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Li Z, Wang Y, Meng Z, Wang Y, Lou X, Zhu Z, Jin J, Zhao YE. The Impact of Different Optical Zone Diameter on Corneal Astigmatism Correction Using Femtosecond Laser Corneal Relaxing Incisions: 8 mm vs 9 mm. Curr Eye Res 2024:1-7. [PMID: 39364648 DOI: 10.1080/02713683.2024.2408395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/27/2024] [Accepted: 09/20/2024] [Indexed: 10/05/2024]
Abstract
PURPOSE To compare the impact of 8 mm versus 9 mm optical zone (OZ) diameters on corneal astigmatism correction and to evaluate the impact of incision depth percentage after femtosecond laser corneal relaxing incisions (CRIs) combined with cataract surgery. METHODS Thirty-nine eyes from 39 patients were enrolled and randomly assigned to two groups based on the OZ diameter: 8 mm and 9 mm. Corneal astigmatism and CRI depth were measured using Pentacam and anterior segment optical coherence tomography. Vector analysis was performed using Alpins method. RESULTS In the 8 mm group, postoperative corneal astigmatism was reduced by 0.77 ± 0.61 diopters (D), significantly greater than the reduction of 0.42 ± 0.40 D in the 9 mm group (p < 0.05). The 8 mm group exhibited greater surgically induced astigmatism (SIA), net corneal changes, and a smaller angle of error (AE) (p < 0.05). At 3 months postsurgery, the correction index (CI) values were 0.84 ± 0.39 for the 8 mm group, exceeding the 0.52 ± 0.32 observed in the 9 mm group (p < 0.05). The mean incision depth percentage was significantly higher in the 9 mm group (79.30 ± 10.76%) compared to the 8 mm group (72.58 ± 8.73%) (p < 0.05). In the 8 mm group, CI values closer to 1.00 were associated with lower percentages of incision depth. CONCLUSIONS CRIs with an 8 mm OZ diameter demonstrated superior efficacy in correcting corneal astigmatism with shallower incision depths compared to those with a 9 mm diameter.
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Affiliation(s)
- Zhangliang Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
| | - Yiyi Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
| | - Ziqi Meng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
| | - Yalan Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
| | - Xicong Lou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
| | - Zehui Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
| | - Jing Jin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
| | - Yun-E Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Zhejiang, China
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Ding X, Zhang F, Li S. Modified femtosecond laser-assisted arcuate keratotomy for managing low corneal astigmatism using trifocal intraocular lens implantation in Chinese cataract patients. Lasers Med Sci 2024; 39:178. [PMID: 38990392 DOI: 10.1007/s10103-024-04131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
To evaluate the visual outcome and astigmatic correction following trifocal intraocular lens (IOL) implantation using the modified femtosecond laser-assisted arcuate keratotomy (FSAK) in Chinese cataract patients with low astigmatism. This retrospective study included consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 1.5 D who underwent FSAK combined with the trifocal IOL implantation between November 2020 and September 2022. Monocular uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, and refractive data were collected at the 3-month follow-up. The pre- and post-operative high-order aberrations (HOAs) were recorded. The variation in astigmatism was analyzed using Alpins vector analysis. A total of 27 eyes from 23 patients were analyzed. The monocular uncorrected distance visual acuity (UDVA) (5 m) at the 3-month follow-up was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR), which was significantly improved compared with the preoperative value of 0.95 ± 0.51 logMAR (P <.001). The corneal astigmatism was significantly reduced from 1.24 ± 0.42 D to 0.49 ± 0.34 D (P <.001). The target-induced astigmatism (TIA) was 1.25 ± 0.43 D, the surgically induced astigmatism (SIA) was 1.16 ± 0.52 D, and the difference vector (DV) was 0.5 ± 0.34 D. The magnitude of error (ME) (difference between SIA and TIA) was -0.1 ± 0.41 D, and the correction index (CI) (ratio of SIA to TIA) was 0.93 ± 0.36. The angle of error was 3.92° ± 16.90°. Total HOA was reduced from 0.89 ± 1.11 to 0.41 ± 0.55 (P = 0.184), and the corneal HOA was lowered from 0.17 ± 0.18 to 0.10 ± 0.10 (P = 0.129). Implantation of trifocal IOL following the modified FSAK in Chinese cataract patients exhibited excellent visual efficacy and effectively reduced corneal astigmatism.
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Affiliation(s)
- Xue Ding
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China
| | - Fan Zhang
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China
| | - Shaowei Li
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China.
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China.
- Institute of Corneatology in Aier Eye Hospital, Beijing, 100021, China.
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Zhou J, Li S, He G, Wang W. Predicting the impact of femtosecond-assisted arcuate keratotomy combined with tri-planar clear corneal incisions on astigmatism in implantable collamer lens surgery: one-year follow-up. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06547-1. [PMID: 38896281 DOI: 10.1007/s00417-024-06547-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE To investigate the factors associated with and impact on the femtosecond-assisted (FS-assisted) limbal relaxing incision (LRI) combined with the steep-meridian tri-planar clear corneal incision (TCCI) to reduce astigmatism in patients undergoing Implantable Collamer Lens (ICL) surgery. METHODS Retrospective case series. The study reviewed patients with ICL surgery combined with FS-assisted LRIs paired with steep-meridian TCCIs. Correlation analysis examined the relationship between independent variables, including preoperative characteristics (intraocular pressure, corneal thickness, axial length, et al.), TCCI, and LRI surgical parameters. The predictors of surgically induced astigmatism (SIA) were determined using individual-level analysis and accounting for inter-eye correlation with the generalized estimating equation (GEE). RESULTS The study enrolled 69 patients, with 114 eyes (55 right and 59 left). The mean spherical equivalent (SEQ) was - 10.29 ± 2.99D and - 9.99 ± 2.72D for the right and left eye, respectively, while the mean preoperative corneal astigmatism was - 1.54 ± 0.47D and - 1.54 ± 0.46D for the right and left eyes, respectively. After 12 months of follow-up, univariate analysis revealed significant correlations between SIA and intraocular pressure (IOP), astigmatism type, TCCI position (degree), peripheral corneal thickness (PCT), LRI arc incision diameter, post depth (%), and angle, respectively (P = 0.046, 0.016, 0.039, 0.040, 0.009, 0.000, 0.000). Multivariate analysis using GEE demonstrated that axial length (AL), astigmatism type, LRI arc diameter, and angle were independent predictors of SIA (P = 0.000, 0.005, 0.029, 0.000). CONCLUSIONS The type of astigmatism and axial length were independent factors that affected SIA when modifying the LRI arc diameter and angle through FS-assisted steep-meridian TCCI paired with LRI in ICL surgery.
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Affiliation(s)
- Jihong Zhou
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China.
- Beijing Ophthalmology and Science Key Lab, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
- Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No. 1 Dongjiaomin Xiang, Dongcheng District, Beijing, 100730, China.
| | - Shaowei Li
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Guoli He
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China
| | - Wenjuan Wang
- Beijing Aier Intech Eye Hospital, Panjiayuan Plaza, #12 Panjiayuan Nanli, Chaoyang District, Beijing, China
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Chen DZ, Chee SP. Femtosecond laser-assisted cataract surgery for complex cataracts - A review. Indian J Ophthalmol 2024; 72:629-636. [PMID: 38648431 PMCID: PMC11168539 DOI: 10.4103/ijo.ijo_2996_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 04/25/2024] Open
Abstract
Since its inception in 2009, femtosecond laser-assisted cataract surgery (FLACS) has become an alternative to conventional phacoemulsification cataract surgery (CPCS). Clinical studies were unable to demonstrate superior visual outcomes, but revealed reduced endothelial cell loss. More recently, the cost-effectiveness of FLACS over CPCS in routine cataract surgeries has been challenged. However, the unique abilities of FLACS to customize anterior capsulotomies precisely, soften and fragment the nucleus without capsular bag stress, and create corneal incisions may have special utility in complex cataract and less-common scenarios. In this article, we review the unique role of FLACS in complex cataract surgeries and how it could play a role to improve the safety and predictability of nonroutine cataract surgery.
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Affiliation(s)
- David Z Chen
- Department of Ophthalmology, National University Hospital, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Soon-Phaik Chee
- Department of Ophthalmology, National University Hospital, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Ocular Inflammation and Immunology, Singapore National Eye Centre, Singapore
- Department of Cataract, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
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Zheng J, He L, Zhong J. Effect of femtosecond laser-assisted arcuate keratotomy versus toric intraocular lens implantation on correction of astigmatism in cataract surgery: a systematic review and meta-analysis. Lasers Med Sci 2023; 38:225. [PMID: 37773468 DOI: 10.1007/s10103-023-03893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To compare the efficacy of femtosecond laser-assisted arcuate keratotomy (FSAK) combined with non-toric intraocular lens (IOL) implantation versus Toric IOL (TIOL) implantation in correcting corneal astigmatism in cataract patients. METHODS Relevant literature was searched in databases including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and SinoMed. Data from the included studies were extracted. A meta-analysis was conducted to compare the correction performance of FSAK combined with non-toric IOL implantation and TIOL implantation using postoperative refractive astigmatism, correction index, and uncorrected distance visual acuity (UDVA) outcomes. Publication bias assessment and sensitivity analysis were also performed. RESULTS Five comparative studies were ultimately included in the meta-analysis. The TIOL group had smaller postoperative refractive astigmatism and a greater correction index compared to the FSAK group. The mean differences in postoperative refractive astigmatism and correction index between the two groups were - 0.19D (95% CI = 0.12 to 0.26, P < 0.01, I2 = 7%) and - 0.09 (95% CI = - 0.18 to 0.00, P = 0.04, I2 = 0%), respectively. We found no statistically significant difference in UDVA between the two groups (95% CI = - 0.01 to 0.11, P = 0.09, I2 = 70%). CONCLUSIONS FSAK combined with non-toric IOL implantation was found to be less effective than TIOL implantation in correcting preoperative corneal astigmatism in cataract patients. The difference in the effectiveness of astigmatism correction between the two surgical methods seems to diminish, as the degree of preoperative corneal astigmatism decreases.
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Affiliation(s)
- Jiang Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Lun He
- Department of Ophthalmology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510260, China
| | - Jingxiang Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.
- The Sixth Affiliated Hospital of Jinan University, Jinan University, Dongguan, 523129, China.
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Lee YW, Cho KS, Hyon JY, Han SB. Application of Femtosecond Laser in Challenging Cataract Cases. Asia Pac J Ophthalmol (Phila) 2023; 12:477-485. [PMID: 37844256 DOI: 10.1097/apo.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 10/18/2023] Open
Abstract
Femtosecond laser can provide precise and customized incision of ocular tissue with excellent accuracy and predictability. Thus, femtosecond laser-assisted cataract surgery (FLACS) can theoretically enhance the safety and efficacy of cataract surgery by providing reproducible and reliable clear corneal incision, limbal relaxing incision, anterior capsulotomy, and lens fragmentation. However, thus far, the superiority of the anatomical and visual outcomes of FLACS over those of conventional cataract surgery have been unclear. Nevertheless, studies have indicated that FLACS can potentially be helpful in improving the safety of cataract surgery in challenging situations, such as zonular weakness, preexisting capsular tear, white cataract, shallow anterior chamber, and pediatric cataracts, which may contribute to enhanced visual and anatomical outcomes. In this review, we provide a summary of the application of femtosecond laser in general cataract cases. In addition, we introduce the application of FLACS in the abovementioned challenging situations and discuss the results of studies regarding the safety and outcome of FLACS in these challenging cases.
