires et les signes vitaux peropératoires. RésultatsOn n'a pas noté de différence significative quant à la perception de la douleur au jour postopératoire 0 et à la semaine postopératoire 1 entre la cohorte chirurgie manuelle de la cataracte et la cohorte CCLF standard (p = 0,94 et p = 0,72, respectivement), ni entre la cohorte CCLF hâtive et la cohorte CCLF standard (p = 0,76 et p = 0,67, respectivement). Les scores de douleur des patients étaient plus élevés pendant l'intervention touchant le deuxième œil que pendant l'intervention touchant le premier œil. ConclusionsLe type de chirurgie de la cataracte de même que le moment où a lieu l'anesthésie dans le cas de la CCLF n'ont pas d'incidence sur la perception de la douleur en période postopératoire. L'intervention touchant le deuxième œil est associée à des scores de douleur plus élevés que l'intervention touchant le premier œil.

Comparative study of anatomical and functional recovery of eye along with patient satisfaction score after small-incision cataract surgery and phacoemulsification cataract surgery.

Functional recovery after cataract surgery depends on the anatomical recovery of the eye. This study compared the improvement in visual function parameters after uniocular manual small-incision cataract surgery (MSICS) and phacoemulsification cataract surgery. This study included 310 patients divided randomly into two groups: 155 who received MSICS (MSICS group) and 155 who underwent phacoemulsification (phaco group) for cataract treatment. Outcome measures assessed included vertical and horizontal keratometry reading. The mean corneal astigmatism tear function measured using Schirmer 1 test results were recorded preoperatively, and on postoperative day 1, day 7, and day 30. Optical coherence tomography (OCT) was done to record the average central macular thickness (μm) on day 7 and day 30. The mean corneal astigmatism and anterior chamber inflammation were more in the MSICS group than in the phaco group immediately postoperatively. However, no statistically significant difference was found between the groups with respect to corneal sensation, mean corneal astigmatism, tear film function, and visual outcomes on postoperative day 30. Uncorrected visual acuity was better in the phacoemulsification group than in the manual SICS group on postoperative day 1, day 7, and day 30 (P &lt; 0.001). Both phacoemulsification cataract surgery and manual small-incision sutureless cataract surgery (MSICS) are safe and effective for visual rehabilitation. Phacoemulsification is the preferred technique where resources are available with the advantages of less mean corneal astigmatism, less anterior chamber inflammation, and better uncorrected visual acuity (UCVA) in the immediate postoperative period.

Dry Eye Following Femtosecond Laser-Assisted Cataract Surgery: A Meta-Analysis.

This study investigates the dry eye effect after femtosecond laser-assisted cataract surgery (FLACS) and also compares the risk of postoperative dry eye between FLACS and manual cataract surgery (MCS). We searched various databases between 1 January 2000 and 15 October 2022 and included peer-reviewed clinical studies in our review. Dry eye parameters were extracted at baseline and postoperative day one, week one, one month, and three months. Parameters included were the ocular surface discomfort index (OSDI), tear secretion (tear meniscus height, Schirmer's test), microscopic ocular surface damage (fluorescein staining), and tear stability (first and average tear breakup time). Additionally, the differences of each parameter at each time point were compared between FLACS and MCS. In total, six studies of 611 eyes were included. On postoperative day one, increased, pooled standardised mean differences (SMDs) were noted in the OSDI, tear secretion, tear film instability, and microscopic damage. During postoperative week one, dry eye worsened. Fortunately, dry eye achieved resolution afterwards and nearly returned to the baseline level at postoperative three months. When the parameters were compared between FLACS and MCS, those of FLACS had higher severities, but most were not statistically significant. Dry eye impact was approximately the same in FLACS and MCS at postoperative three months.

The eye wash technique: A simple and effective technique for intraoperative ocular surface lavage

