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Pichardo-Loera NS, Corredor-Ortega C, Castro-Monreal MA, Massaro-Corredor MG, Pérez-Vázquez JF, Gonzalez-Salinas R. Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: A meta-analysis of randomized controlled trials. Eur J Ophthalmol 2024; 34:1458-1468. [PMID: 38291620 DOI: 10.1177/11206721241229129] [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] [Indexed: 02/01/2024]
Abstract
PURPOSE The main purpose of our study is to compare the adverse events occurrence, complications, and postoperative outcomes of Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification surgery (CPS) in adult patients undergoing cataract surgery. METHODS We conducted our research using PubMed, Scopus, and MEDLINE through EBSCOhost from 2012 to July 2022 with English and Spanish language restriction, including only Randomized Controlled Trials (RCTs). The PRISMA guidelines were observed for data abstraction, including a random-effects model for each outcome. RESULTS We analyzed 4844 eyes from 23 RCTs with some low risk of bias according to RoB 2 tool. We found statistically significant differences between the FLACS and CPS groups for the mean absolute error (MD = -0.12, 95% CI:-0.22-[-0.02], p = 0.01), the circularity of capsulorhexis (MD = 0.04, 95% CI: 0.04-0.05, p ≤ 0.00001), IOL centration (D = -0.07, 95% CI:-0.09-[-0.05], p ≤ 0.00001), CDE count (MD = -1.75, 95% CI: -2.75-[-0.74], p = 0.0006), mean phacoemulsification time (MD = -12.90, 95% CI:-20.89-[-4.92], p = 0.002), EPT (MD = -0.93, 95% CI: -1.68-[-0.019], p = 0.01) and endothelial cell density loss ((MD = -0.6, 95% CI: -1-[-0.19], p = 0.004). Also, the safety analysis showed a lower incidence of posterior capsule tear (PCT) in the FLACS group (OR =0.29, 95% CI: 0.09-1, p = 0.05). CONCLUSIONS Our results suggest that FLACS might be helpful for patients with relatively dense cataracts and low preoperative endothelial cell values.
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Affiliation(s)
| | - Claudia Corredor-Ortega
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
| | | | | | | | - Roberto Gonzalez-Salinas
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
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Asif MI, Sinha R, Anjum S, Sahay P, Singh R, Agarwal T, Sharma N, Titiyal JS. Comparison of clinical outcomes between femtosecond laser-assisted cataract surgery versus conventional phacoemulsification in vitrectomized eyes - A prospective interventional study. Indian J Ophthalmol 2024; 72:1285-1290. [PMID: 38770603 DOI: 10.4103/ijo.ijo_1804_23] [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: 07/09/2023] [Accepted: 02/23/2024] [Indexed: 05/22/2024] Open
Abstract
PURPOSE To compare the clinical outcomes and surgical safety between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS) in vitrectomized eyes. METHODS A prospective interventional comparative study was conducted at a tertiary eye care center. Sixty consecutive cases requiring cataract surgery following pars plana vitrectomy were allocated into Group 1 ( n = 30), who underwent FLACS with intraocular lens implantation, and Group 2 ( n = 30), who underwent CPCS with intraocular lens implantation, and followed up for 3 months. Primary outcome measures were intraoperative ultrasonic cumulative dissipated energy (CDE) and intraoperative and postoperative complications. The secondary outcome measures were postoperative changes in endothelial cell count (ECC) and central corneal thickness (CCT). RESULTS Baseline corrected distance visual acuity (CDVA), ECC, and CCT were comparable. Intraoperative CDE was significantly less in the FLACS group (8.11 vs. 15.83 percentage seconds; P = 0.012) with no intraoperative complication in either group. The postoperative CDVA was comparable between the groups with a trend toward earlier visual recovery in the FLACS group. The postoperative day (POD) 1 endothelial cell loss was higher in the CPCS group (7.54% vs. 2.05%), with the mean endothelial cell density being significantly higher in the FLACS group throughout the follow-up period ( P < 0.05). POD-1 corneal edema was higher in the CPCS group compared to FLACS with no significant difference on follow-up. Intraoperative migration of silicone oil to the anterior chamber was observed in 40% versus 0% in the CPCS versus FLACS groups, respectively. CONCLUSION FLACS can be safely performed in post-vitrectomy eyes with lesser intraoperative ultrasonic energy used, postoperative endothelial cell loss, and change in CCT compared to CPCS.
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Affiliation(s)
- Md Ibrahime Asif
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Song X, Li L, Zhang X, Ma J. Comparing the efficacy and safety between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00172-8. [PMID: 39043258 DOI: 10.1016/j.jcjo.2024.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/18/2024] [Accepted: 05/27/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To investigate the efficacy and safety of femtosecond laser-assisted cataract surgery (FLACS) compared with conventional phacoemulsification cataract surgery (CPCS). METHODS Randomized controlled trials (RCTs) were systematically searched in PubMed, Embase, Cochrane Library, ClinicalTrials.gov, CNKI, and Wanfang. Main outcomes were visual acuity, capsulotomy parameters, effective lens position, and complications. Secondary outcomes included refractive outcomes, intraoperative parameters, and corneal parameters. RESULTS In total, 41 RCTs involving 9310 eyes were included. There was a statistically significant difference in favour of FLACS over CPCS for uncorrected distance visual acuity at 12 months (mean difference [MD] -0.03; 95% CI -0.05 to -0.01); corrected distance visual acuity at 1 week (MD -0.05; 95% CI -0.07 to -0.02) and 12 months (MD -0.02; 95% CI -0.04 to -0.00); area of capsulotomy at 1 month (MD 4.04 mm2; 95% CI 3.45-4.64) and 6 months (MD 5.02 mm2; 95% CI 3.28-6.77); and intraocular lens centroid-pupil centroid distance at 1 week (MD -0.06 mm; 95% CI -0.08 to -0.05), 1 month (MD -0.07 mm; 95% CI -0.09 to -0.06), and 6 months (MD -0.06 mm; 95% CI -0.07 to -0.04). With regard to surgical complications, FLACS was less than CPCS for the incidence of decentred IOL (odds ratio 0.06; 95% CI 0.01-0.24). However, FLACS did not increase the incidence of other intraoperative or postoperative complications except subconjunctival hemorrhage. CONCLUSIONS Both FLACS and CPCS are effective and safe. FLACS achieves better visual outcomes in the early postoperative period and long-term follow-up, accompanied by more accurate capsulotomy and more optimized effective lens position than CPCS. However, no difference of visual outcomes was found after middle-term follow-up.
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Affiliation(s)
- Xinzhi Song
- Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, China.
| | - Ling Li
- Gansu University Key Laboratory for Molecular Medicine & Chinese Medicine Prevention and Treatment of Major Diseases, Gansu University of Chinese Medicine, Lanzhou, China.
| | - Xuemei Zhang
- Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, China
| | - Jianjun Ma
- Department of Ophthalmology, Gansu Provincial Hospital, Lanzhou, China
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Zhang X, Xu W, Shentu X, Chen P, Yu Y, Lai K, Li J, Wang W, Chen X, Yao K. Incidence and analysis of intraoperative complications in femtosecond laser-assisted cataract surgery: a large-scale cohort study to establish the learning curve. Br J Ophthalmol 2024:bjo-2023-323897. [PMID: 38589209 DOI: 10.1136/bjo-2023-323897] [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: 05/09/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
AIMS To assess the safety of femtosecond laser-assisted cataract surgery (FLACS) based on surgical parameters and intraoperative complications analysis and to determine the length of the learning curve for FLACS. METHODS A prospective consecutive cohort study was conducted on Chinese patients who underwent either FLACS (3289 cases) or contemporaneous conventional phacoemulsification cataract surgery (2130 cases). The laser group was divided into four subgroups in chronological order. We recorded intraoperative complication incidences and compared with surgical parameters between groups. Subgroup analysis was conducted to explore the learning curve of FLACS. RESULTS The laser group had a 4.93% incidence of incomplete capsulotomies and a 1.22% incidence of anterior capsule tears. Subgroup analysis showed significant differences in 8 aspects between the first 250 cases (50 cases per surgeon) and the last 2539 cases, but only 2 aspects differed between the second 250 cases (50 cases per surgeon) and the last 2539 cases. There were no significant differences between the third 250 cases (50 cases per surgeon) and the last 2539 cases. CONCLUSIONS The intraoperative complications of FLACS were reported, and the learning curve is associated with a significant reduction in the incidence of intraoperative complications. The length of the basic learning curve of FLACS is 100 cases, and the length of the advanced learning curve was 150 cases. This study demonstrated that FLACS is characterised by a relatively straightforward and secure operative technique.