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Affiliation(s)
- Yong Woo Lee
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon Province, Korea
| | - Kyu Seong Cho
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon Province, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Province, Korea
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon Province, Korea
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Zhang Z, Cheng N, Liu Y, Song J, Liu X, Zhang S, Zhang G. Prediction of corneal astigmatism based on corneal tomography after femtosecond laser arcuate keratotomy using a pix2pix conditional generative adversarial network. Front Public Health 2022; 10:1012929. [PMID: 36187623 PMCID: PMC9523441 DOI: 10.3389/fpubh.2022.1012929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose This study aimed to develop a deep learning model to generate a postoperative corneal axial curvature map of femtosecond laser arcuate keratotomy (FLAK) based on corneal tomography using a pix2pix conditional generative adversarial network (pix2pix cGAN) for surgical planning. Methods A total of 451 eyes of 318 nonconsecutive patients were subjected to FLAK for corneal astigmatism correction during cataract surgery. Paired or single anterior penetrating FLAKs were performed at an 8.0-mm optical zone with a depth of 90% using a femtosecond laser (LenSx laser, Alcon Laboratories, Inc.). Corneal tomography images were acquired from Oculus Pentacam HR (Optikgeräte GmbH, Wetzlar, Germany) before and 3 months after the surgery. The raw data required for analysis consisted of the anterior corneal curvature for a range of ± 3.5 mm around the corneal apex in 0.1-mm steps, which the pseudo-color corneal curvature map synthesized was based on. The deep learning model used was a pix2pix conditional generative adversarial network. The prediction accuracy of synthetic postoperative corneal astigmatism in zones of different diameters centered on the corneal apex was assessed using vector analysis. The synthetic postoperative corneal axial curvature maps were compared with the real postoperative corneal axial curvature maps using the structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR). Results A total of 386 pairs of preoperative and postoperative corneal tomography data were included in the training set, whereas 65 preoperative data were retrospectively included in the test set. The correlation coefficient between synthetic and real postoperative astigmatism (difference vector) in the 3-mm zone was 0.89, and that between surgically induced astigmatism (SIA) was 0.93. The mean absolute errors of SIA for real and synthetic postoperative corneal axial curvature maps in the 1-, 3-, and 5-mm zone were 0.20 ± 0.25, 0.12 ± 0.17, and 0.09 ± 0.13 diopters, respectively. The average SSIM and PSNR of the 3-mm zone were 0.86 ± 0.04 and 18.24 ± 5.78, respectively. Conclusion Our results showed that the application of pix2pix cGAN can synthesize plausible postoperative corneal tomography for FLAK, showing the possibility of using GAN to predict corneal tomography, with the potential of applying artificial intelligence to construct surgical planning models.
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Affiliation(s)
- Zhe Zhang
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China,Department of Cataract, Shanxi Eye Hospital, Taiyuan, China,First Hospital of Shanxi Medical University, Taiyuan, China
| | - Nan Cheng
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan, China
| | - Yunfang Liu
- Department of Ophthalmology, First Affiliated Hospital of Huzhou University, Huzhou, China
| | - Junyang Song
- Department of Ophthalmology, First Affiliated Hospital of Huzhou University, Huzhou, China,*Correspondence: Junyang Song
| | - Xinhua Liu
- Shenzhen Eye Hospital, Jinan University, Shenzhen Eye Institute, Shenzhen, China
| | - Suhua Zhang
- Department of Cataract, Shanxi Eye Hospital, Taiyuan, China,Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China,Suhua Zhang
| | - Guanghua Zhang
- Department of Intelligence and Automation, Taiyuan University, Taiyuan, China,Graphics and Imaging Laboratory, University of Girona, Girona, Spain,Guanghua Zhang
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Ahn H, Jun I, Seo KY, Kim EK, Kim TI. Femtosecond laser-assisted arcuate keratotomy for the management of corneal astigmatism in patients undergoing cataract surgery: Comparison with conventional cataract surgery. Front Med (Lausanne) 2022; 9:914504. [PMID: 36091670 PMCID: PMC9453263 DOI: 10.3389/fmed.2022.914504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the effects of femtosecond laser arcuate keratotomy with femtosecond laser-assisted cataract surgery in the management of corneal astigmatism, compared with conventional phacoemulsification cataract surgery. Design Retrospective comparative interventional case series. Methods A total of 2,498 eyes of consecutive patients who presented with 3.00 diopters (D) or under of astigmatism were included. The patients were treated with conventional phacoemulsification cataract surgery (conventional group) and femtosecond laser arcuate keratotomy with femtosecond laser-assisted cataract surgery (femtosecond group). Results Surgically induced astigmatism (SIA) was higher in the femtosecond group than the conventional group (0.215, p < 0.001). Difference vector (DV) was lower in the femtosecond group (-0.136, p < 0.001). The cut-off value of the overcorrection in the femtosecond group was 0.752 D of target induced astigmatism (TIA). For patients with TIA 0.75 D or under, DV and the value of index of success (TIA into DV) were significantly higher in the femtosecond group (p = 0.022 and < 0.001). The overcorrection ratios were 48.8% in the conventional and 58.9% in the femtosecond group. (p < 0.001). For patients with TIA over 0.75 D, SIA and correction index (TIA into SIA) was higher in femtosecond group (0.310 and 0.250, p < 0.001 and < 0.001, respectively). Absolute angle of error was 20.612 ± 18.497 in the femtosecond group and higher than the conventional group (2.778, p = 0.010). Conclusion Femtosecond laser arcuate keratotomy in cataract surgery was effective in SIA between 0.75 to 3.00 D of corneal astigmatism. However, the overcorrection in the lower astigmatism and angle of error in the higher astigmatism were due to the postoperative corneal astigmatism not decreasing as much as SIA. Overcoming these challenges will lead to better management of corneal astigmatism.
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Affiliation(s)
- Hyunmin Ahn
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ikhyun Jun
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eung Kweon Kim
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Saevit Eye Hospital, Goyang, South Korea
| | - Tae-im Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Tae-im Kim,
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González-Cruces T, Cano-Ortiz A, Sánchez-González MC, Sánchez-González JM. Cataract surgery astigmatism incisional management. Manual relaxing incision versus femtosecond laser-assisted arcuate keratotomy. A systematic review. Graefes Arch Clin Exp Ophthalmol 2022; 260:3437-3452. [PMID: 35713710 DOI: 10.1007/s00417-022-05728-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/16/2022] [Accepted: 05/17/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This systematic review aims to compare corneal astigmatism correction in cataract surgery through corneal relaxing incision, manually and femtosecond laser assisted. METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. We used PubMed, Scopus, and Web of Science (WOS) as databases from January 2010 to March 30, 2021. Patients with keratoconus, corneal ectasia, and a previous history of eye surgery were excluded because our aim was to analyze only healthy eyes. RESULTS A total of 1025 eyes were evaluated from 946 patients (mean age was 68.90 ± 5.12) in manual incision group articles, while 1905 eyes of 1483 patients (mean age was 65.05 ± 4.57) were evaluated in femtosecond laser arcuate keratotomy (FLAK) articles. The mean uncorrected distance visual acuity (UDVA) was 0.19 ± 0.12 and 0.15 ± 0.05 logMAR for manual incision and FLAK articles, respectively (p = 0.39). The mean correction index (CI) was similar in both groups: 0.77 ± 0.18 in manual incision and 0.79 ± 0.17 in femtosecond laser assisted incision (p = 0.70). Refractive stability was found after 3 months and no serious complications were reported during the follow-up in any group. CONCLUSION Both techniques are safe and moderately effective in corneal astigmatism correction in cataract surgery. FLAK represents a more precise and predictable approach. However, since visual and refractive outcomes appear to be similar in both cases, the cost-benefit analysis is controversial.
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Affiliation(s)
- Timoteo González-Cruces
- Department of Anterior Segment, Cornea and Refractive Surgery, Hospital La Arruzafa, Cordoba, Spain.,Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain
| | - Antonio Cano-Ortiz
- Department of Anterior Segment, Cornea and Refractive Surgery, Hospital La Arruzafa, Cordoba, Spain
| | - María Carmen Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes Street, Seville, Spain.
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Ahn H, Jun I, Seo KY, Kim EK, Kim TI. Femtosecond laser-assisted cataract surgery after corneal refractive surgery. Sci Rep 2022; 12:4263. [PMID: 35277568 PMCID: PMC8917192 DOI: 10.1038/s41598-022-08297-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Cataract is the leading cause of blindness worldwide, and advanced cataract techniques such as femtosecond laser-assisted cataract surgery (FLACS) have been commercially available. Corneal refractive surgery (CRS) is one of the most popular surgeries for the correction of refractive errors. CRS changes the cornea not only anatomically but also pathophysiologically. However, there has been no clinical research analyzing the refractive and safety outcomes of FLACS after CRS. The aim of this retrospective chart review and comparative study is to evaluate the effect and safety of FLACS after CRS comparing with conventional PCS. Participants with a previous CRS history who underwent FLACS or conventional PCS were included in this study. The visual outcomes and the refractive outcomes including refractive, corneal, and ocular residual astigmatism were compared. The safety outcomes were then studied intraoperatively and postoperatively. A total of 102 patients with age-related cataract were enrolled. At 3 months postoperatively, UCVA, BCVA, and predictive error were not significantly different between the FLACS and conventional PCS groups. Reduction of refractive astigmatism was higher in FLACS. Postoperative ORA was significant lower in FLACS. Reduction of ORA was higher in FLACS. The intraoperative and postoperative complications were also not significantly different between the two groups. FLACS could effectively change refractive astigmatism and ORA; without more complications than conventional PCS. FLACS’ competitive edge in postoperative ORA may provide better visual quality than conventional PCS in patients with a previous history of CRS.
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Affiliation(s)
- Hyunmin Ahn
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Ikhyun Jun
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.,Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea
| | - Eung Kweon Kim
- Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.,Saevit Eye Hospital, Goyang, Gyunggi-do, Korea
| | - Tae-Im Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. .,Department of Ophthalmology, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemungu, Seoul, 03722, Korea.
