Short-term Clinical Outcomes of Femtosecond Laser-assisted Cataract Surgery: Comparison with Conventional Phacoemulsification

Jae Hwan Choi; Chan Min Yang; Na Yeon Chung; Dong Hui Lim; Tae-Young Chung

doi:10.3341/jkos.2018.59.5.419

Journal List > J Korean Ophthalmol Soc > v.59(5) > 1010898

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Yang, Chung, Lim, and Chung: Short-term Clinical Outcomes of Femtosecond Laser-assisted Cataract Surgery: Comparison with Conventional Phacoemulsification

Original Article

Journal of the Korean Ophthalmological Society 2018; 59(5): 419-427.

Published online: 17 May 2018

DOI: https://doi.org/10.3341/jkos.2018.59.5.419

Short-term Clinical Outcomes of Femtosecond Laser-assisted Cataract Surgery: Comparison with Conventional Phacoemulsification

Jae Hwan Choi, MD, Chan Min Yang, MD, Na Yeon Chung, MD, Dong Hui Lim, MD, Tae-Young Chung, MD, PhD

Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint requests to Tae-Young Chung, MD, PhD. Department of Ophthalmology, Samsung Medical Center, #81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea. Tel: 82-2-3410-3548, Fax: 82-2-3410-0074, tychung@skku.edu

Received 21 September 2017 Revised 1 February 2018 Accepted 19 April 2018

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the short-term clinical outcome of femtosecond laser-assisted cataract surgery at the initial phase and to compare it with results from conventional phacoemulsification.

Methods

This retrospective study was performed on 50 eyes who underwent femtosecond laser-assisted cataract surgery and 50 eyes who underwent conventional phacoemulsification. The short-term outcomes included uncorrected and corrected distance visual acuity and spherical equivalent. The complications of femtosecond laser-assisted cataract surgery were evaluated, and the prevalences of complications between the initial 25 eyes and latter 25 eyes of the cases were compared to evaluate the importance of the learning curve.

Results

There were no significant differences in uncorrected (p = 0.78) and corrected (p = 0.89) distance visual acuity between groups 1 month postoperatively. There was no difference in spherical equivalent (p = 0.09). The phacoemulsification time was not different between groups (p = 0.15). However, there was a significant decrease in cumulative dissipated energy in the femtosecond laser-assisted cataract surgery group (p = 0.04). There were complications during femtosecond laser-assisted cataract surgery, such as subconjunctival hemorrhage, miosis, early entry corneal incision, and incomplete corneal incision. The prevalence of complications in the latter 25 eyes was less than that of the first 25 eyes treated with femtosecond laser-assisted cataract surgery; the prevalence of subconjunctival hemorrhage was reduced significantly (p = 0.02).

Conclusions

The short-term clinical outcomes of the femtosecond laser-assisted cataract surgery group at the initial phase were not different, and in some cases, better than those of the conventional phacoemulsification group. A learning period is therefore required during the initial phase of femtosecond laser-assisted cataract surgery.

Keywords: Cataract surgery, Clinical outcomes, Femtosecond laser

Figures and Tables

Figure 1

The phacoemulsification time (PT) and cumulative dissipated energy (CDE) between femtosecond laser assisted cataract surgery (FLACS) group and conventional cataract surgery group. The CDE and PT of the FLACS group were significantly lower than those of the Conventional group (p = 0.04, 0.01, respectively). ^*Student t-test.

Figure 2

Intraoperative complications. (A) Subconjunctival hemorrhage occurred as ring-shaped, corresponded with the place suction take place. (B) Miosis occurred after femtosecond laser. (C) Irregular continuous curvilinear capsulorrhexis margin also observed. CDE = cumulative dissipated energy.

Table 1

Treatment parameters for femtosecond laser

Table 2

Preoperative characteristics of patients with FLACS, and conventional cataract surgery group

Values are presented as n (%) unless otherwise indicated.

FLACS = femtosecond laser assisted cataract surgery; SD = standard deviation; ASC = anterior subcapsular cataract; NS = nucleosclerosis; CC = cortical cataract; PSC = posterior subcapsular cataract; IOP = intraocular pressure.

^*Chi-square test; ^†Student t-test.