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Affiliation(s)
- Xiaobo Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wen Xu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xingchao Shentu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yibo Yu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kairan Lai
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiayong Li
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Wang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinyi Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Narayan A, Evans JR, O'Brart D, Bunce C, Gore DM, Day AC. Laser-assisted cataract surgery versus standard ultrasound phacoemulsification cataract surgery. Cochrane Database Syst Rev 2023; 6:CD010735. [PMID: 37369549 PMCID: PMC10288823 DOI: 10.1002/14651858.cd010735.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Cataract is the leading cause of blindness in the world and, as such, cataract surgery is one of the most commonly performed operations globally. Surgical techniques have changed dramatically over the past half century with associated improvements in outcomes and safety. Femtosecond lasers can be used to perform the key steps in cataract surgery, such as corneal incisions, lens capsulotomy and fragmentation. The potential advantage of femtosecond laser-assisted cataract surgery (FLACS) is greater precision and reproducibility of these steps compared to manual techniques. The disadvantages are the costs associated with FLACS technology. OBJECTIVES To compare the effectiveness and safety of FLACS with standard ultrasound phacoemulsification cataract surgery (PCS) by gathering evidence from randomised controlled trials (RCTs). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2022, Issue 5); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov; the WHO ICTRP and the US Food and Drug Administration (FDA) website. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 10 May 2022. SELECTION CRITERIA We included RCTs where FLACS was compared to PCS. DATA COLLECTION AND ANALYSIS Three review authors independently screened the search results, assessed risk of bias and extracted data using the standard methodological procedures expected by Cochrane. The primary outcome for this review was intraoperative complications in the operated eye, namely anterior capsule, and posterior capsule tears. The secondary outcomes included corrected distance visual acuity (CDVA), quality of vision (as measured by any validated patient-reported outcome measure (PROM)), postoperative cystoid macular oedema complications, endothelial cell loss and cost-effectiveness. We assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 42 RCTs conducted in Europe, North America, South America and Asia, which enrolled a total of 7298 eyes of 5831 adult participants. Overall, the studies were at unclear or high risk of bias. In 16 studies the authors reported financial links with the manufacturer of the laser platform evaluated in their studies. Thirteen of the studies were within-person (paired-eye) studies with one eye allocated to one procedure and the other eye allocated to the other procedure. These studies were reported ignoring the paired nature of the data. There was low-certainty evidence of little or no difference in the odds of developing anterior capsular tears when comparing FLACS and PCS (Peto odds ratio (OR) 0.83, 95% confidence interval (CI) 0.40 to 1.72; 5835 eyes, 27 studies) There was one fewer anterior capsule tear per 1000 operations in the FLACS group compared with the PCS group (95% CI 4 fewer to 3 more). There was low-certainty evidence of lower odds of developing posterior capsular tears with FLACS compared to PCS (Peto OR 0.50, 95% CI 0.25 to 1.00; 5767 eyes, 26 studies). There were four fewer posterior capsule tears per 1000 operations in the FLACS group compared with the PCS group (95% CI 6 fewer to same). There was moderate-certainty evidence of a very small advantage for the FLACS arm with regard to CDVA at six months or more follow-up, (mean difference (MD) -0.01 logMAR, 95% CI -0.02 to 0.00; 1323 eyes, 7 studies). This difference is equivalent to 1 logMAR letter between groups and is not thought to be clinically important. From the three studies (1205 participants) reporting a variety of PROMs (Cat-PROMS, EQ-5D, EQ-SD-3L, Catquest9-SF and patient survey) up to three months following surgery, there was moderate-certainty evidence of little or no difference in the various parameters between the two treatment arms. There was low-certainty evidence of little or no difference in the odds of developing cystoid macular oedema when comparing FLACS and PCS (Peto OR 0.84, 95% CI 0.56 to 1.28; 4441 eyes, 18 studies). There were three fewer cystoid macular oedema cases per 1000 operations in the FLACS group compared with the PCS group (95% CI 10 fewer to 6 more). In one study the incremental cost-effectiveness ratio (ICER) (cost difference divided by quality-adjusted life year (QALY) difference) was GBP £167,620 when comparing FLACS to PCS. In another study, the ICER was EUR €10,703 saved per additional patient who had treatment success with PCS compared to FLACS. Duration ranged from three minutes in favour of FLACS to eight minutes in favour of PCS (I2 = 100%, 11 studies) (low-certainty evidence). There was low-certainty evidence of little or no important difference in endothelial cell loss when comparing FLACS with PCS (MD 12 cells per mm2 in favour of FLACS, 95% CI -40 to 64; 1512 eyes, 10 studies). AUTHORS' CONCLUSIONS: This review of 42 studies provides evidence that there is probably little or no difference between FLACS and PCS in terms of intraoperative and postoperative complications, postoperative visual acuity and quality of life. Evidence from two studies suggests that FLACS may be the less cost-effective option. Many of the included studies only investigated very specific outcome measures such as effective phacoemulsification time, endothelial cell count change or aqueous flare, rather than those directly related to patient outcomes. Standardised reporting of complications and visual and refractive outcomes for cataract surgery would facilitate future synthesis, and guidance on this has been recently published.
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Affiliation(s)
- Akshay Narayan
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London Medical School, London, UK
| | - Jennifer R Evans
- Cochrane Eyes and Vision, Queen's University Belfast, Belfast, UK
| | - David O'Brart
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Catey Bunce
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel M Gore
- Anterior Segment, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Alexander C Day
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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Slezak F, Thumann G, Kropp M, Cvejic Z, De Clerck EEB, Bravetti GE, Guber I, Pajic B. Comparison of Conventional and Femtosecond Laser-Assisted Cataract Surgery Regarding Macula Behavior and Thickness. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040639. [PMID: 37109597 PMCID: PMC10145739 DOI: 10.3390/medicina59040639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/05/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023]
Abstract
Background: The aim of the study was to compare macular thickness behavior and clinical outcomes after femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification conventional surgery (PCS). Methods: Macular Optical Coherence Tomography OCT was analyzed in 42 patients preoperatively, 1 day, 12 days, 4 weeks and 6 weeks postoperatively according to the 9-field Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Clinical findings were collected in both the FLACS group and the PCS group. Results: There was no significant difference in macular thickness between the FLACS and PCS groups (p > 0.05). However, from postoperative day 12 onwards, there was a significant increase in macular thickness observed in both groups (p < 0.001). In the FLACS group, a significant increase in visual acuity was observed on the first postoperative day, as compared to the PCS group (p = 0.006). Conclusions: The use of a low-energy high-frequency femtosecond laser has potentially no effect on postoperative macular thickness. In the FLACS group, visual rehabilitation was significantly faster as compared to the PCS group. No complications occurred intraoperatively in either group.
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Affiliation(s)
- Filip Slezak
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
| | - Gabriele Thumann
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Martina Kropp
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Zeljka Cvejic
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
| | - Eline Elodie Barbara De Clerck
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Giorgio Enrico Bravetti
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Ivo Guber
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Bojan Pajic
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
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Ao M, Shi H, Li X, Huang H, Ao Y, Wang W. Effects of visual restoration on gait performance and kinematics of lower extremities in patients with age-related cataract. Chin Med J (Engl) 2023; 136:596-603. [PMID: 36877988 PMCID: PMC10106207 DOI: 10.1097/cm9.0000000000002509] [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: 07/04/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Visual inputs are critical for locomotor navigation and sensorimotor integration in the elderly; however, the mechanism needs to be explored intensively. The present study assessed the gait pattern after cataract surgery to investigate the effects of visual restoration on locomotion. METHODS The prospective study recruited 32 patients (70.1 ± 5.2 years) with bilateral age-related cataracts in the Department of Ophthalmology at Peking University Third Hospital from October 2016 to December 2019. The temporal-spatial gait parameters and kinematic parameters were measured by the Footscan system and inertial measurement units. Paired t -test was employed to compare data normally distributed and Wilcoxon rank-sum test for non-normally distributed. RESULTS After visual restoration, the walking speed increased by 9.3% (1.19 ± 0.40 m/s vs. 1.09 ± 0.34 m/s, P =0.008) and exhibited an efficient gait pattern with significant decrease in gait cycle (1.02 ± 0.08 s vs. 1.04 ± 0.07 s, P =0.012), stance time (0.66 ± 0.06 s vs. 0.68 ± 0.06 s, P =0.045), and single support time (0.36 ± 0.03 s vs. 0.37 ± 0.02 s, P =0.011). High amplitude of joint motion was detected in the sagittal plane in the left hip (37.6° ± 5.3° vs. 35.5° ± 6.2°, P =0.014), left thigh (38.0° ± 5.2° vs. 36.4° ± 5.8°, P =0.026), left shank (71.9° ± 5.7° vs. 70.1° ± 5.6°, P =0.031), and right knee (59.1° ± 4.8° vs. 56.4° ± 4.8°, P =0.001). The motor symmetry of thigh improved from 8.35 ± 5.30% to 6.30 ± 4.73% ( P =0.042). CONCLUSIONS The accelerated gait in response to visual restoration is characterized by decreased stance time and increased range of joint motion. Training programs for improving muscle strength of lower extremities might be helpful to facilitate the adaptation to these changes in gait.
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Affiliation(s)
- Mingxin Ao
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Huijuan Shi
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China
| | - Xuemin Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Hongshi Huang
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China
| | - Yingfang Ao
- Department of Sports Medicine, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China
| | - Wei Wang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
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Chang P, Zhang F, Li H, Liu Z, Li S, Qian S, Zhao Y. Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification Surgery: Clinical Outcomes with EDOF IOLs. J Pers Med 2023; 13:jpm13030400. [PMID: 36983582 PMCID: PMC10056641 DOI: 10.3390/jpm13030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
In this study, we evaluate and compare the outcomes of conventional phacoemulsification cataract surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS) with the implantation of an extended depth of field (EDOF) intraocular lens (IOL). A prospective, consecutive cohort study was conducted. Patients were given the option to choose FLACS or CPS and were implanted with an EDOF IOL. Refractive data, visual acuity data, ocular aberration measured with a wavefront aberrometer, and optical quality measured with an optical quality analysis system II were collected at one month postoperatively. A total of 92 eyes of 64 patients were enrolled in this study; 35 eyes of 26 patients were treated with FLACS, whereas 57 eyes of 38 patients were treated with CPS. Uncorrected visual acuity at far, intermediate, and near distance and best-spectacle-corrected visual acuity were not statistically significantly different between the groups (all p > 0.05), nor were the mean cylinder and mean spherical equivalent refraction (both p > 0.05). The FLACS group had a lower ocular trefoil than the CPS group (p = 0.033), and there was no significant difference between the two groups considering other aberration parameters, whether ocular or internal (all p > 0.05). Optical-quality-related parameters showed also no significant difference between the two groups (all p > 0.05). In conclusion, there was no significant difference between FLACS and CPS with implantation of EDOF IOLs in postoperative ocular parameters, refractive outcomes, ocular aberration, optical quality, and aberration parameters, except a lower ocular trefoil in the FLACS group. In terms of these indicators, FLACS does not provide an additional clinical benefit for patients over CPS.
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Affiliation(s)
- Pingjun Chang
- Department of Ophthalmology, Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou 325027, China
| | - Fan Zhang
- Department of Ophthalmology, Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou 325027, China
| | - Hongzhe Li
- Department of Ophthalmology, Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou 325027, China
| | - Zhuohan Liu
- Department of Ophthalmology, Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou 325027, China
| | - Siyan Li
- Department of Ophthalmology, Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou 325027, China
| | - Shuyi Qian
- Department of Ophthalmology, Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou 325027, China
| | - Yune Zhao
- Department of Ophthalmology, Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Key Laboratory of Vision Science, Ministry of Health, Wenzhou 325027, China
- Correspondence:
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Furino C, Niro A, Reibaldi M, Boscia F, Alessio G. Dexamethasone intravitreal implant along with femtosecond laser assisted cataract surgery in patients with diabetic macular edema and cataract. Eur J Ophthalmol 2022; 33:1425-1433. [PMID: 36567493 DOI: 10.1177/11206721221146328] [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: 12/27/2022]
Abstract
PURPOSE To assess the safety and efficacy of intraoperative dexamethasone intravitreal (DEX) implant in patients with diabetic macular edema (DME) undergoing femtosecond laser assisted cataract surgery (FLACS). METHODS In this single-center retrospective study, the charts of patients who underwent combined FLACS and DEX implant in the previous three months were reviewed. Primary outcome measures were ocular complications; secondary outcome measures were the change of best-corrected visual acuity (BCVA) and central retinal thickness (CRT). RESULTS 20 eyes of 20 patients were included. None developed intraoperative or postoperative complications. Mean BCVA was 20/120 (logMAR, 0.78 ± 0.31) at baseline and improved significantly to 20/63 (logMAR, 0.52 ± 0.24; p = 0.01), 20/58 (LogMAR, 0.48 ± 0.28; p < 0.001) and to 20/58 (LogMAR, 0.48 ± 0.31; p < 0.001) at month 1,2 and 3, respectively. A mean improvement of 0.30 LogMAR was recorded at month 1 and 3. Mean CRT decreased significantly from 416.6 ± 76.1 μm at baseline to 322.4 ± 46.4 μm (p < 0.001), to 300.7 ± 29.7 μm (p < 0.001), and to 319.8 ± 54.7 μm (p < 0.001) at month 1,2 and 3, respectively. Comparing to the 1-month follow-up, the largest mean reduction in CRT (112.4 ± 68.9 µm) was observed at month 2 (p = 0.001). Fourteen patients (70%) had an improvement of CRT over the first 2 months followed by a recurrence of edema at month 3. CONCLUSION DEX implant following FLACS seems to be a safe and effective approach for patients with coexisting cataract and DME.