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Outcome of astigmatism correction using femtosecond laser combined with cataract surgery: penetrating vs intrastromal incisions. J Cataract Refract Surg 2022; 48:1063-1072. [PMID: 35171145 DOI: 10.1097/j.jcrs.0000000000000911] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the effectiveness of penetrating vs intrastromal femtosecond laser corneal relaxing incisions (CRI) in reducing corneal astigmatism during cataract surgery. SETTINGS Baylor College of Medicine and Mercy Clinic Eye Specialists. DESIGN Prospective randomized study. METHODS Subjects were randomly assigned to undergo paired penetrating (8-mm optical zone (OZ) at one center and 9-mm OZ at the other) or intrastromal CRIs (8-mm OZ at both centers). The lengths of the CRIs were based on published nomograms but modified to take into account posterior corneal astigmatism. Vector analysis was performed, and net corneal changes along the CRI meridian were calculated. Multiple regression analysis was performed to assess factors contributing to net corneal changes. RESULTS Preoperatively, 9-18% of eyes had corneal astigmatism of ≤ 0.5 D, and 76-93% of eyes had postoperative refractive astigmatism of ≤ 0.5 D (P<0.05). Both penetrating and intrastromal CRIs produced significant mean net corneal changes along the CRI meridian (-0.49 D to -1.21 D), and 71% - 84% of eyes had postoperative astigmatism vector prediction errors of ≤0.50 D. The 8-mm penetrating CRIs induced greater net corneal changes but more eyes with overcorrection than did the intrastromal and 9-mm penetrating CRIs (all P<0.05). Greater net corneal changes occurred with longer CRI length, higher preoperative corneal astigmatism magnitude, and preoperative against-the-rule corneal astigmatism. Nomograms based on anterior and total corneal astigmatism are proposed. CONCLUSIONS Both penetrating and intrastromal CRIs were effective in reducing corneal astigmatism during cataract surgery.
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Hernandez R, Almenara C, Soriano D, Idoipe M, Larrosa JM, Pablo LE, Garcia-Martin E. Toric intraocular lens implantation vs. femtosecond laser-assisted arcuate keratotomy for correction of moderate astigmatism in cataract surgery. J Cataract Refract Surg 2021; 48:887-893. [PMID: 34935711 DOI: 10.1097/j.jcrs.0000000000000879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare toric intraocular lens (TIOL) implantation and femtosecond laser-assisted arcuate keratotomy (FSAK) during phacoemulsification surgery in correction of moderate astigmatism. SETTING Clinical research study. DESIGN Prospective randomized comparison study. METHODS Patients with age-related cataract and moderate preoperative corneal astigmatism of 1.25 to 3.0 diopters (D) were randomized into a TIOL implant group and an FSAK group with symmetrical paired corneal arcuate keratotomies. The preoperative evaluation included corrected distance visual acuity (CDVA), corneal topography, autokeratometry and ocular biometry. Postoperative examinations were performed at 1 and 3 months and included CDVA and uncorrected distance visual acuity (UDVA), manifest refraction, autokeratometry and corneal topography. Vector analysis of astigmatic changes was performed using the Alpins vector method. RESULTS This study comprised 75 eyes from 67 patients. Mean residual refractive astigmatism at 3 months was -0.63 ± 0.55 D in the TIOL group and -0.90 ± 0.53 D in the FSAK group (P = 0.037) and was ≤ 1.00 D in 32 eyes (84%) and 25 eyes (64%), respectively. There were no statistically significant differences in difference vector (DV), angle error (AE), magnitude error (ME) or correction index (CI) in the 3-month follow-up. The index of success (IS) was 0.32 ± 0.33 D in the TIOL group and 0.48 ± 0.29 D in the FSAK group (P = 0.029). CONCLUSION TIOL implantation showed better results in correcting moderate astigmatism. Despite this, FSAK is shown to be a safe technique for reducing astigmatism.
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Affiliation(s)
- Ruben Hernandez
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain. Miguel Servet Ophthalmology Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
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Chung JK, Han GL, Noh H, Lim DH, Chung TY. Astigmatism Correction during Femtosecond Laser-assisted Transepithelial Arcuate Keratotomy Using the Wound Open Method. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.12.1592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: The purpose of this study was to compare corneal astigmatism correction between “wound open” and “wound intact” methods during femtosecond laser-assisted transepithelial arcuate keratotomy.Methods: From April 2016 to December 2018, a retrospective survey was conducted on patients undergoing femtosecond laser cataract surgery at the Ophthalmology Department of Samsung Medical Center. Size comparison and vector analysis of corneal astigmatism before and after surgery were performed in the wound open and wound intact groups.Results: In the wound open and wound intact groups, the target-induced astigmatism (TIA) was 1.28 ± 0.55; and 1.26 ± 0.29 diopters, the surgically induced astigmatism (SIA) was 0.80 ± 0.52; and 0.53 ± 0.32 diopters, and the correction index (CI) was 0.63 ± 0.28; and 0.43 ± 0.26, respectively. The astigmatism correction was superior in the wound open group (p = 0.048, p = 0.025). In a subgroup with TIA < 1.2 diopters, there were no significant differences in SIA or CI between the two groups; however, in the subgroup with a TIA > 1.2 diopters, the SIA was 1.09 ± 0.59; and 0.54 ± 0.37 diopters and the CI was 0.60 ± 0.28; and 0.36 ± 0.23 in the wound open and wound intact groups, respectively (p = 0.022, p = 0.047). Thus, astigmatism correction was superior in the wound open group.Conclusions: The wound open method during femtosecond laser-assisted transepithelial arcuate keratotomy was superior for astigmatism correction compared to the wound intact method.
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Teuma EV, Bucci FA, Bedi R, Gray G, Packer M. Accuracy and safety of partial thickness femtosecond laser radial and arcuate keratotomy incisions in porcine eyes. EYE AND VISION 2021; 8:41. [PMID: 34847968 PMCID: PMC8638553 DOI: 10.1186/s40662-021-00268-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
Background To evaluate the accuracy and safety of micro radial and arcuate keratotomy incisions constructed by a femtosecond laser system with a curved contact patient interface in porcine eyes.
Methods Partial thickness micro radial and arcuate keratotomy incisions were constructed in porcine eyes with a femtosecond laser system and evaluated for precision of depth, quality, and consistency. Optical coherence tomography was used to determine the accuracy and precision of incision depth. Corneal endothelial safety was assessed by a fluorescent live/dead cell viability assay to demonstrate laser-induced endothelial cell loss. Quality was evaluated by ease of opening and examination of interfaces. Results In two micro radial incision groups, intended incision depths of 50% and 80% resulted in mean achieved depths of 50.01% and 77.69%, respectively. In three arcuate incision groups, intended incision depths of 80%, 600 μm or 100 μm residual uncut bed thickness resulted in mean achieved depths of 80.16%, 603.03 μm and residual bed of 115 μm, respectively. No loss of endothelial cell density occurred when the residual corneal bed was maintained at a minimum of 85–116 µm. The incisions were easy to open, and interfaces were smooth. Conclusions A femtosecond laser system with curved contact interface created precise and reproducible micro radial and arcuate keratotomy incisions. Accuracy and precision of the incision depth and preservation of endothelial cell density demonstrated the effectiveness and safety of the system.
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Wendelstein JA, Hoffmann PC, Mariacher S, Wingert T, Hirnschall N, Findl O, Bolz M. Precision and refractive predictability of a new nomogram for femtosecond laser-assisted corneal arcuate incisions. Acta Ophthalmol 2021; 99:e1297-e1306. [PMID: 33629542 PMCID: PMC9540120 DOI: 10.1111/aos.14837] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/12/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Validating a new nomogram for low to moderate astigmatism (0.75 D to 2.5 D) correction with epithelium- and Bowman-penetrating femtosecond laser-assisted arcuate incisions. METHODOLOGY Prospective, interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Cataract patients with low to moderate corneal astigmatism were treated with femtosecond laser-assisted arcuate incisions. Patients with previous refractive corneal treatment were excluded. Outcome assessment was based on manifest refraction, astigmatic vector analysis and visual acuity. RESULTS The study analysed 43 eyes of 33 patients after three months and 35 eyes of 27 patients after 12 months. After 12 months, 100% of all eyes treated had ≤1.0 D and 97% ≤0.5 D of subjective residual astigmatism. Mean residual astigmatism was 0.27 D. 90% of all eyes were within one line of difference between UDVA and CDVA. SEQ Mean Absolute Error was 0.26 D and SEQ. Mean error was -0.08 ± 0.32 D. CI was 0.98 ± 0.2 D, and Index of Success, 0.20 ± 0.18 D. CONCLUSION The Castrop nomogram showed results that are comparable to or better than results presented in the literature for existing nomograms. Our results for astigmatic reduction are comparable to published results for TIOL implantation. It seems to be a predictable and safe measure to reduce manifest astigmatism.
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Affiliation(s)
- Jascha A. Wendelstein
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | | | - Siegfried Mariacher
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | - Tina Wingert
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
| | - Nino Hirnschall
- VIROS – Vienna Institute for Research in Ocular SurgeryKarl Landsteiner InstituteHanusch HospitalViennaAustria
| | - Oliver Findl
- VIROS – Vienna Institute for Research in Ocular SurgeryKarl Landsteiner InstituteHanusch HospitalViennaAustria
| | - Matthias Bolz
- Department of Ophthalmology and OptometryKepler University Hospital GmbHJohannes Kepler University LinzLinzAustria
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Wendelstein JA, Hoffmann PC, Schwarzenbacher L, Fischinger IR, Hirnschall N, Menapace R, Langenbucher A, Findl O, Bolz M. Lasting Effects: Seven Year Results of the Castrop Nomogram for Femtosecond Laser-Assisted Paired Corneal Arcuate Incisions. Curr Eye Res 2021; 47:225-232. [PMID: 34464547 DOI: 10.1080/02713683.2021.1975761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Long-term results of arcuate incisions are rarely reported. This is unfortunate as long-term stability of astigmatic correction is of great interest to surgeons performing astigmatic correction. This study investigates the 7 year stability of results after application of femtosecond laser-assisted arcuate incisions with the Castrop nomogram. METHODS Prospective interventional case series at the Augen- und Laserklinik, Castrop-Rauxel, Germany. Single site, single surgeon study. Seven year results of cataract patients with low to moderate corneal astigmatism receiving femtosecond laser-assisted arcuate incisions using a TechnolasVictus SW 2.7 (Bausch & Lomb Inc, Dornach, Germany) were assessed and compared to 1 year results. Outcome evaluation was based on astigmatic vector analysis, manifest refraction, and visual acuity. RESULTS The study analyzed 19 eyes of 19 patients 7 years after surgery. Ocular residual astigmatism changed from -0.26 to -0.39 D. Preoperative corneal astigmatism was -1.51 D. Correction Index changed from 1.0 to 1.16. The magnitude of difference vector changed from 0.26 to 0.39 D. The index of success changed from 0.20 to 0.29. Spherical equivalent remained stable. A slight tendency to change toward astigmatic overcorrection was mainly observed for patients with preoperative with the rule astigmatism, but not with patients with against the rule astigmatism. CONCLUSIONS The Castrop nomogram showed stable results 7 years after surgery. Similar to toric IOL surgery, it is advisable to be less aggressive when correcting with the rule astigmatism, to avoid overcorrection over a long period.