Objectives: The author proposes an extremely effective and practical method of ocular surface hydrating and cleaning during anterior segment surgery, the Eye Wash Technique (EWT), in substitution for the traditional methods employing a syringe and cannula for ocular irrigation. Materials and Methods: The EWT utilizes the intraocular irrigating solution (IS) used in the surgery. It is performed by employing the irrigating line of the phacoemulsification (phaco) machine or the irrigating fluid IV drip in case of manual cataract surgery. The eye irrigation is performed directly from the Luer end attachment of these irrigating lines, which is positioned above the inner cantus pointing to the globe’s nasal limbal region. With the phaco machine pedal in position 1 (irrigation only) or in panel continuous irrigation mode in case of phaco surgery, or by opening the roller clamp of the IV drip line in case of manual surgery, IS flow ensues and is directed to the eye from a nasal direction to provide a steady flow to wash the exposed eye surface as well as the lid margins and lid speculum. The irrigation is maintained for two to five seconds with side-to-side jiggling if needed, to ensure complete ocular surface coverage. Cornea hydration is achieved and any unwanted material on the ocular surface is washed out. Results: The EWT was easily incorporated into the surgical routine with no difficulty in adaptation to the technique or in its employment. The surgical time was not prolonged when employing the technique. The EWT effectively provided both corneal hydration and ocular surface cleaning every time it was used, with no need to resort to the traditional syringe and cannula irrigation method at any time. Conclusion: The EWT should be incorporated into the anterior segment surgical routine and performed at the beginning of surgery, before inserting the intraocular lens, and at the end of the surgery; also, at any time during surgery should the need arise, enhancing anterior segment surgical visualization and safety.

Efficacy and Safety of iStent Inject Implantation in Manual and Femtosecond Laser-assisted Cataract Surgery before Lens Extraction.

AimTo describe the efficacy and safety of iStent implantation prior to phacoemulsification in manual as well as femtosecond laser-assisted cataract surgery (FLACS), and highlight this approach as a reasonable, if not necessary, step to advance one's ability and confidence in the use of microinvasive glaucoma surgery (MIGS) technology in phakic patients.MethodsA retrospective consecutive case series of patients with open angle glaucoma or ocular hypertension who underwent iStent inject implantation followed by cataract surgery (manual or FLACS). All cases underwent postoperative video review and were assessed and classified for intraoperative lens injury and hyphaema. Postoperative data included intraocular pressure (IOP), medication usage and adverse events.ResultsSixty-three eyes (n = 40 manual, n = 23 FLACS) were analyzed. Preoperatively, the mean IOP was 19.2 ± 4.9 mm Hg on 1.4 ± 0.96 mean medications, with 100% of eyes treated with medication. Intraoperatively, no lens injury was identified, and no significant hyphaema that impeded surgery occurred. At 6 months postoperative, mean IOP was 14.2 ± 1.8 mm Hg (38% reduction: p < 0.001), and >90% of eyes had IOP ≤ 16 mm Hg. The mean number of medications reduced to 0.11 ± 0.3 (92% reduction: p < 0.001), with 89% of eyes medication free. Safety was excellent for both manual and FLACS, with two iStents implanted in all eyes, and no cases of significant hyphaema or lens injury.ConclusionEarly implantation is safe, maximizes corneal clarity and angle visualization, avoids the risk of non-implantation due to surgical complications, and has a high success rate in both manual cataract surgery and the setting of FLACS.Clinical significanceThe conventional recommended approach of iStent implantation following cataract extraction has been adopted by many, however, with the advent of stand-alone procedures and concern about potential lens injury, there is an opportunity to gain experience with minimal risk in patients undergoing MIGS procedures combined with cataract surgery by implanting iStents at the start of the procedure. There is currently little emphasis or data published in the literature on an early approach to implantation to guide surgeons.How to cite this articleManning DK, Haider A, Clement C, et al. Efficacy and Safety of iStent Inject Implantation in Manual and Femtosecond Laser-assisted Cataract Surgery before Lens Extraction. J Curr Glaucoma Pract 2022;16(2):105-110.

Surgically induced astigmatism following femtosecond laser-assisted cataract surgery compared with conventional phacoemulsification

ObjectiveIn the present study, we reviewed surgically induced astigmatism (SIA) in femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification in patients who have cataract.BackgroundTo assess SIA following clear corneal incisions created manually or with the Catalys femtosecond laser.Patients and methodsIn the present study, patients undergoing FLACS or manual cataract surgery between 2017 and 2019 from a single surgical center in Egypt were considered for inclusion. Postoperative corneal astigmatism values were compared with preoperative astigmatism indices to determine the SIA at 3 months postoperatively using the Alpins vector method.ResultsRefractive and topographic outcomes from 80 eyes of 40 patients (40 eyes in the manual group and 40 eyes in the FLACS group) were included. There was no significant difference in SIA (manual: 0.96 D and FLACS: 0.72 D) after 3 months postoperatively.ConclusionsThere was no significant difference in SIA between FLACS and manual cataract surgery after 3 months of surgery.

Ultrasound energy consumption and macular changes with manual and femtolaser-assisted high-fluidics cataract surgery: a prospective randomized comparison.