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Affiliation(s)
- Claudio Furino
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS. ANNUNZIATA", 170130ASL TA, Taranto, Italy
| | | | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
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10
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Mrugacz M, Olszewski M, Pony-Uram M, Brymerski J, Bryl A. Assessment of the Refractive Error and Stabilisation of Refraction after Cataract Surgery in Relation to the Length of the Eyeball. J Clin Med 2022; 11:jcm11185447. [PMID: 36143091 PMCID: PMC9506347 DOI: 10.3390/jcm11185447] [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: 07/27/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to analyse the changes in refraction, depending on the length of the eyeball, in patients who had undergone cataract surgery using the phacoemulsification method and to assess the stability of refraction. A total of 90 patients (46 to 85 years of age) took part in the study and were divided into three groups: emmetropic, hypermetropic, and myopic. Two types of intraocular lenses were used: Bausch (Akreos AO) and Rayner (C-flex). In conclusion, stabilization of refraction was achieved in the third week in 91% of the emmetropic, 77% of the myopic, and 46% of the hypermetropic patients, respectively. The correct postoperative refraction was achieved using optical biometry and the Barrett Universal II formula to calculate the power of the lens implant.
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Affiliation(s)
- Małgorzata Mrugacz
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
| | - Mateusz Olszewski
- Department of Ophthalmology, Subcarpathian Hospital in Krosno, Korczynska 57, 38-400 Krosno, Poland
| | - Magdalena Pony-Uram
- Department of Ophthalmology, Subcarpathian Hospital in Krosno, Korczynska 57, 38-400 Krosno, Poland
- Correspondence:
| | - Jacek Brymerski
- Department of Ophthalmology, Subcarpathian Hospital in Krosno, Korczynska 57, 38-400 Krosno, Poland
| | - Anna Bryl
- Department of Ophthalmology and Eye Rehabilitation, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
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11
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Guo Y, Kratky V, Xie H, Shentu X, Man X, Wang Y, Wen W, Rokohl AC, Heindl LM. Grand Challenges and Opportunities in Surgical Ophthalmology: Together for a Shared Future. FRONTIERS IN OPHTHALMOLOGY 2022; 2:922240. [PMID: 38983527 PMCID: PMC11182242 DOI: 10.3389/fopht.2022.922240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/06/2022] [Indexed: 07/11/2024]
Affiliation(s)
- Yongwei Guo
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University Eye Hospital, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Vladimir Kratky
- Department of Ophthalmology, Queen's University, Kingston, ON, Canada
| | - Huatao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingchao Shentu
- Eye Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University Eye Hospital, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xiaofei Man
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China
| | - Wen Wen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
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12
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Romero Valero D, Escolano Serrano J, Monera Lucas CE, Castilla Martínez G, Martínez Toldos JJ. Limits of the precision in refractive results after cataract surgery. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:370-375. [PMID: 35624062 DOI: 10.1016/j.oftale.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 11/10/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE In order to improve refractive results in cataract surgery with an intraocular lens implant, it is important to know the sources of error as well as the limit of this process. Therefore, the objective of the present work is to approximate the theoretical limit in the precision in the refractive result after cataract surgery with the currently available means and to assess the impact of different sources of error in this process. MATERIALS AND METHODS We conducted a search of the literature to determine the variability provided by each component of the process. Based on the Barrett Universal-II formula, we performed an error propagation analysis. The theoretical limit was defined as the situation in which the refractive result is only affected by the variability in the parameters introduced in the formula, the tolerance of the intraocular lens and the subjective refraction. RESULTS The main contributors to the error were (1) intraoperative and postoperative variability variables not considered by the formulas (49.33%), (2) postoperative subjective refraction (38.29%), (3) mean keratometry (5.98%) and (4) the variability in the labelling of the power of the intraocular lens (5.09%). The theoretical limit obtained for the intraocular lens calculation with the means available today was 91.9% of the eyes between ±0.50D. CONCLUSIONS We found a theoretical limit for the intraocular lens calculation of 91.9% of the eyes between ±0.50D. Approaching the precision limit described in the study requires the use of optical biometrics and state-of-the-art formulas, a reproducible surgical technique, and the compensation of systematic errors by adjusting constants.
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Affiliation(s)
- D Romero Valero
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain.
| | - J Escolano Serrano
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - C E Monera Lucas
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - G Castilla Martínez
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - J J Martínez Toldos
- Servicio de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain
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Xu J, Chen X, Wang H, Yao K. Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: A meta-analysis and systematic review. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100027. [PMID: 37846222 PMCID: PMC10577854 DOI: 10.1016/j.aopr.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 10/18/2023]
Abstract
Purpose To compare the complications of femtosecond laser-assisted cataract surgery (FLACS) with those of conventional phacoemulsification surgery (CPS) for age-related cataracts. Methods PubMed, Cochrane Library, and EMBASE were systematically searched for studies comparing FLACS and CPS. Outcomes were operative complications, including the intraoperative capsule tear, postoperative corneal edema, macular edema, uncontrolled IOP, etc. The effect measures were weighted with odds ratios with 95% CIs. Results Nineteen RCTs and 18 cohort studies, including 24,806 eyes (11,375 of the FLACS group and 13,431 of the CPS group), were identified. There were no significant differences between the two groups in anterior capsule tear, corneal edema, macular edema, uncontrolled IOP, vitreous loss, posterior vitreous detachment, etc. Posterior capsule tear rate showed a significantly lower in RCT subgroups (P = 0.04) and without differences in total (P = 0.63). Significant differences were observed in the incidence of descemet membrane tear/trauma (P = 0.02) and IFIS/iris trauma (P = 0.04. Additionally, The FLACS specific complications showed a significantly higher rate of miosis (P < 0.0001), corneal epithelial defect (P = 0.001), corneal haze (P = 0.002), and subconjunctival hemorrhage (P = 0.01). Conclusions FLACS maintains the same safety compared with CPS in terms of all intraoperative and postoperative complications. Although FLACS did show a statistically significant difference for several FLACS specific complications, it would not influence the visual outcome and heal itself.
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Affiliation(s)
| | | | | | - Ke Yao
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
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14
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Koo EH, Bolton EM, Vanner EA, Eghrari AO, Donaldson KE. Outcomes of Femtosecond Laser-Assisted Cataract Surgery Compared to Conventional Phacoemulsification in Eyes with Pseudoexfoliation Syndrome. Semin Ophthalmol 2022; 37:631-636. [PMID: 35345981 DOI: 10.1080/08820538.2022.2051054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To compare the outcomes including complications, in a large cohort of eyes with pseudoexfoliation syndrome that underwent Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification. DESIGN Retrospective cohort study. PARTICIPANTS A total of 513 eyes from 366 patients with pseudoexfoliation syndrome that underwent cataract surgery between April 1, 2014, and December 31, 2018. METHODS Charts were reviewed for preoperative examination findings, intraoperative complications, and post-operative outcomes. Best-corrected visual acuity (BCVA) was measured by logMAR and compared between groups at one month and the final follow-up visit. RESULTS Of 513 eyes, 71 (13.8%) underwent FLACS, and 442 (86.2%) eyes underwent conventional cataract surgery. Between the two groups, there was no difference in the incidence of vitreous prolapse, capsular tear, pupillary expansion device usage, capsular tension support device usage, or postoperative cystoid macular edema (p > .05 for all). At the final visit, there was no significant difference in BCVA between FLACS and conventional phacoemulsification groups (mean logMAR 0.26 vs. 0.25, p = .87). CONCLUSIONS When comparing FLACS and conventional phacoemulsification in eyes with pseudoexfoliation syndrome, no difference was seen in the incidence of complications. BCVA was comparable between the two groups. Zonular weakness significantly increased the risk of complications in both groups.
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Affiliation(s)
- Ellen H Koo
- Department of Ophthalmology, Bascom Palmer Eye InstituteUniversity of Miami Miller School of Medicine, Miami, FL, United States
| | - Elizabeth M Bolton
- Department of Ophthalmology, Bascom Palmer Eye InstituteUniversity of Miami Miller School of Medicine, Miami, FL, United States
| | - Elizabeth A Vanner
- Department of Ophthalmology, Bascom Palmer Eye InstituteUniversity of Miami Miller School of Medicine, Miami, FL, United States
| | - Allen O Eghrari
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kendall E Donaldson
- Department of Ophthalmology, Bascom Palmer Eye InstituteUniversity of Miami Miller School of Medicine, Miami, FL, United States
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15
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Liu YC, Setiawan M, Chin JY, Wu B, Ong HS, Lamoureux E, Mehta JS. Randomized Controlled Trial Comparing 1-Year Outcomes of Low-Energy Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification. Front Med (Lausanne) 2022; 8:811093. [PMID: 34977102 PMCID: PMC8718704 DOI: 10.3389/fmed.2021.811093] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose: To compare 1-year clinical outcomes, phacoemulsification energy, aqueous profiles, and patient-reported outcomes of low-energy femtosecond laser-assisted cataract surgery (FLACS) vs. conventional phacoemulsification. Methods: The study is a randomized controlled trial (RCT) with paired-eye design. Eighty-five patients were randomized to receive FLACS (Ziemer LDV Z8) in one eye and conventional phacoemulsification in the fellow eye. Clinical data including phacoemulsification energy parameters (cumulative dissipated energy, phacoemulsification power, and phacoemulsification time), uncorrected and corrected distance visual acuities (UCDVA and BCDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness (CCT), endothelial cell count (ECC), anterior chamber flare, and post-operative complications were obtained for 1 year. Aqueous humor was collected for the analysis of prostaglandin (PGE)2, cytokines and chemokines concentrations. Patients' reported-outcomes on surgical experiences were evaluated using an in-house questionnaire. Results: Compared to conventional phacoemulsification, the low-energy assisted FLACS group had significantly less ECC reduction at 3 months (1.5 ± 0.3% vs. 7.0 ± 2.4%; P < 0.01) and 1 year (8.2 ± 2.8% vs. 11.2 ± 3.6%; P = 0.03). There were no significant differences in the phacoemulsification energy parameters, UCDVA, BCDVA, MRSE, CCT, occurrence of post-operative complications between the 2 groups throughout post-operative 1 year. Patients' subjective surgical experiences, including the surgical duration and perceived inconvenience, were comparable between the 2 groups. FLACS resulted in significantly higher aqueous PGE2 (P < 0.01), interleukin (IL)-6 (P = 0.03), IL-8 (P = 0.03), and interferon (IFN)-γ (P = 0.04) concentrations and greater anterior chamber flare at 1 day (P = 0.02). Conclusions: Our RCT presented 1-year longitudinal clinical and laboratory data. The long-term ECC result was more favorable in low-energy FLACS. The rest of the intraoperative and post-operative outcomes, as well as patient-reported outcomes, were comparable between these two procedures.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Melina Setiawan
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Jia Ying Chin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Benjamin Wu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Hon Shing Ong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Population Health Group, Singapore Eye Research Institute, Singapore, Singapore.,Health Services and System Research Department, Population Health Research, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
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16
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Tverdova DV, Kopaev SY. [Historical development of energetic cataract surgery]. Vestn Oftalmol 2022; 138:88-94. [PMID: 35801886 DOI: 10.17116/oftalma202213803188] [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] [Indexed: 06/15/2023]
Abstract
This article reviews scientific literature analyzing the history of ultrasound and laser phaco surgery of combined or isolated designs: erbium YAG laser, 1.064 μm Nd:YAG laser for dissection of the lens capsule and nucleus, exclusively-laser technique of lens destruction with 1.44 µm Nd:YAG laser without manual, vacuum or ultrasonic action, femtosecond laser assistance with automated transcorneal delivery of radiation into the eye cavity.