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Affiliation(s)
- Jascha A Wendelstein
- Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Peter C Hoffmann
- Department of Ophthalmology, Augen-und Laserklinik, Castrop-Rauxel, Germany
| | - Luca Schwarzenbacher
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Isaak R Fischinger
- Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria.,Department of Ophthalmology, Augentagesklinik Spreebogen Berlin, Berlin, Germany
| | - Nino Hirnschall
- Department of Ophthalmology, Viros - Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Oliver Findl
- Department of Ophthalmology, Viros - Vienna Institute for Research in Ocular Surgery, Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria
| | - Matthias Bolz
- Department of Ophthalmology and Optometry, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
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Kwon HJ, Lee H, Lee JA, Kim JY, Tchah H. Astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus Toric intraocular Lens Impantation with conventional phacoemulsification. BMC Ophthalmol 2021; 21:298. [PMID: 34391403 PMCID: PMC8364067 DOI: 10.1186/s12886-021-02059-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background To compare the efficacies in astigmatic correction of simultaneous femtosecond laser-assisted cataract surgery (FLACS) with intrastromal arcuate keratotomy (ISAK) versus toric intraocular lens (IOL) implantation with conventional phacoemulsification in moderate astigmatism. Methods A retrospective chart review was conducted for patients who had undergone cataract surgery by one surgeon. We identified patients with preoperative corneal astigmatism from + 0.75 to + 2.00 diopters (D) who had undergone astigmatic correction with FLACS with ISAK or toric IOL implantation with conventional phacoemulsification. We measured the visual acuity, intraocular pressure, automated keratometer, manifest refraction, and topography preoperatively and 1-day, 1-month, 3-month, and 6-month postoperatively. The vector analysis of refractive astigmatism was performed. Results Of a total of 48 eyes of 48 patients, 27 eyes of 27 patients had FLACS with ISAK (AK group), and 21 eyes of 21 patients had conventional cataract surgery with toric IOL implantation (toric IOL group). Refractive astigmatism was significantly decreased in both groups. The mean preoperative and 6-month postoperative refractive astigmatism were 1.85 ± 1.07 and 0.99 ± 0.51 D, respectively, in the AK group (P = 0.028), and 1.84 ± 0.81 and 0.68 ± 0.21 D, respectively, in the toric IOL group (P < 0.001). There was no significant difference in refractive astigmatism between the two groups at 6-month postoperatively (0.99 ± 0.51 vs 0.68 ± 0.21 D, P = 0.057). At 6-month postoperatively, parameters for vector analysis of refractive astigmatism showed no statistical difference between the two groups. Corneal astigmatism was significantly decreased in the AK group. Corneal astigmatism from topography and the automated keratometer were significantly lower in the AK group 6-month postoperatively compared to toric IOL group (0.94 ± 0.40 vs. 1.53 ± 0.46 D, P = 0.018 for topography; and 0.98 ± 0.69 vs. 1.37 ± 0.41 D, P = 0.032 for the automated keratometer). Conclusions FLACS with ISAK could be an effective procedure for reducing astigmatism as well as toric IOL implantation in cataract surgery.
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Affiliation(s)
- Hye Ji Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jin Ah Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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Rani K, Grover AK, Singh AK, Grover T, Garg SP. Correction of preexisting astigmatism by penetrating arcuate keratotomy in femtosecond laser-assisted cataract surgery. Indian J Ophthalmol 2021; 68:1569-1572. [PMID: 32709778 PMCID: PMC7640873 DOI: 10.4103/ijo.ijo_2060_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Purpose: To evaluate the astigmatism correcting effect of penetrating arcuate keratotomy (AK) done during femtosecond laser-assisted cataract surgery (FLACS). Methods: In this nonrandomized prospective study, 80 eyes of 70 patients were studied. The study included patients who underwent combined FLACS and AK, with corneal astigmatism ranging from 0.4 to 1.5 diopters (D). Femtosecond laser-assisted penetrating arcuate keratotomies were created at 8 mm optical zone at 80% depth and were centered at the limbus. Keratometric astigmatism was measured prior to and 3 months post-surgery. Vector analysis was performed using Power vector analysis method. Results: The mean preoperative keratometric astigmatism without accounting for axis was 0.85 ± 0.27 D, which reduced significantly to 0.47 ± 0.27 D at 3-month follow-up. The mean astigmatism correction attained without accounting for axis was 0.38 ± 0.32 D. The vector corrected mean preoperative astigmatism was 0.85 ± 0.27 D which reduced significantly to 0.50 ± 0.31 D postoperatively (P < 0.001, 95% CI). Vector corrected mean astigmatism correction attained was 0.35 ± 0.38 D. There were no significant intraoperative or postoperative complications. Conclusion: Preexisting astigmatism can be tackled effectively with penetrating AK during FLACS although under correction is observed with present nomograms. Further refinements may achieve better correction.
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Affiliation(s)
| | | | | | | | - S P Garg
- Vision Eye Centre, New Delhi, India
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Schwarzenbacher L, Schartmüller D, Röggla V, Meyer E, Leydolt C, Menapace R. One-Year Results of Arcuate Keratotomy in Patients With Low to Moderate Corneal Astigmatism Using a Low-Pulse-Energy Femtosecond Laser. Am J Ophthalmol 2021; 224:53-65. [PMID: 33309694 DOI: 10.1016/j.ajo.2020.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/11/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To investigate corneal astigmatism (CA) reduction and corneal optical quality after surface-penetrating femtosecond laser arcuate keratotomies (Femto AK) considering anterior (CAant) and posterior corneal curvature (CApost), total corneal refractive power astigmatism (CAtot), and corneal higher-order aberrations (HOAs) through 1 year. DESIGN Prospective interventional case series. METHODS Setting: Department of Ophthalmology, Medical University of Vienna. PatientPopulation: Forty-three eyes of 43 patients with age-related cataract and CAtot between 1 and 3 diopters (D). INTERVENTION Paired keratotomies were created with a low-energy femtosecond laser (LDV Z8; Ziemer Ophthalmic Systems, Port, Switzerland) and combined with an astigmatic neutral manual posterior-limbal cataract incision. CA and HOAs measurements were obtained preoperatively and after 1 month, 3 months, and 1 year. MainOutcomeMeasure: Change of CA and HOAs after low-energy Femto AK through 1 year. RESULTS Mean preoperative CAant and CAtot (1.62 ± 0.49 D and 1.58 ± 0.44 D) were significantly reduced, to 0.66 ± 0.38 and 0.50 ± 0.30 D (P < .001) 1 year after surgery, respectively. CApost showed no significant change, from 0.31 ± 0.19 D preoperatively to 0.31 ± 0.13 D (P = .732) at the 1-year follow-up period. Astigmatism as calculated by vector astigmatism analysis stayed stable at 1 month, 3 months, and 1 year. Corneal wavefront HOAs significantly improved at 1 month, 3 months, and 1 year. CONCLUSIONS Paired surface-penetrating keratotomies created by a low-energy femtosecond laser showed efficient and stable CA reduction within 1 year after surgery. The optical quality of the cornea was preserved with lower HOAs than preoperatively.
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Affiliation(s)
| | | | - Veronika Röggla
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Elias Meyer
- Section for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christina Leydolt
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Rupert Menapace
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria.
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Lopes D, Loureiro T, Carreira R, Rodrigues Barros S, Nobre Cardoso J, Campos P, Machado I, Campos N. Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:408-414. [PMID: 34340778 DOI: 10.1016/j.oftale.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). METHODS This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3 months of follow-up were the difference between pre-operative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. RESULTS The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36 ± 0.37 D in the transepithelial group and 0.53 ± 0.42 D in the intrastromal group (p < 0.001). The mean CI was 0.83 ± 0.71 in the transepithelial group and 0.68 ± 0.29 in intrastromal group (p = 0.17). Five eyes (25 %) had an astigmatism overcorrection in the transepithelial group and 1 eye (5%) in the intrastromal group. CONCLUSIONS Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.
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Affiliation(s)
- D Lopes
- Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal.
| | - T Loureiro
- Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal
| | - R Carreira
- Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal
| | | | - J Nobre Cardoso
- Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal
| | - P Campos
- Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal
| | - I Machado
- Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal
| | - N Campos
- Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal
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Evaluation of Astigmatic Correction Using Vector Analysis after Combined Femtosecond Laser-Assisted Phacoemulsification and Intrastromal Arcuate Keratotomy. J Ophthalmol 2021; 2021:2860840. [PMID: 33564469 PMCID: PMC7867465 DOI: 10.1155/2021/2860840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/05/2020] [Accepted: 01/16/2021] [Indexed: 12/02/2022] Open
Abstract
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.
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FOCUSED (Femtosecond Optimized Continuous Uncorrected Sight with EDOF and Diffractive Multifocal IOLs) - A Review. Curr Opin Ophthalmol 2020; 32:3-12. [PMID: 33122490 DOI: 10.1097/icu.0000000000000723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review techniques to maximize all-distance uncorrected visual acuity and minimize photic phenomena after the implantation of multifocal and extended-depth of focus (EDOF) intraocular lenses (IOLs). This review examines the role of femtosecond laser-assisted cataract surgery (FLACS) in postoperative minimization of astigmatism and optimization of outcomes with multifocal and EDOF lenses. RECENT FINDINGS By incorporating intraoperative and preoperative imaging, femtosecond platforms such as those that utilize iris or conjunctival vessel registration, can enable a precision of corneal incisions and toric IOL markings that enable the lowest possible postoperative levels of astigmatism. Current studies suggest that with increasing IOL complexity, that is, trifocal versus bifocal, image degradation with even low levels of postoperative astigmatism are increased. To this end, current data support the utility of femtosecond laser arcuate incisions to enable the achievement of 0.5 D or less postoperative astigmatism for best outcomes with multifocal lenses. SUMMARY The synergistic combination of multifocal/EDOF IOLs with FLACS is an extremely promising route in achieving postoperative spectacle independence for patients. The marriage of the precision of FLACS with the increasing complexity of multifocal/EDOF IOLs will fuel nomogram adjustment and systematic improvements, such as the Wörtz-Gupta formula. Such strategies provide an unprecedented precision to cataract surgery that makes FOCUSED (Femtosecond Optimized Continuous Uncorrected Sight with EDOF and Diffractive Multifocal IOLs) a reality.
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Chen W, Ji M, Wu J, Wang Y, Zhou J, Zhu RR, Lu H, Guan HJ. Effect of femtosecond laser-assisted steepest-meridian clear corneal incisions on preexisting corneal regular astigmatism at the time of cataract surgery. Int J Ophthalmol 2020; 13:1895-1900. [PMID: 33344187 DOI: 10.18240/ijo.2020.12.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the clinical efficacy and safety of femtosecond laser-assisted steepest-meridian clear corneal incisions for correcting preexisting corneal astigmatism performed at the time of cataract surgery. METHODS This prospective case series study comprised consecutive age-related cataract patients with corneal regular astigmatism (range: +0.75 to +2.50 D) who had femtosecond laser-assisted steepest-meridian clear corneal incisions (single or paired). Corneal astigmatism was performed with the Pentacam preoperatively and 3mo postoperatively. Total corneal astigmatism and steepest-meridian measured in the 3-mm central zone were used to guide the location, size and number of clear corneal incision. The vector analysis of astigmatic change was performed using the Alpins method. RESULTS Totally 138 eyes of 138 patients were included. The mean preoperative corneal astigmatism was 1.31±0.41 D, and was significantly reduced to 0.69±0.34 D (equivalent to difference vector) after surgery (P<0.01). The surgically-induced astigmatism was 1.02±0.54 D. The correction index (ratio of target induced astigmatism and surgically-induced astigmatism: 0.72±0.36) as well as the magnitude of error (difference between surgically-induced astigmatism and target induced astigmatism: -0.29±0.51) represented a slight under correction. For angle of error, the arithmetic mean was 1.11±13.70, indicating no significant systematic alignment errors. CONCLUSION Femtosecond-assisted steepest-meridian clear corneal incision is a fast, customizable, adjustable, precise, and safe technique for the reduction of low to moderate corneal astigmatism during cataract surgery.