PurposeThe purpose of the study was to compare ultrasound (US) consumption and central macular thickness (CMT) and volume changes with manual and femtosecond laser (FSL)‐assisted cataract nucleus workup.MethodsSixty patients scheduled for immediate sequential bilateral surgery underwent a prospective randomized intraindividual comparison of nucleus sector fragmentation performed manually in one eye and with low‐energy FSL assistance in the partner eye, followed by high‐fluidics phacoaspiration with a maximum US power of 30%. Ultrasound (US) energy consumption and macular thickness and volume were compared as measured by intraoperative effective phacoemulsification time (EPT) and high‐resolution spectral domain optical coherence tomography pre‐ and 1 week, 3 weeks and 6 weeks postoperatively. Results are presented as means ± SD or medians [min; max].ResultsFifty‐two patients completed the full follow‐up. For the manual and FSL‐assisted groups, nuclear hardness was almost identical with a mean LOCS III grade of 2.44 ± 1.08 and 2.50 ± 1.00 (p = 0.371). Median EPT was 1.40 [0.2; 8.3] and 1.25 [0.2; 9.4] seconds. Median preoperative CMT was 276.50 [263.25; 289.75] µm and 276.00 [262.00; 290.00] µm. Median postoperative CMT was 278.00 [260.50; 288.00] versus 275.50 [264.00; 290.50] µm at 1 week, 279.50 [266.75; 292.25] versus 280.00 [266.50; 294.50] µm at 3 weeks and 280.50 [268.00, 293.75] versus 279.50 [264.75; 295.25] µm at 6 weeks. Differences in CMT and total macular volume between the groups were not statistically significant at any point in time.ConclusionFemtosecond laser (FSL) prefragmentation of the nucleus into six sectors did not reduce US energy consumption compared with manual splitting of the nucleus into four quadrants in this particular surgical setting. Sectorial FSL‐prechopping with the low‐energy FSL used had no additional impact on postoperative macular thickness and volume.

Evaluating newer generation intraocular lens calculation formulas in manual versus femtosecond laser-assisted cataract surgery.

To determine the refractive accuracy of the Haigis, Barrett Universal II (Barrett), and Hill-radial basis function 2.0 (Hill-RBF) intraocular lens (IOL) power calculations formulas in eyes undergoing manual cataract surgery (MCS) and refractive femtosecond laser-assisted cataract surgery (ReLACS). This was a REB-approved, retrospective interventional comparative case series of 158 eyes of 158 patients who had preoperative biometry completed using the IOL Master 700 and underwent implantation of a Tecnis IOL following uncomplicated cataract surgery using either MCS or ReLACS. Target spherical equivalence (SE) was predicted using the Haigis, Barrett, and Hill-RBF formulas. An older generation formula (Hoffer Q) was included in the analysis. Mean refractive error (ME) was calculated one month postoperatively. The lens factors of all formulas were retrospectively optimized to set the ME to 0 for each formula across all eyes. The median absolute errors (MedAE) and the proportion of eyes achieving an absolute error (AE) within 0.5 diopters (D) were compared between the two formulas among MCS and ReLACS eyes, respectively. Of the 158 eyes studied, 64 eyes underwent MCS and 94 eyes underwent ReLACS. Among MCS eyes, the MedAE did not differ between the formulas (P=0.59), however among ReLACS eyes, Barrett and Hill-RBF were more accurate (P=0.001). Barrett and Hill-RBF were both more likely to yield AE<0.5 D among both groups (P<0.001). The Barrett and Hill-RBF formula lead to greater refractive accuracy and likelihood of refractive success when compare to Haigis in eyes undergoing ReLACS.

PSU1 An Umbrella Review Comparing the Safety and Effectiveness of Femtosecond Laser-Assisted Cataract Surgery with Manual Cataract Surgery

Femtosecond laser-assisted cataract surgery (FLACS) automates corneal incision, capsulotomy, and lens fragmentation steps of manual cataract surgery (MCS) which may provide advantages in clinical effectiveness and safety outcomes. A narrative umbrella review of systematic reviews and meta-analyses (MAs) was conducted to summarize the totality of evidence available for clinical effectiveness and safety outcomes.

Comment on: Comparison of femtosecond laser-assisted cataract surgery and conventional cataract surgery: a meta-analysis and systematic review.