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Affiliation(s)
- D V Tverdova
- Krasnodar branch of S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Krasnodar, Russia
| | - S Yu Kopaev
- S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Moscow, Russia
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17
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Donmez O, Asena BS, Aydin Akova Y. Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery. Eur J Ophthalmol 2021; 32:2225-2233. [PMID: 34528478 DOI: 10.1177/11206721211046496] [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: 11/16/2022]
Abstract
PURPOSE To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS). METHODS This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group. RESULTS The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group (p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and -1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos. CONCLUSIONS This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients' satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.
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Affiliation(s)
- Oya Donmez
- Tinaztepe University Galen Hospital, Izmir, Turkey
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18
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Koo EH, Paranjpe V, Feuer WJ, Persad PJ, Donaldson KE. Refractive Outcomes in Fuchs' Endothelial Corneal Dystrophy: Conventional and Femtosecond Laser-Assisted Cataract Surgery. Clin Ophthalmol 2021; 15:3419-3429. [PMID: 34408397 PMCID: PMC8367218 DOI: 10.2147/opth.s309869] [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: 03/06/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the refractive outcomes of eyes with Fuchs’ endothelial corneal dystrophy (FECD) following phacoemulsification. Methods This is a retrospective chart review of patients with FECD who underwent phacoemulsification. Manifest refraction at the early postoperative period (1–6 weeks) and late postoperative period (3–12 months) was collected. The spherical equivalent (SE) and variance of SE from target in diopters (D) were analyzed. Results A total of 219 eyes from 175 FECD patients (73 FLACS, 146 conventional phacoemulsification) were included. In the early postoperative period, when comparing variance from intended target, 62% (n=126) had a SE variance of ≤0.5 D, 22% (n=44) >0.5 D and ≤1 D, and 17% (n=34) >1 D. In the late postoperative period, 62% (n=85) had a SE variance of ≤0.5 D, 19% (n=26) >0.5 D and ≤1 D, and 20% (n=27) >1 D. There was no difference in the variance of SE comparing FLACS versus conventional phacoemulsification in either the early postoperative period (p=0.78) or the late postoperative period (p=0.29). Conclusion Patients with mild-to-moderate FECD had favorable refractive outcomes with phacoemulsification. There was no difference in refractive outcomes in eyes with FECD between the group that underwent FLACS versus the group that underwent conventional phacoemulsification.
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Affiliation(s)
- Ellen H Koo
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Vikram Paranjpe
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - William J Feuer
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Patrice J Persad
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Kendall E Donaldson
- Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, FL, USA
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Chen L, Hu C, Lin X, Li HY, Du Y, Yao YH, Chen J. Clinical outcomes and complications between FLACS and conventional phacoemulsification cataract surgery: a PRISMA-compliant Meta-analysis of 25 randomized controlled trials. Int J Ophthalmol 2021; 14:1081-1091. [PMID: 34282395 DOI: 10.18240/ijo.2021.07.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To update and investigate the clinical outcomes and complications between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). METHODS A Meta-analysis was performed using databases, including Pubmed, Embase, and the Cochrane library. At least one of the clinical outcomes and/or complications data in each included randomized controlled trials (RCT) was reported. The quality of the RCT was assessed with the Cochrane risk assessments tool. RESULTS Overall, 25 RCTs including 3781 eyes were included. No statistically significant difference detected between FLACS and CPCS in terms of corrected distant visual acuity (CDVA), uncorrected distant visual acuity (UDVA), and central corneal thickness (CCT) at the long-term follow up, although FLACS showed better CDVA at 1wk postoperatively, and less increase in CCT at 1d and 1wk. FLACS had better postoperative endothelial cell count (ECC) at 1 and 4-6wk, while there was no significantly difference between FLACS and CPCS at 1d, 3 and 6mo [weighted mean difference (WMD): 51.54, 95% confidence interval (CI): -5.46 to 108.54, P=0.08; WMD: 48.52, 95%CI: -17.54 to 114.58, P=0.15; WMD: 12.17, 95%CI: -48.61 to 72.94, P=0.69, respectively]. Postoperative endothelial cell loss (ECL) of the FLACS was significantly lower than that of the CPCS at 1, 4-6wk, and 3mo (P=0.02, 0.008, 0.03, respectively). However, there was no significant difference between two groups at 6mo (WMD: -30.36, 95%CI: -78.84 to 18.12, P=0.22). No significant difference was discovered with respect to the macular edema [odds ratio (OR): 0.93, 95%CI: 0.42 to 2.05, P=0.85], capsular complication excluding posterior capsular tears (OR: 0.79, 95%CI: 0.42 to 1.50, P=0.47) and intraocular pressure change (OR: 0.82, 95%CI: 0.39 to 1.72, P=0.60). However, posterior capsular tears were more common in CPCS group (OR: 0.12, 95%CI: 0.01 to 0.98, P=0.05). The effective phacoemulsification times were significantly lower in the FLACS group compared to the CPCS group (WMD: -0.78, 95%CI: -1.23 to -0.34, P=0.0006). CONCLUSION No statistically significant difference is discovered between FLACS and CPCS in clinical outcomes at the long-term follow up. However, higher rate of posterior capsular tears is detected in patients receiving CPCS.
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Affiliation(s)
- Li Chen
- Department of Ophthalmology, the Affiliated Nanping First Hospital of Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Chen Hu
- Department of Ophthalmology, the Affiliated Nanping First Hospital of Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Xiao Lin
- Department of Ophthalmology, the Affiliated Nanping First Hospital of Fujian Medical University, Nanping 353000, Fujian Province, China
| | - Hao-Yu Li
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi Zhuang Autonomous Region, China
| | - Yi Du
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530000, Guangxi Zhuang Autonomous Region, China
| | - Yi-Hua Yao
- Department of Ophthalmology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350000, Fujian Province, China
| | - Jun Chen
- Department of Ophthalmology, the Affiliated Nanping First Hospital of Fujian Medical University, Nanping 353000, Fujian Province, China
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Łabuz G, Varadi D, Khoramnia R, Auffarth GU. Central and mid-peripheral corneal astigmatism in an elderly population: a retrospective analysis of Scheimpflug topography results. Sci Rep 2021; 11:7968. [PMID: 33846337 PMCID: PMC8041809 DOI: 10.1038/s41598-021-81772-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
Implantation of toric intraocular lenses (IOLs) has become standard in the correction of corneal astigmatism. The IOL selection is based on keratometric measurements of the central cornea. However, mid-peripheral corneal changes may yield suboptimal correction in patients with larger pupils. This study retrospectively analyzed corneal topography data collected using a Scheimpflug device during routine clinical examinations. Of 11,953 patients, 641 met the inclusion criteria. Total corneal astigmatism was compared between five concentric zones (2–6 mm) using vector analysis. The absolute difference between astigmatism at 2 mm and 6 mm was 0.30 D (− 0.36 to 0.64), which decreased to 0.10 D (0 to 0.20) between the 5- and 6-mm zone. With-the-rule astigmatism was the most prevalent (53%), 34% had against-the-rule (ATR), and 13% had oblique. The decrease of the cylinder power with the diameter differed significantly between the three types, with ATR and oblique astigmatism being associated with the steepest change. Patients with high corneal astigmatism tend to demonstrate larger differences between the center and mid-periphery than those with low and moderate astigmatism. In conclusion, we demonstrated that central corneal astigmatism differs from that measured at the mid-periphery and that a larger difference was found in patients with ATR, oblique and high astigmatism.
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Affiliation(s)
- Grzegorz Łabuz
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Dorottya Varadi
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Ramin Khoramnia
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Gerd U Auffarth
- David J Apple Center for Vision Research, Department of Ophthalmology, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany.
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21
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Salgado RMPC, Torres PFAAS, Marinho AAP. Femtosecond Laser-assisted Lens Surgery with Low-energy Pulse versus Conventional Phacoemulsification for Presbyopia Correction: An Intraindividual Study. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Lens surgery with multifocal IOL implantation for presbyopia correction is performed by femtosecond laser-assisted lens surgery or conventional phacoemulsification.
Objective:
To compare the clinical results of femtosecond laser-assisted with low-energy pulse conventional phacoemulsification lens surgery for presbyopia correction intraindividually.
Methods:
Charts from patients who underwent Refractive Lens Exchange (RLE) for presbyopia correction in a single center, with Femtosecond Laser-Assisted Lens Surgery (FLALS) in one eye and Conventional Phacoemulsification (CP) in the other, were retrospectively reviewed. All eyes had the same multifocal Intraocular Lens (IOL) implanted. The clinical outcomes and the results of the level of satisfaction questionnaire were compared between the two groups according to the technique employed (FLALS vs. CP) for a period of up to four years. Stability, efficacy and safety indices were also assessed.
Results:
This study comprised a total of 56 eyes of 28 patients randomly assigned FLALS in one eye and CP in the other. No statistically significant difference was observed between the two techniques regarding postoperative visual acuities, duration of surgical procedure, efficacy or safety indexes (p>0.05). Refraction was stable in all FLALS eyes, whereas a change occurred in 2 eyes (7.1%) operated with CP upon 6 months postoperatively, but without statistical significance (p˃0.05). Satisfaction was slightly better with FLALS but not statistically significant (p=0.134). No immediate myosis or other adverse events after the femtosecond laser were registered.
Conclusion:
The parameters assessed showed no significant differences between the two techniques, in spite of a difference of refraction stability upon 6 months postoperatively.