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Affiliation(s)
- Wei Chen
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Min Ji
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jian Wu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Yong Wang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jing Zhou
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Rong-Rong Zhu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Hong Lu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Huai-Jin Guan
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery. ACTA ACUST UNITED AC 2020. [PMID: 33341283 DOI: 10.1016/j.oftal.2020.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). METHODS This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3months of follow-up were the difference between preoperative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. RESULTS The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36±0.37D in the transepithelial group and 0.53±0.42D in the intrastromal group (P<.001). The mean CI was 0.83±0.71 in the transepithelial group and 0.68±0.29 in intrastromal group (P=.17). Five eyes (25%) had an astigmatism overcorrection in the transepithelial group and 1eye (5%) in the intrastromal group. CONCLUSIONS Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.
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Five-Year Changes in Corneal Astigmatism After Combined Femtosecond-Assisted Phacoemulsification and Arcuate Keratotomy. Am J Ophthalmol 2020; 217:232-239. [PMID: 32437671 DOI: 10.1016/j.ajo.2020.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the long-term stability of corneal astigmatism after combined femtosecond (fs)-assisted phacoemulsification and arcuate keratotomy. DESIGN Retrospective, interventional case series. METHODS Surgery was performed using a Victus (Bausch & Lomb) platform. A single, 450-μm-deep arcuate keratotomy was paired at the 8-mm zone with the main phacoemulsification incision in the opposite meridian. The keratotomy incisions were not opened. Corneal astigmatism measurements obtained preoperatively and at 2 and 5 years postoperatively were analyzed using vector analysis. RESULTS A total of 44 eyes of 44 patients (mean age 66.0 ± 10.1 years) were included. The mean preoperative corneal astigmatism was 1.40 ± 0.66 diopters (D). This was reduced to 0.74 ± 0.54 D at 2 years and 0.70 ± 0.50 at 5 years postoperatively (P < .001). There were no statistically significant differences between postoperative corneal astigmatism at 2 years and at 5 years (P = .609). Both magnitude of error and absolute angle of error were comparable between the 2 postoperative time points (P > .805). At the end of 5 years, 65% of the eyes were within 15 degrees of the preoperative astigmatic meridian. Comparative analysis showed significantly higher surgically induced astigmatism, lower differences in vector and absolute angles of error for the eyes with preoperative with-the-rule (WTR) astigmatism than eyes with against-the-rule (ATR) astigmatism at 5 years (P < .004). CONCLUSIONS Our study showed the stability of femtosecond (fs)-assisted arcuate keratotomy was well-maintained over 5 years. There was a tendency of increasing overcorrection of preoperative WTR astigmatism and undercorrection of ATR astigmatism over time.
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Wortz G, Gupta PK, Goernert P, Hartley C, Wortz B, Chiu J, Jaber N. Outcomes of Femtosecond Laser Arcuate Incisions in the Treatment of Low Corneal Astigmatism. Clin Ophthalmol 2020; 14:2229-2236. [PMID: 32982147 PMCID: PMC7500082 DOI: 10.2147/opth.s264370] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate real-world outcomes of astigmatism management with femtosecond laser arcuate incisions in patients with low corneal astigmatism (<1.0 D) using a novel formula for arcuate incision calculation compared to outcomes after conventional cataract surgery without surgical management of astigmatism. Patients and Methods The Wörtz-Gupta™ Formula (available at www.lricalc.com) was used to calculate femtosecond laser arcuate parameters for 224 patients with <1 D of corneal astigmatism who underwent cataract surgery; lens power was determined with the Barrett Universal II formula. Uncorrected distance visual acuity (UCDVA) and refractive astigmatism measurements were obtained, with an average follow-up of 4 weeks. Results The average preoperative cylinder was similar (0.61 D in the femtosecond group [n=124] and 0.57 D in the conventional group [n=100] (P>0.05)). More patients had ≤0.5 D of postoperative corneal astigmatism in the femtosecond group (n=110/124, 89%) than in the conventional group (n=71/100, 71%), respectively (P=0.001). The mean absolute postoperative refractive astigmatism was higher in the conventional surgery group than in the femtosecond group (0.43 ± 0.4 D vs 0.26 ± 0.28 D); these differences were statistically significant (P<0.001). The percentage of patients with UCDVA of 20/20 or better vision was higher in the femtosecond group (62%) than the conventional group (48%) (P=0.025). Conclusion Using the femtosecond laser for arcuate incisions in combination with a novel nomogram can provide excellent anatomic and refractive outcomes in patients with lower levels of preoperative astigmatism at the time of cataract surgery. ![]()
Point your SmartPhone at the code above. If you have a QR code reader, the video abstract will appear. Or use: https://youtu.be/ui1VbqXe3Ss
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Affiliation(s)
- Gary Wortz
- Commonwealth Eye Surgery, Lexington, KY 40504, USA
| | | | - Philip Goernert
- Department of Psychology, Brandon University, Brandon, MB R7A 6A9, Canada
| | | | | | - Jin Chiu
- Commonwealth Eye Surgery, Lexington, KY 40504, USA
| | - Nikita Jaber
- Commonwealth Eye Surgery, Lexington, KY 40504, USA
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Piñero A, Kanclerz P, Barraquer RI, Maldonado MJ, Alió JL. Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application. ACTA ACUST UNITED AC 2020; 95:528-537. [PMID: 32694026 DOI: 10.1016/j.oftal.2020.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.
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Affiliation(s)
- A Piñero
- Fellow Curso online Experto Universitario en Cirugía Refractiva, Córnea y Catarata, Clínica Piñero, Sevilla, España
| | | | - R I Barraquer
- Centro de Oftalmología Barraquer, Barcelona, España; Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
| | - M J Maldonado
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España
| | - J L Alió
- División de Oftalmología, Universidad Miguel Hernández, Alicante, España; Vissum Instituto Oftalmológico de Alicante, Alicante, España.
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Kanclerz P, Alio JL. The benefits and drawbacks of femtosecond laser-assisted cataract surgery. Eur J Ophthalmol 2020; 31:1021-1030. [PMID: 32508179 DOI: 10.1177/1120672120922448] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Since the introduction, femtosecond laser-assisted cataract surgery was believed to revolutionize cataract surgery. However, the judgment of clinical benefit was found to be far more complex than initially might have been thought. The aim of this review was to analyze the benefits and drawbacks of femtosecond laser-assisted cataract surgery compared with traditional phacoemulsification cataract surgery. METHODS PubMed and the Web of Science were used to search the medical literature. The following keywords were searched in various combinations: femtosecond laser, femtosecond laser-assisted cataract surgery, phacoemulsification cataract surgery, FLACS. RESULTS The benefits of femtosecond laser-assisted cataract surgery include lower cumulated phacoemulsification time and endothelial cell loss, perfect centration of the capsulotomy, and opportunity to perform precise femtosecond-assisted arcuate keratotomy incisions. The major disadvantages of femtosecond laser-assisted cataract surgery are high cost of the laser and the disposables for surgery, femtosecond laser-assisted cataract surgery-specific intraoperative capsular complications, as well as the risk of intraoperative miosis and the learning curve. CONCLUSION Femtosecond laser-assisted cataract surgery seems to be beneficial in some groups of patients, that is, with low baseline endothelial cell count, or those planning to receive multifocal intraocular lens. Nevertheless, having considered that the advantages of femtosecond laser-assisted cataract surgery might not be clear in every routine case, it cannot be considered as cost-effective.
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Affiliation(s)
| | - Jorge L Alio
- Vissum Instituto Oftalmologico de Alicante, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Abstract
PURPOSE Review scientific literature concerning femtosecond laser-assisted cataract surgery. METHODS 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'. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Harry W Roberts
- King's College London, London, UK.,Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | | | - David Ps O'Brart
- King's College London, London, UK.,Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Lim CW, Somani S, Chiu HH, Maini R, Tam ES. Astigmatic Outcomes of Single, Non-Paired Intrastromal Limbal Relaxing Incisions During Femtosecond Laser-Assisted Cataract Surgery Based on a Custom Nomogram. Clin Ophthalmol 2020; 14:1059-1070. [PMID: 32368004 PMCID: PMC7183774 DOI: 10.2147/opth.s238016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/25/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine astigmatic changes of intrastromal limbal-relaxing incisions (LRIs) performed during femtosecond laser-assisted cataract surgery (FLACS). Design Retrospective case series. Patients and Methods Patients undergoing FLACS with adjunctive astigmatism management with intrastromal LRIs were included. All eyes had preoperative corneal cylinder (Kcyl) ≥0.20 D on ocular biometry. An intrastromal LRI nomogram of single, non-paired LRIs placed at the 9 mm optical zone was used. Keratometry was measured preoperatively, and postoperatively at 1 week, 1 month, and 3 months (POM3). Alpins astigmatism analysis was used to calculate target-induced astigmatism (TIA, equivalent to preoperative Kcyl), surgically induced astigmatism (SIA), difference vectors (DV), and correction indices (CI). Secondary analysis included multivariable binary logistic regression to determine clinical factors associated with corrections >125% (CI > 1.25). Results A total of 154 eyes (125 patients) were studied. Mean preoperative Kcyl was 0.87±0.42 D (SD), which did not significantly differ from POM3 Kcyl (0.87±0.51 D, p=0.470). Only the against-the-rule (ATR) subgroup demonstrated a small but significant reduction in Kcyl from preoperative (0.96±0.51D) to POM3 (0.89±0.55D, p=0.032). Sixteen eyes (10.4%) had Kcyl ≤0.5 D preoperatively, compared to 46 eyes (29.9%) at POM3 (p<0.0001). Mean SIA was 0.80±0.52 D. Mean DV was 0.85±0.47. Mean CI was 0.79. Fifty-one eyes (33%) had astigmatism correction >125%. On multivariable regression analysis, ATR astigmatism class (p=0.026) and lower arc lengths (30º) (p=0.005) were associated with correction >125%. Lower preoperative corneal astigmatism was inversely correlated with CI (p<0.001). Conclusion Although intrastromal LRIs can be conveniently performed during FLACS and appear safe, only patients with ATR astigmatism demonstrated a significant reduction in corneal astigmatism 3-months postoperatively under the current nomogram. Areas for future refinements to the nomogram were identified.
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Affiliation(s)
- Carter W Lim
- Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada.,Eye Foundation of Canada, Toronto M3N 2V6, Canada.,William Osler Health System, Brampton L6R 3J7, Canada
| | - Sohel Somani
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Hannah H Chiu
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Raj Maini
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
| | - Eric S Tam
- William Osler Health System, Brampton L6R 3J7, Canada.,Uptown Eye Specialists, Brampton L6Y 0P6, Canada.,Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
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Han SB, Liu YC, Mohamed-Noriega K, Mehta JS. Application of Femtosecond Laser in Anterior Segment Surgery. J Ophthalmol 2020; 2020:8263408. [PMID: 32351726 PMCID: PMC7171667 DOI: 10.1155/2020/8263408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.