We read with interest the review of femtosecond laser–assisted cataract surgery (FLACS) and conventional cataract surgery (CCS) by Kolb et al.1 We feel that it is necessary to highlight the area about the reporting of posterior capsular complications. The article states that posterior capsule ruptures were reported in 0.42% of eyes with FLACS and 0.27% of eyes with CCS and a statistically significant difference was not found. A link to Supplemental Digital Content was then provided for those reading the article online.1 What is not evident to those reading the printed article with no access to the various links was that 75% of the posterior capsular complications occurred with the use of 2 of the 5 FLACS systems. Further subgroup analysis revealed that there was an unequal distribution of patients with 1 group reporting more than 60% of the patients who had posterior capsular complications. Readers of the printed copy would, therefore, accept the statement that there was no statistically significant difference in capsule rupture rates between FLACS and CCS as presented in the abstract. Those who accessed the article with links online would be directed to explore the evidence base and would rather accept the statement in the text that posterior capsule rupture seemed less with FLACS, which was of clinical importance even if statistical importance is missed. A recent prospective randomized trial showed a statistically significant decrease in posterior capsule rupture in patients undergoing FLACS.2 This is not unexpected because it has been suggested that most surgeons who convert from manual cataract surgery to FLACS are likely to note a decrease in their posterior capsule rupture rate.3,4 This study states that “visual and refractive results are the most important endpoints for patients' satisfaction.” The importance of this statement cannot be overemphasized. A ruptured posterior capsule predisposes to cystoid macular edema, retinal detachment, and secondary surgery. Patients now have a larger choice of intraocular lenses (IOLs), including multifocal IOLs and extended-depth-of-focus IOLs, the success of which depends on correct lens placement in the bag. A ruptured posterior capsule unable to support an IOL in the presence of a capsulorhexis either too large or too small to offer optic capture can lead to a very unsatisfied patient postoperatively. FLACS offers an anterior capsulotomy of precisely predetermined size, position, and circularity to cover the implanted IOL. This allows for anterior optic capture with haptics positioned in the ciliary sulcus if needed.5 The meta-analysis offers a review of trials published about the different outcomes between FLACS and CCS. It cannot be used as guidance in cases that have been excluded from the studies that would be uniquely suited for FLACS, such as those with intumescent cataracts or those with loose zonular fibers making capsulorhexis difficult. The achievement of a precise anterior capsulotomy, low rate of posterior capsular complications, and the decrease in ultrasound energy needed to remove a cataract should play a part in the decision whether to use FLACS, especially for surgeons who have a complication rate of more than 1%, in trainees, or when tackling difficult cases.

Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons

Abstract Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p &lt; 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

Cataract surgery in surgical camps: outcomes in a rural area of Cameroon.

To assess the complications and visual outcomes of cataract surgery during an outreach eye camp in Cameroon in which two foreign ophthalmologists operate alongside a local one. This is a retrospective and comparative cohort study. The patients were consecutively assigned to three groups depending on the ophthalmologist who performed the cataract surgeries. All eyes underwent manual sutureless incision cataract surgery with posterior chamber intraocular lens (PCIOL) implantation under peribulbar anesthesia. Postoperative visits were scheduled for the first day, first week and second month after the procedures. Intra- and postoperative complications, best-corrected visual acuity and also refractive errors were assessed. A total of 263 eyes underwent cataract extraction with PCIOL implantation. The percentage of eyes in which two or more lines of corrected distance visual acuity decreased were 2.4%, 2.7% and 0% for groups A, B and C, respectively. The percentage of eyes with good visual outcome (uncorrected distance visual acuity UDVA > 20/60) were, respectively, 82.09%, 81.43% and 80.82% for the three groups. Similar results were found between the three groups regarding complications. Ocular hypertension, transient corneal edema and hyphema were the incidences registered at the first postoperative control performed 24h after surgery. The most common complication observed 2months after surgery was posterior capsular opacity (2.6%). High-volume cataract surgery in low- and middle-income countries may have good visual outcomes and a low rate of complications when the procedures are performed by either foreign or local ophthalmologists. A program of high-volume cataract surgery carried out in a rural environment with few resources can give good visual outcomes in the hands of both foreign and local experienced ophthalmologists.