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Assaf AH, Aly MG, Zaki RG, Shaaban YM, Aziz BF. Femtosecond Laser-Assisted Cataract Surgery in Soft and Hard Nuclear Cataracts: A Comparison of Effective Phacoemulsification Time. Clin Ophthalmol 2021; 15:1095-1100. [PMID: 33731984 PMCID: PMC7956887 DOI: 10.2147/opth.s300145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/26/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To compare effective phacoemulsification time (EFX) in femtosecond laser-assisted cataract surgery (FLACS) versus traditional quick chop phacoemulsification (QCP) in senile nuclear cataracts with different densities focusing on soft and hard ones. Patients and Methods A prospective non-randomized comparative study was carried out in Al Watany Eye Hospital and Ain Shams University Hospital, Cairo, Egypt; 250 eyes with senile nuclear cataract (NC) were included and classified into two main groups, FLACS and QCP groups. Each of them was stratified according to nuclear density into three subgroups, subgroups I (Soft NC), II (Medium NC), and III (Hard NC). Sextans-softened fragmentation pattern was performed in the FLACS group. Total EFX utilized for nucleus disassembly and removal was recorded by the completion of each surgery. Results A total of 117 eyes were included in the FLACS group and 133 eyes in the QCP group. No significant difference in EFX was observed between the two groups (P = 0.228). Regarding subgroups, EFX showed no statistically significant difference between FLACS and QCP (P = 0.283) in soft NC. For hard NC, a trend to lower values of EFX in FLACS compared with QCP was found, but without statistically significant difference (P = 0.122). Only in medium NC were significantly lower values obtained in FLACS compared with QCP (P < 0.0001). Conclusion When compared with QCP technique, FLACS can be used for advantages aside from EFX reduction, including astigmatic keratotomies, accurate sizing, and centration of capsulotomies especially in hard and soft nuclear cataracts. Significant reduction of total EFX with FLACS is most prominent only in medium-density nuclear cataracts.
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Affiliation(s)
- Ahmed H Assaf
- Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt.,Al Watany Eye Hospital, Cataract and Refractive Department, Cairo, Egypt
| | - Mohamed G Aly
- Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt
| | - Rania G Zaki
- Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt
| | - Yasmine M Shaaban
- Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt
| | - Bassem F Aziz
- Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt.,Al Watany Eye Hospital, Cataract and Refractive Department, Cairo, Egypt
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23
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Connell BJ, Kane JX, Vajpayee RB. A Comparison of Refractive Accuracy Between Conventional and Femtosecond Laser Cataract Surgery Techniques Using Modern IOL Formulas. Clin Ophthalmol 2021; 15:899-907. [PMID: 33688158 PMCID: PMC7936686 DOI: 10.2147/opth.s296032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To compare the refractive outcome prediction accuracy between conventional (CCS) and femtosecond laser assisted (FLACS) cataract surgery techniques using optimized lens constants for modern intraocular lens (IOL) formulas. PATIENTS AND METHODS Our retrospective, comparative, interventional case series, compared data from 196 eyes undergoing CCS and 456 eyes undergoing FLACS with Acrysof IOL (Alcon laboratories, Inc) implantation. After optimizing IOL constants, the predicted refractive outcome was calculated for all formulas for each case. This was compared to the actual refractive outcome to provide the prediction error. The performance of CCS and FLACS was compared by the absolute prediction error and percentage of eyes within 0.25D, 0.5D and 1.0D of anticipated refractive outcome. RESULTS There was no statistically significant difference in median absolute error between the CCS and LACS groups for the Kane (0.256, 0.236; p=0.389), SRK T (0.298, 0.302, p=0.910), Holladay (0.312, 0.275; p=0.090), Hoffer Q (0.314, 0.289; p=0.330), Haigis (0.309, 0.258; p=0.177), Barrett Universal 2(0.250, 0.250; p=0.866), Holladay 2 (0.250, 0.258; p=0.860) and Olsen (0.260, 0.255; p=0.570) formulas. Similarly, there was no consistent difference between the two techniques for percentage of patients within 0.25, 0.50 and 1.0D of predicted refractive outcome for each formula. CONCLUSION There was no difference in refractive outcome prediction accuracy between the CCS and FLACS techniques.
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Affiliation(s)
- Benjamin J Connell
- Eye Surgery Associates, Melbourne, Victoria, Australia
- Corneal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Jack X Kane
- Corneal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Rasik B Vajpayee
- Corneal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Victoria, Australia
- Vision Eye Institute, Melbourne, Victoria, Australia
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24
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Assaf AH, Aziz BF. Ultrasound-Energy Consumption During Phases of Phacoemulsification of Nuclear Cataracts Using Femtosecond Laser: A Comparative Study. Clin Ophthalmol 2020; 14:2829-2835. [PMID: 33061267 PMCID: PMC7522599 DOI: 10.2147/opth.s257813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare ultrasound (US) energy utilized in different phases of nuclear cataract removal in femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS) in relation to different nuclear densities. Methods A prospective nonrandomized comparative study was conducted at Ain Shams University and Al Watany Eye Hospital, Cairo, Egypt on 250 eyes with senile nuclear cataracts (NCs) of different nuclear densities (1-6). Eyes were divided into two groups - FLACS and CPS - and each group was subdivided according to cataract density into subgroups A (NC 1-2), B (NC 3-4) and C (NC 5-6). sextant-softened fragmentation patterns were assessed in the FLACS group and the quick-chop technique used in the CPS group. US energy required for nucleus cracking (EFX split) and for quadrant removal (EFX quadrant) was recorded. Results Total eyes included in the FLACS and CPS groups were 117 and 133, respectively. No significant differences between the groups for EFX quadrant and EFX split groups were observed (P=0.18 and P=0.49, respectively). For subgroup A, no significant difference was found between FLACS and CPS on EFX split (P=0.08) and EFX quadrant (P=0.49). For subgroup B, significantly lower values of EFX split (P=0.0001) and EFX quadrant (P<0.0001) were obtained with FLACS than CPS. For subgroup C, no significant difference was found for EFX split (P=0.86); however, EFX quadrant was significantly lower in the FLACS group (P=0.05). Conclusion FLACS lowers US energy utilized during quadrant removal at different nuclear densities, with highest significance in medium-density nuclear cataracts. Nucleus cracking by femtosecond laser is less effective in very hard cataracts. However, femtosecond-laser softening of hard nuclei is capable of of US-energy reduction during quadrant removal.
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Affiliation(s)
- Ahmed H Assaf
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Al Watany Eye Hospital, Cairo, Egypt
| | - Bassem F Aziz
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Al Watany Eye Hospital, Cairo, Egypt
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25
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Comparison of femtosecond laser–assisted cataract surgery and conventional cataract surgery: a meta-analysis and systematic review. J Cataract Refract Surg 2020; 46:1075-1085. [DOI: 10.1097/j.jcrs.0000000000000228] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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26
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Charlesworth E, Alderson AJ, de Juan V, Elliott DB. When is refraction stable following routine cataract surgery? A systematic review and meta-analysis. Ophthalmic Physiol Opt 2020; 40:531-539. [PMID: 32696501 DOI: 10.1111/opo.12719] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE We systematically reviewed the literature to investigate when refraction is stable following routine cataract surgery implanting monofocal intraocular lenses. Current advice recommends obtaining new spectacles 4-6 weeks following surgery. Due to advancements in surgical techniques, we hypothesised that refractive stability would be achieved earlier, which could have major short-term improvements in quality of life for patients. METHODS Medline, CINAHL, AMED, Embase, Web of Science and the Cochrane Library were searched with key words chosen to find articles, which assessed refraction following uncomplicated cataract surgery. Citation chains and the reference lists of all included papers were searched. Unpublished literature was identified using OpenGrey (www.opengrey.eu). The review considered studies that measured refraction at regular intervals following surgery until stability was achieved. RESULTS The search identified 6,680 papers. Two reviewers independently screened the abstracts and nine papers were found to fit the criteria, of which five were included in the meta-analysis. The quality of the papers was evaluated using the Methodological Index for Non-Randomised Studies (MINORS) instrument. Meta-analysis of 301 patients' data of spherical, cylindrical and spherical equivalent correction were performed using Review Manager 5 (RevMan 5.3) (https://revman.cochrane.org/). Refraction at 1-week versus the gold standard of 4-weeks showed no significant difference for sphere data (effect size and 95% confidence interval of; ES = 0.00, 95% CI: -0.17, 0.17; p = 1.00), cylindrical data (ES = +0.06; 95% CI: -0.05, 0.17; p = 0.31), and spherical equivalent (ES = -0.01; 95% CI: -0.12, 0.10; p = 0.90). Heterogeneity was non-significant (I2 < 25%) for all refractive elements. Data were similar for 2- versus 4-weeks post-surgery. Acquired data from one study highlighted a small number of patients with very unstable cylindrical corrections at 1-week post-operatively. CONCLUSIONS No statistical difference was found when comparing sphere, cylindrical and spherical equivalent values at 1- and 4-weeks post cataract surgery. This suggests that new glasses could be provided 1-week after surgery. However, from a clinical perspective, a small number of patients (~7%) from an acquired dataset (N = 72) showed very unstable cylindrical corrections at 1-week. Further work is needed to determine why this is the case and how these patients can be detected.
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Affiliation(s)
- Emily Charlesworth
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Alison J Alderson
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Victoria de Juan
- Ophthalmology Service, University Hospital Ramón y Cajal, School of Medicine and Health Science, University of Alcalá (IRYCIS), Madrid, Spain
| | - David B Elliott
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
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27
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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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Scott WJ, Tauber S, Eck CD, Scott RA, Ohly J. The Clinical Relationship of Anterior Capsular Tears and Vertical Spacing in the Femtosecond Laser Capsulotomy Procedure. J Refract Surg 2019; 35:280-284. [PMID: 31059576 DOI: 10.3928/1081597x-20190410-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 04/09/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the frequency of anterior capsule tears and capsule edge irregularities in femtosecond laser anterior capsulotomy, including the effect of optimized vertical spacing settings. METHODS Three thousand eight hundred thirty-four cases were examined and grouped according to the femtosecond laser capsulotomy settings using manufacturer default settings with a vertical spacing of 10, 15, and 20 µm. Capsulotomy edge irregularities and anterior capsule tears were recorded intraoperatively. RESULTS The anterior capsule tear rates for the 10, 15, and 20 µm groups were 0.79%, 0.35%, and 0.09%, respectively. The capsule edge irregularity rates for the 10, 15, and 20 µm groups were 6.25%, 1.13%, and 1.15%, respectively. The treatment times for the 10, 15, and 20 µm groups were 1.6, 0.7, and 0.8 second, respectively. The risk reduction of anterior capsule tears positively correlated with the 15 and 20 µm group settings. The anterior capsule tear rate difference between the 10 and 20 µm group settings was statistically significant. Capsule edge irregularity rates were reduced in the 15 and 20 µm group settings. Eye movement was monitored in the 20 µm group and was observed in 9 of 13 patients with capsule edge irregularities. CONCLUSIONS Anterior capsule tear rates are low with femtosecond laser cataract surgery. The rate can be further reduced with optimization of the settings, including an increase in vertical spacing. [J Refract Surg. 2019;35(5):280-284.].