Table 3

Pre and postoperative visual outcomes, endothelial cell density in FLACS and conventional cataract surgery group

Values are presented as mean ± SD unless otherwise indicated.

FLACS = femtosecond laser assisted cataract surgery; UDVA = uncorrected distance visual acuity; CDVA = corrected distance visual acuity; D = diopter; ECD = endothelial cell density.

^*Student t-test.

Table 4

The comparison between first 25 eyes taken FLACS and later 25 eyes taken FLACS

Values are presented as mean ± SD or n (%) unless otherwise indicated.

FLACS = femtosecond laser assisted cataract surgery; CDE = cumulative dissipated energy; PT = phacoemulsification time; CCC = continuous curvilinear capsulorrhexis; PCR = posterior capsular rupture; NA = non-available.

^*Fisher's exact test; ^†Student t-test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

References

1. Fine IH. Architecture and construction of a self-sealing incision for cataract surgery. J Cataract Refract Surg. 1991; 17:Suppl. 672–676.

2. Alio JL, Soria F, Abdou AA. Femtosecond laser assisted cataract surgery followed by coaxial phacoemulsification or microincisional cataract surgery: differences and advantages. Curr Opin Ophthalmol. 2014; 25:81–88.

3. Friedman NJ, Palanker DV, Schuele G, et al. Femtosecond laser capsulotomy. J Cataract Refract Surg. 2011; 37:1189–1198.

4. Nagy ZZ, Takacs AI, Filkorn T, et al. Complications of femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2014; 40:20–28.

5. Chylack LT Jr, Wolfe JK, Singer DM, et al. The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group. Arch Ophthalmol. 1993; 111:831–836.

6. Bali SJ, Hodge C, Lawless M, et al. Early experience with the femtosecond laser for cataract surgery. Ophthalmology. 2012; 119:891–899.

7. Lee WS, Han SY, Lee KH. Comparison of laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification. J Korean Ophthalmol Soc. 2013; 54:1227–1235.

8. Mastropasqua L, Toto L, Mastropasqua A, et al. Femtosecond laser versus manual clear corneal incision in cataract surgery. J Refract Surg. 2014; 30:27–33.

9. Uy HS, Edwards K, Curtis N. Femtosecond phacoemulsification: the business and the medicine. Curr Opin Ophthalmol. 2012; 23:33–39.

10. Nagy Z, Takacs A, Filkorn T, Sarayba M. Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Refract Surg. 2009; 25:1053–1060.

11. Chang JS, Chen IN, Chan WM, et al. Initial evaluation of a femtosecond laser system in cataract surgery. J Cataract Refract Surg. 2014; 40:29–36.

12. Yesilirmak N, Diakonis VF, Sise A, et al. Differences in energy expenditure for conventional and femtosecond-assisted cataract surgery using 2 different phacoemulsification systems. J Cataract Refract Surg. 2017; 43:16–21.

13. Conrad-Hengerer I, Hengerer FH, Schultz T, Dick HB. Effect of femtosecond laser fragmentation of the nucleus with different softening grid sizes on effective phaco time in cataract surgery. J Cataract Refract Surg. 2012; 38:1888–1894.

14. Abell RG, Darian-Smith E, Kan JB, et al. Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 cases at a single center. J Cataract Refract Surg. 2015; 41:47–52.

15. Walkow T, Anders N, Klebe S. Endothelial cell loss after phacoemulsification: relation to preoperative and intraoperative parameters. J Cataract Refract Surg. 2000; 26:727–732.

16. Chen X, Xiao W, Ye S, et al. Efficacy and safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: a meta-analysis of randomized controlled trials. Sci Rep. 2015; 5:13123.

17. Schultz T, Joachim SC, Kuehn M, Dick HB. Changes in prostaglandin levels in patients undergoing femtosecond laser-assisted cataract surgery. J Refract Surg. 2013; 29:742–747.

18. Jun JH, Hwang KY, Chang SD, Joo CK. Pupil-size alterations induced by photodisruption during femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2015; 41:278–285.

19. Grewal DS, Dalal RR, Jun S, et al. Impact of the learning curve on intraoperative surgical time in femtosecond laser-assisted cataract surgery. J Refract Surg. 2016; 32:311–317.

TOOLS

Similar articles