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Affiliation(s)
- Sang Beom Han
- Department of Ophthalmology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Yu-Chi Liu
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Karim Mohamed-Noriega
- Department of Ophthalmology, University Hospital, Faculty of Medicine, Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore
- Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Comparison of astigmatism correction between anterior penetrating and intrastromal arcuate incisions in eyes undergoing femtosecond laser–assisted cataract surgery. J Cataract Refract Surg 2020; 46:394-402. [DOI: 10.1097/j.jcrs.0000000000000069] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shaheen MS, AbouSamra A, Helaly HA, Said A, Elmassry A. Comparison between refractive outcomes of femtosecond laser-assisted cataract surgery and standard phacoemulsification. BMC Ophthalmol 2020; 20:1. [PMID: 31898534 PMCID: PMC6941343 DOI: 10.1186/s12886-019-1277-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/16/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To 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). METHODS A 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. RESULTS Logarithm 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). CONCLUSION Femtosecond 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 NUMBER PACTR201804003256258 (date: 27 Mar 2018) Available at: https://pactr.samrc.ac.za/.
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Affiliation(s)
- Mohamed Shafik Shaheen
- Ophthalmology Department, Faculty of Medicine, Alexandria University, 30 Roshdystreet, Roshdy, Alexandria, Egypt
| | - Amir AbouSamra
- Ophthalmology Department, Faculty of Medicine, Alexandria University, 30 Roshdystreet, Roshdy, Alexandria, Egypt
| | - Hany Ahmed Helaly
- Ophthalmology Department, Faculty of Medicine, Alexandria University, 30 Roshdystreet, Roshdy, Alexandria, Egypt
| | - Amr Said
- Ophthalmology Department, Faculty of Medicine, Alexandria University, 30 Roshdystreet, Roshdy, Alexandria, Egypt
| | - Ahmed Elmassry
- Ophthalmology Department, Faculty of Medicine, Alexandria University, 30 Roshdystreet, Roshdy, Alexandria, Egypt
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Simple steep-axis marking technique using a corneal analyzer. J Cataract Refract Surg 2019; 43:153-155. [PMID: 28366359 DOI: 10.1016/j.jcrs.2016.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022]
Abstract
We describe a simple steep-axis marking technique that uses a corneal analyzer (OPD III scan) during arcuate keratotomy in femtosecond laser-assisted cataract surgery. The technique requires a single reference mark at the limbus, which does not have to be on the horizontal axis. Using the corneal analyzer, the angle between the steep axis and the reference line between the reference mark and the center of the cornea can be determined. The angle from the reference mark is used intraoperatively to locate the steep axis. This eliminates the potential error from different head positions during keratometry measurement and during traditional marking under the slitlamp. The marking technique can also be applied to toric intraocular lens implantation during cataract surgery.
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Byun YS, Kim S, Lazo MZ, Choi MH, Kang MJ, Lee JH, Yoo YS, Whang WJ, Joo CK. Astigmatic correction by intrastromal astigmatic keratotomy during femtosecond laser-assisted cataract surgery: Factors in outcomes. J Cataract Refract Surg 2019; 44:202-208. [PMID: 29587975 DOI: 10.1016/j.jcrs.2017.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/09/2017] [Accepted: 11/30/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the 6-month outcomes of femtosecond laser astigmatic keratotomy (AK) combined with femtosecond laser-assisted cataract surgery and identify factors affecting the efficacy of astigmatic correction. SETTING Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, South Korea. DESIGN Retrospective case series. METHODS Femtosecond laser AK was performed during femtosecond laser-assisted cataract surgery. The keratometric astigmatism, refractive cylinder, corneal hysteresis (CH), and corneal resistance factor (CRF) were measured preoperatively and postoperatively at 1 week, 2 months, and 6 months. Vector analysis to evaluate the 6-month outcomes of femtosecond laser AK and univariable regression analysis to determine the factors influencing the correction index were performed. RESULTS The study enrolled 89 eyes of 89 patients. The stigmatism type, CH, CRF, and absolute angle of error showed significant correlations with the correction index (P = .041, P = .029, P = .044, and P < .001, respectively). There was a significant difference in the correction index and no difference in keratometric astigmatism between with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism (P = .044). The keratometric astigmatism with ATR and oblique astigmatism (0.66 diopter [D] ± 0.42 [SD] and 0.46 ± 0.27 D, respectively) was significantly lower than the refractive cylinder (0.92 ± 0.56 D and 0.78 ± 0.43 D, respectively) (P < .05); this was not the case for WTR astigmatism. CONCLUSIONS The efficacy of femtosecond laser AK was affected by the biomechanical properties of the cornea and astigmatism type. Further studies incorporating the individual biomechanical properties of the cornea and total corneal astigmatism in a nomogram are recommended.
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Affiliation(s)
- Yong-Soo Byun
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Seonjoo Kim
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Marjorie Z Lazo
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Mi-Hyun Choi
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Min-Ji Kang
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Jee-Hye Lee
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Young-Sik Yoo
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Woong-Joo Whang
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea
| | - Choun-Ki Joo
- From the Department of Ophthalmology and Visual Science, College of Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, and the Catholic Institute of Visual Science, Catholic University of Korea, Seoul, South Korea.
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Xiang W, Chen W, Liu R, Chen H, Yang C, Zhong L, Zhang S, Chen W. Ocular Cyclorotation and Corneal Axial Misalignment in Femtosecond Laser-Assisted Cataract Surgery. Curr Eye Res 2019; 44:1313-1318. [PMID: 31296058 DOI: 10.1080/02713683.2019.1638943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To explore ocular cyclorotation and the source of corneal axial misalignment during femtosecond laser-assisted cataract surgery (FLACS).Methods: Forty-five sequential patients (50 eyes) who had undergone FLACS (LenSx Laser System, Alcon Inc) were recruited. We took screenshots from videos of FLACS to analyze ocular cyclorotation and the real angle between primary incision and secondary incision (RAPS). In addition, crystalline lens tilt and theoretic angle between the primary and secondary incisions (TAPS) was also calculated.Results: The mean absolute value of ocular cyclorotation was 8.03 ± 4.48 degrees (0-19.1 degrees). The crystalline lens tilt was 3.30 ± 1.44 degrees (0.93-6.44 degrees). And the mean preoperative uncorrected visual acuity was 0.89 ± 0.50 LogMAR units. Pearson bivariate correlation analysis showed significant positive correlation between ocular cyclorotation with crystalline lens tilt (r = 0.37, p = .008), and ocular cyclorotation negatively correlated with axial length (r = -0.29, p = .038). In addition, the TAPS was 89.78 ± 1.45 degrees, and the RAPS was 85.68 ± 2.04 degrees. The angle error was 4.11 ± 1.28 degrees (p<0.001).Conclusions: Ocular cyclorotation commonly occurred during FLACS. In addition, increased axial length was associated with less ocular cyclorotation and increased crystalline lens tilt was related to more ocular cyclorotation. Importantly, machinery systemic errors during corneal astigmatism correction by arcuate incision in FLACS should be taken into consideration.
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Affiliation(s)
- Wu Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rongjiao Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunyan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shaochong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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Bang CW, Choi JW, Han SY. Long-term Results of Arcuate Keratotomy in Femtosecond Laser-assisted Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.10.946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ninomiya Y, Minami K, Miyata K, Eguchi S, Sato R, Okamoto F, Oshika T. Toric intraocular lenses in eyes with with-the-rule, against-the-rule, and oblique astigmatism: One-year results. J Cataract Refract Surg 2018; 42:1431-1440. [PMID: 27839597 DOI: 10.1016/j.jcrs.2016.07.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/17/2016] [Accepted: 07/04/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess 1-year clinical results of toric intraocular lenses (IOLs) in eyes having with-the-rule (WTR), against-the-rule (ATR), or oblique corneal astigmatism. SETTING Four ophthalmic surgical sites, Japan. DESIGN Prospective case series. METHODS One of 3 toric IOLs or 1 nontoric IOL was implanted in eyes having phacoemulsification and IOL implantation. RESULTS The study comprised 218 eyes (155 patients). Based on the suggestion of an online toric calculator with anterior corneal curvature data, 63 eyes received the SN6AT3 IOL with a cylinder power of 1.50 diopters [D] at IOL plane (1.50 D cylinder IOL) 55 eyes the SN6AT4 IOL with a cylinder power of 2.25 D at IOL plane (2.25 D cylinder IOL), and 58 eyes the SN6AT5 IOL with a cylinder power of 3.00 D at IOL plane (3.00 D cylinder IOL) (all Acrysof IQ toric), and 42 eyes received the SN60WF IOL (nontoric IOL). One hundred ninety-four eyes (89.0%) completed 1-year of follow-up. The centroid error in predicted residual astigmatism calculated using vector analysis was close to the origin in eyes with WTR astigmatism (0.17 diopter [D] @ 174.9 ± 0.54 D), while those with ATR and oblique astigmatism were significantly shifted toward the ATR direction (P < .001). The distance from the origin was significantly smaller in the WTR group than in ATR and oblique groups (P < .05). The centroid errors were shifted toward ATR in all toric IOL groups (P < .001); however, the distance from the origin was not different between groups (P = .52). Postoperatively, the mean absolute misalignment of the IOLs was 5.92 degrees ± 5.59 (SD) at 1 day and 6.24 ± 5.87 degrees at 1 year. The results of other clinical parameters were excellent, with no significant differences between astigmatism categories or IOL models. CONCLUSION Based on anterior corneal curvature alone, toric IOLs undercorrected ATR and oblique astigmatism; however, 1-year clinical results of toric IOLs were highly stable and satisfactory. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Yoshihiko Ninomiya
- From the Division of Ophthalmology (Ninomiya), Yukioka Hospital, Osaka, the Miyata Eye Hospital (Minami, Miyata), Miyazaki, the Eguchi Eye Hospital (Eguchi), Hokkaido, and the Department of Ophthalmology (Sato, Okamoto, Oshika), Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Keiichiro Minami
- From the Division of Ophthalmology (Ninomiya), Yukioka Hospital, Osaka, the Miyata Eye Hospital (Minami, Miyata), Miyazaki, the Eguchi Eye Hospital (Eguchi), Hokkaido, and the Department of Ophthalmology (Sato, Okamoto, Oshika), Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kazunori Miyata
- From the Division of Ophthalmology (Ninomiya), Yukioka Hospital, Osaka, the Miyata Eye Hospital (Minami, Miyata), Miyazaki, the Eguchi Eye Hospital (Eguchi), Hokkaido, and the Department of Ophthalmology (Sato, Okamoto, Oshika), Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shuichiro Eguchi
- From the Division of Ophthalmology (Ninomiya), Yukioka Hospital, Osaka, the Miyata Eye Hospital (Minami, Miyata), Miyazaki, the Eguchi Eye Hospital (Eguchi), Hokkaido, and the Department of Ophthalmology (Sato, Okamoto, Oshika), Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Rie Sato
- From the Division of Ophthalmology (Ninomiya), Yukioka Hospital, Osaka, the Miyata Eye Hospital (Minami, Miyata), Miyazaki, the Eguchi Eye Hospital (Eguchi), Hokkaido, and the Department of Ophthalmology (Sato, Okamoto, Oshika), Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Fumiki Okamoto
- From the Division of Ophthalmology (Ninomiya), Yukioka Hospital, Osaka, the Miyata Eye Hospital (Minami, Miyata), Miyazaki, the Eguchi Eye Hospital (Eguchi), Hokkaido, and the Department of Ophthalmology (Sato, Okamoto, Oshika), Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Tetsuro Oshika
- From the Division of Ophthalmology (Ninomiya), Yukioka Hospital, Osaka, the Miyata Eye Hospital (Minami, Miyata), Miyazaki, the Eguchi Eye Hospital (Eguchi), Hokkaido, and the Department of Ophthalmology (Sato, Okamoto, Oshika), Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
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Song C, Baharozian CJ, Hatch KM, Talamo JH. Assessment of surgeon experience with femtosecond laser-assisted cataract surgery. Clin Ophthalmol 2018; 12:1373-1377. [PMID: 30122889 PMCID: PMC6084079 DOI: 10.2147/opth.s171743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the collective user experience with an image-guided femtosecond laser (FSL) for cataract surgery in a high-volume, multi-surgeon, ambulatory surgical center. SUBJECTS AND METHODS A detailed online survey was distributed to all surgeons in a single ambulatory surgical center who had performed cataract surgery using a FSL since its acquisition in December 2012. Information collected included the number of cases performed, typical surgical techniques and parameters, satisfaction with individual features of the laser (rated on a scale from 1=completely unsatisfied to 10=extremely satisfied) and commentary on ease of use and suggested improvements. RESULTS Seventeen of 30 surgeons (56.7%) completed the survey, representing a case volume of 1,967 eyes. Fourteen surgeons (82.4%) felt they required ≤10 cases with the FSL to operate with the same safety and control as in standard phacoemulsification surgery. Satisfaction was highest for capsulotomies, lens fragmentation, lens softening, arcuate incisions and the graphic user interface (mean scores 9.4, 8.7, 8.7, 7.2 and 8.9, respectively). Preferred capsulotomy diameter was 4.8-5.2 mm (64.7% of respondents). About half (52.9%) of respondents centered the capsulotomy on the pupil and the other 47.1% centered the capsulotomy using optical coherence tomography. Most respondents (81.3%) preferred transepithelial arcuate incisions compared to intrastromal incisions. Satisfaction was lowest with FSL-created, main, clear corneal incisions and paracenteses (mean scores 4.4 and 4.2, respectively). CONCLUSION Laser-assisted cataract surgery has a short learning curve and a high rate of user satisfaction. Further software and hardware development is warranted to improve user satisfaction with peripheral and clear corneal incisions.