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Refractive Laser-Assisted Cataract Surgery versus Conventional Manual Surgery: Comparing Efficacy and Safety in 3144 Eyes. Am J Ophthalmol 2019; 206:32-39. [PMID: 31009596 DOI: 10.1016/j.ajo.2019.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To report on outcomes of the efficacy and safety in 1 of the largest series of eyes undergoing either conventional manual cataract surgery (MCS) or refractive femtosecond laser-assisted cataract surgery (ReLACS). DESIGN Retrospective, consecutive, interventional comparative case series. METHODS This study included 3144 consecutive eyes, of which 1580 were treated via MCS, and 1564 were treated via ReLACS at Uptown Surgical Centre in Vaughan, Ontario, Canada. Preoperative characteristics, best corrected visual acuity (BCVA), mean absolute spherical error (MAE), rates of intraoperative posterior capsular rupture, and postoperative complications were evaluated. RESULTS Across all eyes, ReLACS was superior to MCS for reducing surgical time (MCS: 7.7 ± 0.1 min vs ReLACS: 6.8 ± 0.1 min, P < 0.001); was less commonly associated with postoperative cystoid macular edema (OR = 0.36, 95% CI: 0.14-0.91, P = 0.031) and more commonly reduced MAE (MCS: 0.60 ± 0.02 diopters (D) vs ReLACS: 0.54 ± 0.02 D, P = 0.02). There were no differences in rates of posterior capsular rupture (P = 0.918), overall postoperative complications (P = 0.088) or final BCVA (P = 0.881). When analyzing a subgroup of more difficult cases (n = 833), ReLACS was superior to MCS for: 1) being more likely to yield an improvement of more than 0.1 logarithm of the minimum angle of resolution BCVA (OR = 1.80, 95% CI: 1.15-2.74, P = 0.01); 2) reducing MAE (MCS: 0.73 ± 0.3 D vs ReLACS: 0.60 ± 0.27 D, P = 0.04); and 3) being more likely to yield an MAE within 0.5 D (OR = 1.61, 95% CI: 1.11-2.33, P = 0.012). CONCLUSIONS Across all eyes, our results support that ReLACS and MCS yield similar outcomes. However, our results show trends toward a more pronounced benefit of ReLACS compared to MCS when treating more difficult eyes.
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Comparison of Outcomes after Phacoemulsification with Two Different Corneal Incision Distances Anterior to the Limbus. J Ophthalmol 2019; 2019:1760742. [PMID: 31531233 PMCID: PMC6721498 DOI: 10.1155/2019/1760742] [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: 03/20/2019] [Accepted: 08/05/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare visual performance and visual quality outcomes after phacoemulsification with two different clear corneal incision (CCI) distances anterior to the limbus in senile cataract patients. Methods Retrospective case series. Patients who had undergone phacoemulsification were divided into two groups according to the CCI distances anterior to the limbus. The CCI distances in group A range from 1 mm to 1.5 mm, while those in group B range from 0.5 mm to 1 mm. The visual acuity, refraction, surgically induced astigmatism (SIA), corneal aberrations, anterior segment parameters, and subjective vision quality were evaluated. Results This study enrolled 54 eyes, with 27 eyes per group. Both groups had significant improvement in postoperative uncorrected visual acuity (UCVA) and corrected distance visual acuity (CDVA) (P < 0.05). There were no statistically significant between-group differences in postoperative UDVA, CDVA, SIA, corneal aberrations, anterior segment parameters, or VF-QOL questionnaire performance (P > 0.05). Conclusions The phacoemulsification with CCI distances ranging from 0.5 mm to 1.5 mm is an effective and safe therapy to senile cataract. The CCI distance anterior to the limbus that ranges from 0.5 mm to 1.5 mm is recommended for routine phacoemulsification.
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31
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Comparative Analysis of Clinical and Functional Results and Position of Intraocular Lens after Femtolaser-Assisted and Standard Cataract Phacoemulsification. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.4.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Modern surgical treatment of cataracts provides effective results. The study of the position of the intraocular lens (IOL) in the capsule bag can be considered as one of the most important factors influencing the final visual and refractive result of the operation.Aim: comparative analysis of clinical and functional results and position of the IOL in the capsular bag, namely decentration and tilt, when performing femtolazer-assisted phacoemulsification (FLACS) and standard phacoemulsification (CPCS). Materials and methods. We surveyed 57 patients (57 eyes). FLACS was performed in 27 patients, CPCS – in 30 patients. Standard methods of research were used, determination of the position of the IOL (decentration and tilt) in the capsular bag on the device OCT-Casia2 (TOMEY, Germany) and study of wave front were conducted.Results. Comparative analysis of the obtained results showed no significant difference between groups in postoperative visual acuity, however, there was the trend towards higher performance corrected distance visual acuity and uncorrected distance in the group FLACS (0.68 ± 0.18 and 0.74 ± 0.2) compared to the group CPCS (0.58 ± 0.28 and 0.65 ± 0.24). Internal higher order aberrations were significantly low in the group with femtolazer accompaniment: in 3 mm zone almost 2 times (p = 0.041), in 5 mm zone 1.3 times (p = 0.047). Vertical decentration in a CPCS group made 0.217 ± 0.26 mm, in FLACS group – 0.118 ± 0.05 mm, the vertical tilt – 0.75 ± 0.37° and 0.54 ± 0.36 respectively. Conclusion. Decentralizations and IOL tilt tended to lower indices in the FLACS during the observation period up to 2 months after the operation, which was accompanied by lower values of higher order internal aberrations.
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Sramka M, Slovak M, Tuckova J, Stodulka P. Improving clinical refractive results of cataract surgery by machine learning. PeerJ 2019; 7:e7202. [PMID: 31304064 PMCID: PMC6611496 DOI: 10.7717/peerj.7202] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/27/2019] [Indexed: 11/20/2022] Open
Abstract
AIM To evaluate the potential of the Support Vector Machine Regression model (SVM-RM) and Multilayer Neural Network Ensemble model (MLNN-EM) to improve the intraocular lens (IOL) power calculation for clinical workflow. BACKGROUND Current IOL power calculation methods are limited in their accuracy with the possibility of decreased accuracy especially in eyes with an unusual ocular dimension. In case of an improperly calculated power of the IOL in cataract or refractive lens replacement surgery there is a risk of re-operation or further refractive correction. This may create potential complications and discomfort for the patient. METHODS A dataset containing information about 2,194 eyes was obtained using data mining process from the Electronic Health Record (EHR) system database of the Gemini Eye Clinic. The dataset was optimized and split into the selection set (used in the design for models and training), and the verification set (used in the evaluation). The set of mean prediction errors (PEs) and the distribution of predicted refractive errors were evaluated for both models and clinical results (CR). RESULTS Both models performed significantly better for the majority of the evaluated parameters compared with the CR. There was no significant difference between both evaluated models. In the ±0.50 D PE category both SVM-RM and MLNN-EM were slightly better than the Barrett Universal II formula, which is often presented as the most accurate calculation formula. CONCLUSION In comparison to the current clinical method, both SVM-RM and MLNN-EM have achieved significantly better results in IOL calculations and therefore have a strong potential to improve clinical cataract refractive outcomes.
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Affiliation(s)
- Martin Sramka
- Department of Circuit Theory/Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
- Research and Development Department, Gemini Eye Clinic, Zlin, Czech Republic
| | - Martin Slovak
- Research and Development Department, Gemini Eye Clinic, Zlin, Czech Republic
| | - Jana Tuckova
- Department of Circuit Theory/Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Pavel Stodulka
- Research and Development Department, Gemini Eye Clinic, Zlin, Czech Republic
- Department of Ophthalmology/Third Faculty of Medicine, Charles University, Prague, Czech Republic
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33
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Krarup T, Ejstrup R, Mortensen A, la Cour M, Holm LM. Comparison of refractive predictability and endothelial cell loss in femtosecond laser-assisted cataract surgery and conventional phaco surgery: prospective randomised trial with 6 months of follow-up. BMJ Open Ophthalmol 2019; 4:e000233. [PMID: 30997403 PMCID: PMC6440690 DOI: 10.1136/bmjophth-2018-000233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective Femtosecond laser-assisted cataract surgery (FLACS) decreases the use of energy and provides a more precise capsulorhexis compared with conventional phaco surgery (CPS). The purpose of this study was to examine if the lower energy use in FLACS caused less endothelial cell loss compared with CPS and if there was a difference in refractive predictability between CPS and FLACS. Methods and analysis This was a randomised controlled study of 96 patients with a 6-month follow-up comparing one eye surgery by FLACS and the contralateral eye operated by CPS (divide and conquer technique). Both eyes had intraocular aspheric lenses implanted. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), central corneal endothelial cell count and hexagonality (non-contact endothelial cell microscope) were assessed preoperatively at 40 and at 180 days postoperatively. Results The mean phaco energies were 6.55 (95% CI 5.43 to 7.66) and 9.77 (95% CI 8.55 to 10.95) U/S (p<0.0001) by FLACS and CPS, respectively. At day 40, the mean endothelial cell loss (ECL) was 344 cells/mm2 (95% CI 245 to 443) by FLACS (12.89%) and 497 cells/mm2 (95% CI 380 to 614) by CPS (18.19%) (p=0.027). At day 180, ECL was 362 cells/mm2 (95% CI 275 to 450) in FLACS (13.56%) and 465 cells/mm2 (95% CI 377 to 554) in CPS (17.03%) (p=0.036). The mean absolute difference from the attempted refraction was 0.43 (95% CI 0.36 to 0.51) dioptres (D) at day 40 and 0.46 D (95% CI 0.39 to 0.53) at day 180 by FLACS compared with 0.43 D (95% CI 0.36 to 0.51) at day 40 (p=0.95) and 0.46 D (95% CI 0.37 to 0.52) at day 180 (p=0.91) with CPS. Conclusion ECL was significantly lower in FLACS compared with CPS at both day 40 and day 180. ECL was correlated to the energy used. We found no difference in refractive predictability or CDVA between the groups.
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Affiliation(s)
- Therese Krarup
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Rasmus Ejstrup
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Anouck Mortensen
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Lars Morten Holm
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
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Effect of lens thickness and nuclear density on the amount of laser fragmentation energy delivered during femtosecond laser-assisted cataract surgery. J Cataract Refract Surg 2019; 45:485-489. [PMID: 30826239 DOI: 10.1016/j.jcrs.2018.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/25/2018] [Accepted: 11/18/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To study the influence of lens thickness and nuclear density on the amount of laser fragmentation energy delivered during femtosecond laser-assisted cataract surgery. SETTING Ain Shams University and Al-Watany Eye Hospital, Cairo, Egypt. DESIGN Retrospective case series. METHODS This study included eyes of patients with primary cataract of different nuclear densities that had femtosecond laser-assisted cataract surgery using the Catalys Precision system. Variables studied included preoperative lens thickness measured by spectral-domain optical coherence tomography, nuclear density using the Lens Opacities Classification System III, pupil size, laser fragmentation energy, total laser energy, and transversal ultrasound time (Ellips FX). Patients were divided according to the preoperative lens thickness as follows: lens thickness more than 4.8 mm (Group 1) and lens thickness 4.8 mm or less (Group 2). RESULTS The study included 192 eyes of 120 patients. The amount of laser energy for fragmentation was statistically significantly higher in Group 1 than in Group 2 (5.9 J ± 1.5 [SD] versus 4.5 ± 1.8 J) (P < .001). Laser fragmentation energy and total laser time had a strong positive correlation with lens thickness (r = 0.53, P < .001) but not with nuclear density or pupil size. Lens thickness was positively correlated with age (r = 0.42, P < .001) but not with nuclear density. CONCLUSIONS The preoperative lens thickness, not density, determined the amount of laser energy delivered. The laser might deliver unnecessary energy for softer and thicker nuclei while delivering less energy for thinner but harder nuclei.