Manual Sutureless Cataract Surgery (MSCS) in Patients with Pseudo-Exfoliation

Purpose: To document the complications of Manual suture-less cataract surgery in eyes with pseudo-exfoliation.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Naseer memorial hospital, Dadyal, Azad Jammu Kashmir, from 4 July 2017 to 3 July 2019.&#x0D; Methods: One hundred and fifty patients with pseudo-exfoliation (PEX) and cataract were selected by convenient sampling. Patients with systemic diseases, history of trauma, intraocular pressure ≥15 mm Hg on Applanation tonometry and any other associated ocular disease for example retinal detachment or retinal disease, previous history of glaucoma or narrow/closed angle on Gonioscopy were excluded from the study. Dark brown cataracts were also excluded. Pseudo-exfoliation was diagnosed on slit lamp on the basis of presence of dandruff like material on the pupil and the anterior lens capsule. The patients underwent manual suture less cataract surgery under local anesthesia Intraoperative and post-operative complications were noted. first day postoperatively. The collected data and analyzed using statistical package for social sciences (SPSS) version 21 for analysis.&#x0D; Results: The study group consisted of 64% males and 36% females with mean age of 65 ± 15.32 years. The most common difficulty encountered was poor pupil dilatation in 37.3% cases followed by Zonular dehiscence in 7.3%. On the first post-operative day, the most common complication was intraocular lens decentration in 2.6% of the cases.&#x0D; Conclusion: Pupils of patients with pseudo-exfoliation dilate poorly and makes surgery difficult. With good pupillary dilatation, careful capsulorhexis and minimal stress on the zonules, MSCS can be safely performed in eyes with cataract and PEX.&#x0D; Key Words: Pseudo-exfoliation, Cataract, Pupil.

Comparison of real-world treatment outcomes of femtosecond laser-assisted cataract surgery and phacoemulsification cataract surgery: A retrospective, observational study from an outpatient clinic in France.

This study compared real-world safety and efficacy outcomes of cataract surgery performed with LenSx femtosecond laser-assisted cataract surgery or manual phacoemulsification cataract surgery procedures. A retrospective observational study used data from anonymised electronic medical records to compare mean cumulative dissipated energy, the proportion of eyes reaching emmetropia, mean change in best-corrected distance visual acuity and the proportion of eyes with post-surgical complications, including corneal oedema and posterior capsule opacification. Results were adjusted for multiple comparisons for primary and secondary objectives. Data from 811 phacoemulsification cataract surgery and 496 femtosecond laser-assisted cataract surgery procedures were analysed. Mean cumulative dissipated energy was significantly lower for femtosecond laser-assisted cataract surgery (6.5 percent-seconds) than for phacoemulsification cataract surgery (14.3 percent-seconds; p < 0.0001) procedures. More femtosecond laser-assisted cataract surgery (81.2%) procedures achieved emmetropia (⩽ 0.5 dioptre) than did phacoemulsification cataract surgery (73.5%) procedures, although this difference was not statistically significant. Mean change in best-corrected distance visual acuity and the proportion of eyes with corneal oedema, posterior capsule opacification or other complications were not significantly different between cohorts when adjusted for multiple comparisons. In this single-centre, single-surgeon retrospective electronic medical record database study using divide and conquer technique, femtosecond laser-assisted cataract surgery was associated with significantly lower cumulative dissipated energy when compared to manual phacoemulsification cataract surgery. This supports the hypothesis that femtosecond laser-assisted cataract surgery involves less mechanical trauma, which might lead to more consistent refractive and safety outcomes than manual phacoemulsification cataract surgery, though such outcomes were found to be comparable in this study.

PMD40 FEMTOSECOND LASER ASSISTED CATARACT SURGERY: A REVIEW OF ITS EFFICIENCY COMPARED TO MANUAL CATARACT SURGERY

Globally, cataract disease burden is growing due to ageing population and payers and providers are increasingly looking to improve cataract surgery efficiency to meet greater demand. The objective of this study was to review and report published evidence regarding comparative efficiency of femtosecond laser assisted cataract surgery (FLACS) and manual cataract surgery (MCS).

FEMTOSECOND LASER-ASSISTED CATARACT SURGERY IN EYES WITH WHITE MATURE CATARACT

Purpose: To compare the results of femtosecond laser-assisted cataract surgery with manual cataract surgery in eyes with white mature cataract. Material and Methods: Thirty-four eyes of 34 patients with white mature cataract who had undergone femtosecond laser-assisted cataract surgery (FLACS) were compared retrospectively with 34 eyes of 34 patients with white mature cataract who had undergone manual cataract surgery. Results: In respect to age and sex, there was no significant difference between two groups. There was no significant difference between the mean preoperative and postoperative uncorrected distance visual acuity (UCVA) and best corrected visual acuity (BCVA) of the first and second group (P values, 0.659, 0.634, 0.603 and 0.557, respectively). The percentages of radial tears, posterior capsule rupture and vitreous loss were higher in the second group than in the first group, but the differences were not significant statistically (p values, 0.06, 0.06 and 0.113, respectively). Conclusion: FLACS is a safe and effective surgery for white mature cataract. When compared with manual phacoemulsification surgery, although the percentages of some intraoperative complications such as radial tears and posterior capsule ruptures are higher in manual phacoemulsification surgery, the differences are not significant statistically.