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Affiliation(s)
- Christian Song
- Department of Opthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA,
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA,
| | - Connor J Baharozian
- Department of Opthalmology, Boston University School of Medicine, Boston, MA, USA
| | - Kathryn M Hatch
- Department of Opthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA,
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA,
| | - Jonathan H Talamo
- Department of Opthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA,
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA,
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Wang J, Zhao J, Xu J, Zhang J. Evaluation of the effectiveness of combined femtosecond laser-assisted cataract surgery and femtosecond laser astigmatic keratotomy in improving post-operative visual outcomes. BMC Ophthalmol 2018; 18:161. [PMID: 29970039 PMCID: PMC6029423 DOI: 10.1186/s12886-018-0823-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/13/2018] [Indexed: 11/13/2022] Open
Abstract
Background To determine postoperative refractive and visual outcomes and astigmatic changes after femtosecond laser astigmatic keratotomy in femtosecond laser-assisted cataract surgery (FLACS). Methods This was a prospective interventional case series. Patients with age-related cataract and corneal astigmatism (1.0–3.0D) were treated with FLACS and femtosecond laser astigmatic keratotomy (FSAK). All patients underwent examinations before and 3 months after surgery; visual acuity, subjective and objective refraction, and corneal astigmatism were evaluated and recorded for all patients by using an OPD-Scan III topographer. Vector analysis of astigmatic changes was performed by using the Alpins vector method. Results Twenty-five patients were included in the study. Postoperatively, refractive and corneal astigmatism were both reduced significantly (P < 0.05), concurrent with improved uncorrected distance visual acuity and corrected distance visual acuity. The rate of spectacle use was significantly reduced at 3 months postoperatively (P = 0.001). The mean magnitude of the target-induced astigmatism vector (1.40 ± 0.37D) was slightly higher than the mean magnitude of the surgically induced astigmatism vector (1.22 ± 0.46D). The magnitude of error (− 0.18 ± 0.36D), as well as the correction index (0.88 ± 0.29), demonstrated slight undercorrection. The angle of error was 0.85 ± 13.69°, which was close to zero. Conclusions Combined femtosecond laser-assisted cataract surgery and astigmatic keratotomy may be an effective approach to manage preoperative astigmatism in cataract surgery, although slight undercorrection may exist during short-term follow-up. Trial registration ChiCTR-TRC-14004977
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Affiliation(s)
- Jing Wang
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University,The Key Lenticular Laboratory of Liaoning Province, Shenyang, 110005, China
| | - Jiangyue Zhao
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University,The Key Lenticular Laboratory of Liaoning Province, Shenyang, 110005, China
| | - Jun Xu
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University,The Key Lenticular Laboratory of Liaoning Province, Shenyang, 110005, China
| | - Jinsong Zhang
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, Eye Hospital of China Medical University,The Key Lenticular Laboratory of Liaoning Province, Shenyang, 110005, China.
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Cornut T, Touboul D, Rouglan S, Tellouck L, Tellouck J, Korobelnik JF, Schweitzer C. [Refractive outcomes and precision in toric intraocular lens alignment using an automated alignment system]. J Fr Ophtalmol 2018; 41:291-301. [PMID: 29685740 DOI: 10.1016/j.jfo.2017.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/16/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare precision in toric intraocular lens (TIOL) alignment and refractive outcomes between an intraoperative automated digital marker system and the conventional manual-ink marking. MATERIALS AND METHODS Prospective single center study including consecutive patients undergoing uneventful cataract surgery with corneal astigmatism greater than 1 diopter. Total corneal astigmatism was measured using a placido-dual Scheimpflug system (GalileiG4®, Ziemer). Acrysof® SN6AT (Alcon) TIOL's were implanted, and patients were divided into 2 groups, the digital group (Verion®, Alcon) and the ink-marking group (Pendular marker, AMO). Mean error in TIOL axis, visual acuity and residual astigmatism were analyzed at 3 days, one month and 6 months after surgery. RESULTS In total, 45 eyes of 30 patients were included (n=25 digital group, n=20 ink-marking group). The mean preoperative total corneal astigmatism was 1.71±0.53 diopters. At one month, there was a significantly lower mean average error in TIOL axis in the digital group compared to the ink-marking group (2.6±2.3° and 6.4±2.8° respectively, P=0.009). At 6months, these results remained statistically significant. Mean residual astigmatism was 0.7±0.4 diopters at one month, without significant difference between the two groups (P=0.9). The rate of misalignment less than or equal to 5° was 86 % (n=25) in the digital group and 63 % (n=20) in the ink-marking group (P=0.05). CONCLUSION Intraoperative digital marker system is associated with better TIOL alignment accuracy and better reproducibility than the manual ink-marking method.
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Affiliation(s)
- T Cornut
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; ISPED, université Bordeaux, 33000 Bordeaux, France.
| | - D Touboul
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; ISPED, université Bordeaux, 33000 Bordeaux, France
| | - S Rouglan
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France
| | - L Tellouck
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; ISPED, université Bordeaux, 33000 Bordeaux, France
| | - J Tellouck
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; ISPED, université Bordeaux, 33000 Bordeaux, France
| | - J-F Korobelnik
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; ISPED, université Bordeaux, 33000 Bordeaux, France; Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, université Bordeaux, 33000 Bordeaux, France
| | - C Schweitzer
- Service d'ophtalmologie, CHU de Bordeaux, 33000 Bordeaux, France; ISPED, université Bordeaux, 33000 Bordeaux, France; Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, université Bordeaux, 33000 Bordeaux, France
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Chang JSM. Femtosecond laser-assisted astigmatic keratotomy: a review. EYE AND VISION 2018; 5:6. [PMID: 29564359 PMCID: PMC5853056 DOI: 10.1186/s40662-018-0099-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/26/2018] [Indexed: 11/10/2022]
Abstract
Background Astigmatic keratotomy (AK) remains an accessible means to correct surgically induced or naturally occurring astigmatism. The advantages of femtosecond laser-assisted astigmatic keratotomy (FSAK) over conventional methods have been recognized recently. Main text This review evaluates the efficacy, complications, and different methods of FSAK for correction of astigmatism in native eyes and those that underwent previous penetrating keratoplasty (PKP). The penetrating and intrastromal FSAK (IFSAK) techniques can reduce post-keratoplasty astigmatism by 35.4% to 84.77% and 23.53% to 89.42%, respectively. In native eyes, the penetrating and IFSAK techniques reduce astigmatism by 26.8% to 58.62% and 36.3% to 58% respectively, implying that the magnitude of the astigmatic reduction is comparable between the two FSAK procedures. Nonetheless, IFSAK offers the additional advantages of almost no risk of infection, wound gape, and epithelial ingrowth. The use of nomograms, anterior-segment optical coherence tomography, and consideration of posterior cornea and corneal biomechanics are helpful to enhance the efficacy and safety of FSAK. The complications of FSAK in eyes that underwent PKP include overcorrection, visual loss, microperforations, infectious keratitis, allograft rejection, and endophthalmitis. The reported difficulties in native eyes include overcorrection, anterior gas breakthrough, and suction loss. Conclusions In eyes that underwent PKP, FSAK effectively reduces high regular or irregular astigmatism, with rare and manageable complications. Nevertheless, the drawbacks of the procedure include the potential loss of visual acuity and low predictability. For native eyes undergoing femtosecond laser-assisted cataract surgery, IFSAK is a good choice to correct low astigmatism (< 1.5 diopters). The refractive effect of astigmatism from the posterior cornea needs to be considered in the nomograms for native eyes undergoing refractive cataract surgery. To further improve the efficacy of FSAK, more large-scale randomized studies with longer follow-up are needed.