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Horta GA, Horta RC, Steinfeld K, Koch CR, Mello GR, Kara-Junior N. Ultrasound power and irrigation volume in different lens opacity grades: comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification. Clinics (Sao Paulo) 2019; 74:e1294. [PMID: 31664421 PMCID: PMC6807685 DOI: 10.6061/clinics/2019/e1294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/24/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To compare the amount of ultrasound energy and irrigation volume in conventional phacoemulsification cataract surgery versus femtosecond laser-assisted phacoemulsification at different nuclear-cortical cataract grades. METHOD This was a prospective, consecutive, investigator-masked nonrandomized parallel cohort study. Patients were divided into 4 groups (Phaco1, Phaco2, Femto1 and Femto2) according to the surgical technique (conventional phacoemulsification [Group Phaco] or femtosecond laser-assisted cataract surgery [Group Femto]) and the Lens Opacity Classification System III (LOCS) grade (LOCS<11 [group 1] or LOCS≥11 [group 2]). The measured outcomes were effective phacoemulsification time (EPT), indicating the ultrasound energy, and balanced salt solution (BSS) use, indicating the irrigation volume, to indirectly estimate the damage to the corneal endothelium caused by the cataract surgery. RESULTS A total of 160 eyes from 109 patients were included: 87 eyes in Group Phaco, 73 eyes in Group Femto, 76 eyes in group 1 and 84 eyes in group 2. The EPT mean in Femto1 was 53% less (2.73±1.88, 0.1 to 8.65) than that in Phaco1 (5.80±2.86) (p=0.00) and in Femto2 (8.38±9.32) was 33% less than that in Phaco2 (12.55±8.38) (p=0.00). No significant differences in mean LOCS grades between the Phaco1 (8.21±1.44) and Femto1 (7.90±1.90) groups (p=0.73) or between the Phaco2 (13.15±2.55) and Femto2 (12.72±2.18) groups (p=0.95) were found. There were no significant differences in the mean BSS use between the Phaco1 (55.73±12.45) and Femto1 (59.37±10.93) groups (p=0.48) or between the Phaco2 (64.34±21.00) and Femto2 (65.71±17.60) groups (p=0.47). CONCLUSIONS Compared to conventional phacoemulsification at different nuclear-cortical cataract grades, femtosecond laser-assisted cataract surgery provides an EPT reduction but does not influence the BSS use.
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Affiliation(s)
- Guilherme A. Horta
- Centro de Estudos e Pesquisas Oculistas Associados, Rio de Janeiro, RJ, BR
| | | | | | - Camila R. Koch
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | - Newton Kara-Junior
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Roberts HW, Wagh VK, Sullivan DL, Hidzheva P, Detesan DI, Heemraz BS, Sparrow JM, O'Brart DPS. A randomized controlled trial comparing femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery. J Cataract Refract Surg 2018; 45:11-20. [PMID: 30413333 DOI: 10.1016/j.jcrs.2018.08.033] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/13/2018] [Accepted: 08/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the clinical results of conventional phacoemulsification surgery (CPS) with femtosecond laser-assisted cataract surgery. SETTING Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom. DESIGN Single-center prospective randomized interventional case-controlled trial. METHODS Patients undergoing cataract surgery were randomized to receive either CPS or femtosecond laser-assisted cataract surgery. The surgery was performed with a femtosecond laser (Lensx), and all operations were performed with a gravity-fluidics torsional phacoemulsification machine (Infiniti). The visual acuity, refraction, central corneal thickness (CCT), central foveal thickness (CFT), endothelial cell loss, and rates of intraoperative and postoperative events were recorded. Quality of life outcomes were measured with the EuroQOL 5 dimensions questionnaire (EQ-5D) and patient-reported quality of vision was assessed with a cataract surgery patient-reported outcome measures questionnaire (Cat-PROM5). RESULTS The study comprised 400 eyes of 400 patients who had CPS (n = 200) or femtosecond laser-assisted cataract surgery (n = 200). Seven patients (3.5%) in the femtosecond laser-assisted group were not able to complete the treatment and received CPS. The mean uncorrected distance visual acuity (logarithm of the minimum angle of resolution [logMAR]) 0.15 ± 0.21 (SD) and 0.15 ± 0.19 logMAR after CPS and femtosecond laser-assisted surgery, respectively (P = 1.0); the pinhole-corrected visual acuity was 0.04 ± 0.12 and 0.04 ± 0.12, respectively (P = 1.0); the increase in CCT was 13 ± 19 μm and 15 ± 25 μm, respectively (P = .5); and the endothelial cell loss was 9.7 ± 13.7 % and 10.2% ± 13.7, respectively (P = .76). The manifest refraction spherical equivalent error was -0.14 ± 0.60 diopters (D) after CPS and -0.12 ± 0.60 D after femtosecond laser-assisted surgery (P = .74); the mean change in CFT was 9 ± 35 μm and 6 ± 35 μm, respectively (P = .55); and the rate of posterior capsule rupture was 3% and 0%, respectively (P = .03). CONCLUSIONS This study confirms the nonsignificant differences between 2 treatment modalities, notwithstanding a significant reduction in posterior capsule ruptures in the femtosecond laser-assisted surgery group.
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Affiliation(s)
- Harry W Roberts
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom
| | - Vijay K Wagh
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Daniel L Sullivan
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom
| | - Polina Hidzheva
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Delia I Detesan
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Bissoon S Heemraz
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - John M Sparrow
- Bristol Eye Hospital, Bristol, United Kingdom; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David P S O'Brart
- Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom.
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Potvin R. Cataract refractive surgery: Innovative technology provides more choices for Canadian cataract patients. Healthc Manage Forum 2018; 29:227-234. [PMID: 27807219 DOI: 10.1177/0840470416669754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Historically, cataract surgery was aimed at removing the clouded lens of the eye and replacing it with an artificial lens; this provided clear vision to patients but without regard to their refractive error-their need for spectacles or contact lenses after surgery. Modern diagnostic and surgical instrumentation now makes it possible to address these refractive errors at the time of surgery, introducing a new paradigm-cataract refractive surgery. Although not medically necessary, many patients appreciate the chance to reduce or eliminate their need for spectacles after surgery, even if some personal cost is involved.
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Femtosecond laser-assisted cataract surgery versus standard phacoemulsification cataract surgery: Study from the European Registry of Quality Outcomes for Cataract and Refractive Surgery. J Cataract Refract Surg 2018; 42:1779-1790. [PMID: 28007110 DOI: 10.1016/j.jcrs.2016.10.013] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare the visual, refractive, and adverse outcomes of femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery. SETTING Cataract surgery clinics in 9 European countries and Australia (femtosecond-assisted) and 18 European countries and Australia (conventional). DESIGN Multicenter case-control study. METHODS Eyes having femtosecond laser-assisted cataract surgery were matched to eyes from the European Registry of Quality Outcomes for Cataract and Refractive Surgery phacoemulsification cataract surgery database for preoperative corrected distance visual acuity (CDVA), age, and preoperative risk factors. Intraoperative and postoperative complications, postoperative CDVA, and refractive outcome were compared. The follow-up was 7 to 60 days. RESULTS The study matched 2814 femtosecond-assisted cases to 4987 conventional phacoemulsification cases. Femtosecond-assisted surgery compared as follows to conventional phacoemulsification: posterior capsule complications, 0.7% versus 0.4%; postoperative logMAR CDVA, 0.05 (6/6-3) versus 0.03 (6/6-2); worse postoperative CDVA at follow-up (by 5 letters or more), 1.0% versus 0.4%; CDVA 0.3 (6/12) or better, 96.3% versus 97.1%; absolute biometry prediction error, 0.43 diopter (D) versus 0.40 D; within ±0.5 D of target, 72% versus 74.3%; and postoperative complications, 3.4% versus 2.3%. CONCLUSIONS Femtosecond laser-assisted cataract surgery did not yield better visual or refractive outcomes than conventional phacoemulsification cataract surgery. Intraoperative complications were similar and low in both groups. Postoperative complications were lower in conventional phacoemulsification cataract surgery. FINANCIAL DISCLOSURE None of the authors has a financial or proprietary interest in any material or method mentioned.
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Xu D, Zhu H, Fu Q, Xu S, Sun W, Chen G, Lv X. Ketamine delays progression of oxidative and damaged cataract through regulating HMGB-1/NF-κB in lens epithelial cells. Immunopharmacol Immunotoxicol 2018; 40:303-308. [PMID: 30111205 DOI: 10.1080/08923973.2018.1478851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Dong Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongying Zhu
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qingdong Fu
- Department of Ophthalmology, Hangzhou Westlake Chaoju Ophthalmic Hospital, Hangzhou, Zhejiang, China
| | - Songxiao Xu
- Department of Pathology, Sir Run Run Shaw Hospital affiliated to Zhejiang University, Hangzhou, Zhejiang, China
| | - Wen Sun
- Department of Ophthalmology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Guoxiao Chen
- Department of Ophthalmology, First Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoli Lv
- Department of Ophthalmology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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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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Berk TA, Schlenker MB, Campos-Möller X, Pereira AM, Ahmed IIK. Visual and Refractive Outcomes in Manual versus Femtosecond Laser–Assisted Cataract Surgery. Ophthalmology 2018. [DOI: 10.1016/j.ophtha.2018.01.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Foster GJL, Allen QB, Ayres BD, Devgan U, Hoffman RS, Khandelwal SS, Snyder ME, Vasavada AR, Yeoh R. Phacoemulsification of the rock-hard dense nuclear cataract: Options and recommendations. J Cataract Refract Surg 2018; 44:905-916. [PMID: 29960655 DOI: 10.1016/j.jcrs.2018.03.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 01/19/2018] [Accepted: 03/07/2018] [Indexed: 10/28/2022]
Abstract
We describe the essential steps in the successful phacoemulsification of the rock-hard, dense cataract. Appropriate and directed preoperative history, physical examination, and diagnostics allow the surgeon to select the best incision, anesthesia, and intended surgical technique for a given dense nuclear challenge. Hard nucleus-specific approaches for hydrodissection, pupil management, and zonular protection then allow the surgeon to approach the rock-hard nucleus with maximum safety. Dense nuclear dismantling options are then discussed in detail along with fluidic and power modulation considerations. Various specific phacoemusification machine settings for rock-hard cataracts from the authors representing several different phaco systems are then presented. The combination of these steps and considerations allow a more successful dense cataract removal and potential restoration of vision for patients. This paper represents the collective experience and advice of the Challenging and Complex Cataract Surgery Subcommittee.