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Affiliation(s)
- John S M Chang
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, 8/F, Li Shu Pui Block, Phase II, 2 Village Road, Happy Valley, Hong Kong
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Christy JS, Nath M, Mouttapa F, Venkatesh R. Learning curve of femtosecond laser-assisted cataract surgery: Experience of surgeons new to femtosecond laser platform. Indian J Ophthalmol 2017; 65:683-689. [PMID: 28820153 PMCID: PMC5598178 DOI: 10.4103/ijo.ijo_258_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose of this study is to assess the learning curve in the initial 100 cases of cataract surgery performed using femtosecond laser-assisted cataract surgery (FLACS) by experienced cataract surgeons without prior experience in femtosecond laser platform. METHODS This study was conducted at tertiary care eye hospital, South India. This was a prospective interventional study. The first 100 consecutive eyes undergoing FLACS were studied to understand docking time, number of docking attempts, problems encountered during docking, and complications attributable to docking. Phacoemulsification performed after femtosecond laser was also studied for complications, need for additional instrumentation, and total time required for surgery. Comparison was also made between two operating surgeons. RESULTS Successful docking was recorded in 70% eyes at the first attempt. Mean time taken for successful docking was 9.3 ± 6.4 min (median = 6 min, interquartile range (IQR) = 5-10 min, range = 4-35 min). When surgeries were divided into quartiles, docking time reduced significantly from 16.2 ± 7.9 min in the first quartile to 6.2 ± 2.7 min in the fourth quartile (P < 0.001). Phacoemulsification postdocking required 12.9 ± 6.2 min (median = 10 min, IQR = 9-17.5 min). Six eyes showed anterior capsular tags, one had radial extension of capsulorhexis, and two eyes showed pupillary miosis after femtosecond laser application. At 6 weeks, 79% eyes attained uncorrected vision of 20/20, and all eyes had best-corrected vision of 20/20. CONCLUSION Approximately 25-30 cases were required before obtaining reproducible results with FLACS, irrespective of cataract surgical experience, suggesting that training programs must offer a minimum 25 surgeries. Very few complications occurred during the learning curve, making it patient friendly.
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Affiliation(s)
- Josephine Susai Christy
- Department of Cataract, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Puducherry, India
| | - Manas Nath
- Department of Cataract, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Puducherry, India
| | - Fredrick Mouttapa
- Department of Pediatric Ophthalmology and Squint, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Puducherry, India
| | - Rengaraj Venkatesh
- Department of Glaucoma, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Puducherry, India
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Baharozian CJ, Song C, Hatch KM, Talamo JH. A novel nomogram for the treatment of astigmatism with femtosecond-laser arcuate incisions at the time of cataract surgery. Clin Ophthalmol 2017; 11:1841-1848. [PMID: 29075096 PMCID: PMC5648302 DOI: 10.2147/opth.s141255] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to determine an arcuate incision (AI) nomogram to treat astigmatism during femtosecond laser-assisted cataract surgery. Methods This is a retrospective, cohort study. Femtosecond laser (FSL)-assisted transepithelial AIs were created at a 9.0 mm optical zone, 80% depth, centered on the limbus. We modified the manual Donnenfeld limbal relaxing incision nomogram to 70% for with-the-rule (WTR), 80% for oblique (OBL), and 100% for against-the-rule (ATR) astigmatism. The correction index (CI) equaled AI-induced astigmatism/target-induced astigmatism. Measures included preoperative keratometric corneal cylinder (Pre Kcyl), postoperative Kcyl (Post Kcyl), and postoperative residual refractive astigmatism (Post RRA). Results Mean Pre Kcyl and 1–2 months Post RRA in 161 eyes of 116 patients were 0.626±0.417 diopters (D) (range 0.5–2 D), and 0.495±0.400 D (range 0–1.5 D), respectively. Mean absolute astigmatic changes (Pre Kcyl–Post Kcyl) without accounting for axis change in the WTR, ATR, and OBL groups were 0.165±0.383 D (P<0.001), 0.374±0.536 D (P<0.001), and 0.253±0.416 D (P=0.02), respectively. Mean absolute astigmatic changes using RRA as the postoperative measurement (Pre Kcyl–Post RRA) without accounting for axis change were 0.440±0.461 D (P<0.001), 0.238±0.571 D (P<0.05), 0.154±0.450 (P=0.111) in WTR, ATR, and OBL groups, respectively. CIs for WTR, ATR, and OBL were 0.53, 1.01, and 0.95, respectively. There were no intraoperative or postoperative complications related to the AIs. Conclusion Transepithelial FSL-AIs using the modified Donnenfeld nomogram show potential for management of mild to moderate corneal astigmatism. An increase in the magnitude or reduction of the optical zone size for the treatment of WTR and ATR astigmatism for this nomogram may further improve refractive accuracy.
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Affiliation(s)
| | - Christian Song
- Massachusetts Eye and Ear Infirmary.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Kathryn M Hatch
- Massachusetts Eye and Ear Infirmary.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jonathan H Talamo
- Massachusetts Eye and Ear Infirmary.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Reinstein DZ, Archer TJ, Srinivasan S, Mamalis N, Kohnen T, Dupps WJ, Randleman JB. Standard for Reporting Refractive Outcomes of Intraocular Lens-Based Refractive Surgery. J Refract Surg 2017; 33:218-222. [PMID: 28407160 DOI: 10.3928/1081597x-20170302-01] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Löffler F, Böhm M, Herzog M, Petermann K, Kohnen T. Tomographic Analysis of Anterior and Posterior and Total Corneal Refractive Power Changes After Femtosecond Laser-Assisted Keratotomy. Am J Ophthalmol 2017; 180:102-109. [PMID: 28549845 DOI: 10.1016/j.ajo.2017.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze the effect of penetrating femtosecond laser-assisted keratotomy (pFLAK) during laser lens surgery on anterior and posterior corneal astigmatism and total corneal refractive power (TCRP) astigmatism (CAant, CApost, CATCRP) measured with Scheimpflug tomography. DESIGN Prospective, interventional case series. METHODS This institutional study included 27 eyes of 23 patients (aged 65 ± 8 years) with low-to-moderate CATCRP determined with Scheimpflug tomography (Pentacam HR; Oculus, Wetzlar, Germany) after penetrating femtosecond laser-assisted keratotomy (pFLAK) and laser lens surgery. The CAant, CApost, and CATCRP were determined before and 1 and 3 months after surgery. Vector analysis according to the Alpins method was used to calculate surgically induced astigmatism (SIA). RESULTS The mean preoperative CAant (0.97 ± 0.30 diopter [D]) was significantly reduced to 0.63 ± 0.34 D (P < .001). SIAant was 0.71 ± 0.37 D. The CApost showed no significant change, from preoperative 0.26 ± 0.12 D to 0.26 ± 0.10 D postoperatively (P = .625). In line with this finding, SIApost was low (0.12 ± 0.07 D). The CATCRP showed similar results as CAant. CONCLUSION pFLAKs planned according to Scheimpflug-based CATCRP result in a significant reduction of the CAant and CATCRP, but do not affect the posterior corneal curvature significantly, as measured by Scheimpflug tomography. Further research is required to develop a new valid nomogram for laser-assisted lens surgery.
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Affiliation(s)
- Franziska Löffler
- Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Myriam Böhm
- Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Michael Herzog
- Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Kerstin Petermann
- Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.
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Wang L, Jiang L, Hallahan K, Al-Mohtaseb ZN, Koch DD. Evaluation of Femtosecond Laser Intrastromal Incision Location Using Optical Coherence Tomography. Ophthalmology 2017; 124:1120-1125. [PMID: 28412070 DOI: 10.1016/j.ophtha.2017.03.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/10/2017] [Accepted: 03/10/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To use optical coherence tomography (OCT) to evaluate the femtosecond laser intrastromal incisions made during cataract surgery to reduce corneal astigmatism. DESIGN Retrospective case series. PARTICIPANTS Seventy-seven eyes of 77 patients. METHODS Paired intrastromal incisions were created using the Catalys femtosecond laser (Abbott Medical Optics, Inc., Santa Ana, CA). The planned intrastromal incision parameters were 20% uncut anterior, 20% uncut posterior, midpoint depth of 50%, and 90° side cut angle. Optical coherence tomography scans were obtained 3 weeks or more after surgery to assess these 4 parameters, and actual values were compared with intended values. MAIN OUTCOME MEASURES Percentages of uncut anterior and posterior tissue, midpoint depth, and degrees of side cut angle. RESULTS The mean values were 17.2±5.8% (range, 7.2%-36.9%) for uncut anterior, 32.5±8.8% (range, 6.0%-57.9%) for uncut posterior, and 42.3±6.6% (range, 25.5%-65.4%) for midpoint depth, which all were significantly different from the planned parameters (all P < 0.05). The mean side cut angle was 88.5°±5.6° (range, 71°-114°) and was significantly different from the planned side cut angle of 90° (P < 0.05). In 50 eyes that had paired intrastromal incisions scanned by the OCT, there was no correlation between the paired incisions for midpoint depth and side cut angle (correlation coefficient, r = -0.063 and -0.067, respectively; P > 0.05). CONCLUSIONS The intrastromal incision midpoint depth was significantly more anterior than the planned depth of 50%. The locations of paired intrastromal incisions in each eye were not correlated. Further improvements are needed to ensure the precise location of the intrastromal incisions made with this device.
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Affiliation(s)
- Li Wang
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Lai Jiang
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Katie Hallahan
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Zaina N Al-Mohtaseb
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Douglas D Koch
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.
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Reinstein DZ, Archer TJ, Srinivasan S, Mamalis N, Kohnen T, Dupps WJ, Randleman BJ. Standard for reporting refractive outcomes of intraocular lens–based refractive surgery. J Cataract Refract Surg 2017; 43:435-439. [DOI: 10.1016/j.jcrs.2017.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Blehm C, Potvin R. Pseudophakic astigmatism reduction with femtosecond laser-assisted corneal arcuate incisions: a pilot study. Clin Ophthalmol 2017; 11:201-207. [PMID: 28176960 PMCID: PMC5271394 DOI: 10.2147/opth.s127279] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to assess the effectiveness of the Verion-LenSx guided arcuate incision technique to reduce refractive astigmatism in a pseudophakic population. Patients and methods A prospective single-arm study was conducted in which one or both eyes of subjects required reduction of 1.0–2.0 D of refractive astigmatism after previous cataract surgery or refractive lens exchange. The surgeon used the refractive cylinder in the eye and the Woodcock astigmatism nomogram for preoperative planning, while the LenSx femtosecond laser with the Verion Image Guided System was used to create all arcuate incisions. The primary outcome measure was the uncorrected monocular distance visual acuity (UCVA). Secondary outcome measures included the change in corneal astigmatism, the change in refractive astigmatism, the best-corrected visual acuity and spectacle independence at distance from preoperative stage to 1 month and 2 months postoperatively. Results Twenty-eight eyes of 18 subjects were treated. The best-corrected visual acuity at the 2-month postoperative (PO) stage was not statistically significantly different from the preoperative visual acuity (0.02 logarithm of the minimum angle of resolution [logMAR] in both cases, P>0.05). Uncorrected visual acuity was statistically significantly better at the 2-month PO stage relative to the preoperative value (0.14 versus 0.34 logMAR, P<0.01). The mean change in refractive cylinder from the preoperative stage to the 2-month PO stage was 1.0 D. At the 2-month PO stage, two-thirds of the subjects (12/18) reported that they did not use glasses for distance vision and that their spectacle use for distance vision at 2 months was “lower” or “much lower” than the preoperative stage; in 71% of eyes (20/28), the residual refractive cylinder was ≤0.50 D. Vector changes in keratometric astigmatism were weakly associated with changes in refractive cylinder. Conclusion Arcuate incisions made with a femtosecond laser to treat moderate levels of residual refractive astigmatism after previous cataract surgery may reduce dependence on spectacles for distance vision.
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