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Affiliation(s)
- Gary J L Foster
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore.
| | - Quentin B Allen
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | - Brandon D Ayres
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | - Uday Devgan
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | - Richard S Hoffman
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | - Sumitra S Khandelwal
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | - Michael E Snyder
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | - Abhay R Vasavada
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | - Ronald Yeoh
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
| | -
- From the Eye Center of Northern Colorado PC (Foster), Fort Collins, Colorado, the Florida Vision Institute (Allen), Stuart, Florida, Ophthalmic Partners of PA (Ayres), Bala Cynwyd, Pennsylvania, Devgan Eye Surgery (Devgan), Los Angeles, California, Drs. Fine, Hoffman, & Sims, LLC (Hoffman), Eugene, Oregon, Baylor College of Medicine (Khandelwal), Houston, Texas, and Cincinnati Eye Institute (Snyder), Cincinnati, Ohio, USA; Iladevi Cataract & IOL Research Centre (Vasavada), Ahmedabad, India; Singapore National Eye Center (Yeoh), Singapore, Singapore
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Ang RET, Quinto MMS, Cruz EM, Rivera MCR, Martinez GHA. Comparison of clinical outcomes between femtosecond laser-assisted versus conventional phacoemulsification. EYE AND VISION 2018; 5:8. [PMID: 29713653 PMCID: PMC5911953 DOI: 10.1186/s40662-018-0102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/07/2018] [Indexed: 11/10/2022]
Abstract
Background To compare femtosecond laser-assisted versus conventional phacoemulsification in terms of visual and refractive outcomes, cumulative dissipated energy, anterior chamber inflammation and endothelial cell loss. Methods In this retrospective cohort study, records of eyes that underwent femtosecond laser-assisted cataract surgery (FLACS) or conventional phacoemulsification (CP) were reviewed. The Victus femtosecond laser (Bausch and Lomb, Germany) was used to carry out corneal incisions, anterior capsulotomy, and lens fragmentation in FLACS procedures. Manifest refraction spherical equivalence (MRSE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), cumulative dissipated energy (CDE), postoperative cells and flare and endothelial cell count data were collected. Subgroup analysis of the visual acuity tests was performed based on the type of intraocular lens implanted (monofocal, monofocal toric, multifocal, multifocal toric, accommodating). Results A total of 735 eyes were included in the study (296 eyes for the FLACS group and 439 eyes for the CP group). At one year follow-up, 120 eyes comprised the FLACS group and 265 eyes for the CP group. MRSE in the FLACS group was - 0.16 ± 0.58 D and - 0.20 ± 0.52 D in the CP group (P = 0.50). UDVA in the FLACS group was 20/25 (mean logMAR 0.12 ± 0.13) and 20/25 (mean logMAR 0.11 ± 0.13) in the CP group (P = 0.48). CDVA was 20/20 (mean logMAR 0.03 ± 0.07) in the FLACS group and 20/20 (mean logMAR 0.02 ± 0.06) in the CP group (P = 0.15). No statistically significant trend was seen for FLACS versus CP by intraocular type for visual acuity. CDE for the different cataract grades ranged from 6.97 ± 5.74 to 29.02 ± 16.07 in the FLACS group and 7.59 ± 6.42 to 35.69 ± 18.30 in the CP group. The FLACS group was significantly lower for post-operative central corneal edema (P = 0.05), cells and flare (P = 0.01), and endothelial cell loss (P = 0.04). Conclusions Femtosecond laser-assisted cataract surgery and conventional phacoemulsification had similar refractive and visual outcomes. Phacoemulsification energy, anterior chamber inflammation and corneal endothelial cell loss were less in the femtosecond laser group.
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Affiliation(s)
- Robert Edward Ty Ang
- 1Asian Eye Institute, Rockwell Center, Makati City, 1200 Philippines.,Cardinal Santos Medical Center, 10 Wilson St., San Juan City, 1502 Philippines
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Avetisov KS, Ivanov MN, Yusef YN, Yusef SN, Aslamazova AE, Fokina ND. [Morphological and clinical aspects of anterior capsulotomy in femtosecond laser-assisted cataract surgery]. Vestn Oftalmol 2018; 133:83-88. [PMID: 28980571 DOI: 10.17116/oftalma2017133483-88] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The review covers morphological and clinical aspects of femtosecond laser-assisted anterior capsulotomy in cataract surgery. Literature data suggests that femtosecond laser-assisted capsulotomy is more accurate in size, shape, and centration than manual. Femtosecond laser-assisted anterior capsulotomy improves the accuracy of IOL positioning within the capsular bag.
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Affiliation(s)
- K S Avetisov
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - M N Ivanov
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - Yu N Yusef
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - S N Yusef
- Research Institute of Eye Disease, 11 A, B, Rossolimo St., Moscow, Russia, 119021
| | - A E Aslamazova
- First Moscow State Medical University, 2 str. 4 Bol'shaya Pirogovskaya St., Moscow, Russia, 119991
| | - N D Fokina
- First Moscow State Medical University, 2 str. 4 Bol'shaya Pirogovskaya St., Moscow, Russia, 119991
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Roberts HW, Wagh VK, Mullens IJM, Borsci S, Ni MZ, O’Brart DPS. Evaluation of a hub-and-spoke model for the delivery of femtosecond laser-assisted cataract surgery within the context of a large randomised controlled trial. Br J Ophthalmol 2018; 102:1556-1563. [DOI: 10.1136/bjophthalmol-2017-311319] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/08/2017] [Accepted: 01/20/2018] [Indexed: 11/04/2022]
Abstract
AimsTo test a hypothesis that cataract operating room (OR) productivity can be improved with a femtosecond laser (FL) using a hub-and-spoke model and whether any increase in productivity can offset additional costs relating to the FL.Methods400 eyes of 400 patients were enrolled in a randomised-controlled trial comparing FL-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS). 299 of 400 operations were performed on designated high-volume theatre lists (FLACS=134, CPS=165), where a hub-and-spoke FLACS model (1×FL, 2×ORs=2:1) was compared with independent CPS theatre lists. Details of operative timings and OR utilisation were recorded. Differences in productivity between hub-and-spoke FLACS and CPS sessions were compared using an economic model including testing hypothetical 3:1 and 4:1 models.ResultsThe duration of the operation itself was 12.04±4.89 min for FLACS compared with CPS of 14.54±6.1 min (P<0.001). Total patient time in the OR was reduced from 23.39±6.89 min with CPS to 20.34±5.82 min with FLACS (P<0.001)(reduction of 3.05 min per case). There was no difference in OR turnaround time between the models. Average number of patients treated per theatre list was 9 for FLACS and 8 for CPS. OR utilisation was 92.08% for FLACS and 95.83% for CPS (P<0.001). Using a previously established economic model, the FLACS service cost £144.60 more than CPS per case. This difference would be £131 and £125 for 3:1 and 4:1 models, respectively.ConclusionThe FLACS hub-and-spoke model was significantly faster than CPS, with patients spending less time in the OR. This enabled an improvement in productivity, but insufficient to meaningfully offset the additional costs relating to FLACS.
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Lawless M, Levitz L, Hodge C. Reviewing the visual benefits of femtosecond laser-assisted cataract surgery: Can we improve our outcomes? Indian J Ophthalmol 2017; 65:1314-1322. [PMID: 29208811 PMCID: PMC5742959 DOI: 10.4103/ijo.ijo_736_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Femtosecond laser-assisted cataract surgery (FLACS) was introduced in 2009 and has increasingly been incorporated into surgical practice. The automation of three key aspects of cataract surgery was expected to deliver a significant improvement in both refractive and safety outcomes. The published literature has not yet shown consistent refractive improvement above conventional techniques. The purpose of this paper is to review current FLACS refractive outcomes and explore factors that may have contributed to the current findings and whether future improvements are possible.
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Affiliation(s)
- Michael Lawless
- Vision Eye Institute; Department of Ophthalmology, Sydney Medical School, Save Sight Institute, University of Sydney, Australia
| | | | - Chris Hodge
- Vision Eye Institute; Discipline of Orthoptics, Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia
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Lundström M, Dickman M, Henry Y, Manning S, Rosen P, Tassignon MJ, Young D, Stenevi U. Femtosecond laser–assisted cataract surgeries reported to the European Registry of Quality Outcomes for Cataract and Refractive Surgery: Baseline characteristics, surgical procedure, and outcomes. J Cataract Refract Surg 2017; 43:1549-1556. [DOI: 10.1016/j.jcrs.2017.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/04/2017] [Accepted: 09/22/2017] [Indexed: 11/16/2022]
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Dick HB, Schultz T, Gerste RD. New developments in femtosecond cataract surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1402679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- H. Burkhard Dick
- Department of Ophthalmology, Ruhr University Bochum, Bochum, Germany
| | - Tim Schultz
- Department of Ophthalmology, Ruhr University Bochum, Bochum, Germany
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Foreman J, Xie J, Keel S, Wijngaarden P, Crowston J, Taylor HR, Dirani M. Cataract surgery coverage rates for Indigenous and non‐Indigenous Australians: the National Eye Health Survey. Med J Aust 2017; 207:256-261. [DOI: 10.5694/mja17.00057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/27/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Joshua Foreman
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Jing Xie
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Stuart Keel
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Peter Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Jonathan Crowston
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
| | - Mohamed Dirani
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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Schultz T, Tsiampalis N, Dick HB. Laser-Assisted Capsulotomy Centration: A Prospective Trial Comparing Pupil Versus OCT-Based Scanned Capsule Centration. J Refract Surg 2017; 33:74-78. [PMID: 28192584 DOI: 10.3928/1081597x-20161219-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 11/08/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate different capsulotomy centration methods for femtosecond laser-assisted cataract surgery. The overlap between intraocular lens (IOL) optic and lens capsule was measured with different centration methods and IOL types. METHODS This was a prospective randomized clinical trial. Patients with cataract scheduled for femtosecond laser-assisted cataract surgery were assigned to one of four treatment groups: optical coherence tomography (OCT)-based scanned capsule centration (SCC) and three-piece IOL (SCC with three-piece IOL); scanned capsule centration and plate-haptic IOL (SCC with plate-haptic IOL); pupil centration (PC) and three-piece IOL (PC with three-piece IOL); or PC and plate-haptic IOL (PC with plate-haptic IOL). At the end of surgery, the overlap between the IOL optic and capsular bag was measured. RESULTS The results of 160 patients were evaluated (n = 40 in each group). There was no difference in age (P = .27), sex (P = .18), the number of treated left and right eyes (P = .64), or cataract grade (P = .06). With the new SCC method (capsulotomy diameter: 5 mm), a complete overlap was achieved in all cases in both SCC groups. The overlap was also complete in all cases with PC and plate-haptic IOLs. In the PC with three-piece IOL group, the overlap was incomplete in 3 eyes. CONCLUSIONS The SCC method helps to achieve a 360° overlap in all eyes independent of the IOL type. A complete 360° overlap was achieved in all cases up to a calculated capsulotomy diameter of 5.1 mm with this new method. [J Refract Surg. 2017;33(2):74-78.].
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