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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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das Neves NT, Boianovsky C, Lake JC. Functional Profile of a Customized Wound Parameter in Femtosecond Laser-Assisted Corneal Incision for Cataract Surgery. Clin Ophthalmol 2023; 17:175-181. [PMID: 36660307 PMCID: PMC9843498 DOI: 10.2147/opth.s384660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To evaluate the performance of optimized parameters of femtosecond laser for cataract surgery corneal incisions regarding opening, patency and surgically induced astigmatism (SIA). Patients and Methods Patients scheduled for femtosecond laser-assisted cataract surgery between May 2018 and December 2018 were enrolled. Inclusion criteria were a healthy preoperative cornea and uneventful FLACS. Exclusion criteria were preoperative corneal astigmatism over 1.0 D, previous corneal trauma or pathologies. Clinical data were obtained from the electronic medical records. Surgical planning was based on Scheimpflug tomography images for keratometric data. At postoperative day 60, new keratometric evaluation was performed, obtained using the same device. Results 101 eyes (61 patients) matched the criteria for SIA analysis. Overall mean SIA was 0.44 ± 0.33 D (0-1.55 D). Axis and size did not have any statistically significant effects on SIA. The overall centroid of the SIA was 0.11. For the opening analysis, was included 156 eyes (79 patients). Successful opening in 87.7% of cases (137 eyes). Temporal incisions had the highest success rate (98.36%). Conclusion These femtosecond laser parameters showed high opening rates with low opening times. These optimized parameters led to a low incidence of SIA and high predictability regardless of incision site and size. The association between incision opening and SIA was not statistically significant. There was, however, an association between incision opening success and site.
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Affiliation(s)
- Nathália Teles das Neves
- Federal District Eye Hospital – HODF, Brasilla, Brazil,Correspondence: Nathália Teles das Neves, Federal District Eye Hospital – HODF, Brasilia, Brazil, Tel +5561992738688, Email
| | - Celso Boianovsky
- Department of Ophthalmology, Hospital of Vision – OFTALMED, Brasilia, DF, Brazil
| | - Jonathan Clive Lake
- Department of Ophthalmology, Hospital of Vision – OFTALMED, Brasilia, DF, Brazil,Department of Ophthalmology, Hospital Oftalmológico de Brasília – HOB, Brasilia, DF, Brazil
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Zhao J, Zhao J, Yang W, Sun L, Qian Y, Wang X, Zhou X. Influence of Ocular Residual Astigmatism and Target-Induced Astigmatism on the Efficacy of the Implantation of a Toric Implantable Collamer Lens With Central Hole for Myopic Astigmatism Correction. Front Med (Lausanne) 2022; 8:737358. [PMID: 35127737 PMCID: PMC8813979 DOI: 10.3389/fmed.2021.737358] [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: 07/06/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
PurposeTo investigate the effects of ocular residual astigmatism (ORA) and target-induced astigmatism (TIA) on the efficacy of toric implantable collamer lens (TICL) with central hole for myopic astigmatism correction.MethodsRetrospective case series. One hundred and eighteen eyes implanted with a TICL (V4c) from 118 patients were included. Subjective refraction and corneal topography were examined preoperatively, at 1 and 12 months postoperatively. The eyes were divided into the low-ORA ( ≤ 0.5 D) and high-ORA (>0.5 D) groups based on vector analysis, and into the low-TIA (≥0.75D and <2 D) and the high-TIA (≥2 D and ≤ 4 D) groups according to preoperative refractive astigmatism. Correction index (CI) and index of success (IOS) were compared between different groups.ResultsAll surgeries were uneventful, and no complications occurred during follow-up. At 1 and 12 months postoperatively, no significant differences were found in CI or IOS values between the high and low ORA groups, while significantly higher CI and lower IOS were detected in the high-TIA group than in the low-TIA group (P < 0.05). No significant difference was found in CI between 1 and 12 months postoperatively in either group (P > 0.05). However, significantly lower IOS was found at 12 months compared with 1 month postoperatively for each group (P < 0.05).ConclusionsToric implantable collamer lens (TICL) implantation is effective in correcting myopic astigmatism and is more effective in eyes with high TIA, while ORA has a minor effect.
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Affiliation(s)
- Jing Zhao
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Jiao Zhao
- Department of Ophthalmology, People's Hospital of Leshan, Leshan, China
| | - Wen Yang
- Department of Ophthalmology, The 3rd People's Hospital of Chengdu, Chengdu, China
| | - Ling Sun
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Yishan Qian
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xiaoying Wang
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and Ear, Nose, and Throat (ENT) Hospital of Fudan University, Shanghai, China
- National Health Commission (NHC) Key Laboratory of Myopia, Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- *Correspondence: Xingtao Zhou
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He Q, Huang J, He X, Yu W, Yap M, Han W. Effect of corneal incision features on anterior and posterior corneal astigmatism and higher-order aberrations after cataract surgery. Acta Ophthalmol 2021; 99:e1027-e1040. [PMID: 33665973 DOI: 10.1111/aos.14778] [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] [Received: 06/21/2020] [Revised: 12/20/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the influence of 2.2 mm clear corneal incision (CCI) features in surgically induced astigmatism (SIA) and higher-order aberrations (HOAs) after cataract surgery. METHODS Right eyes of 92 subjects receiving 2.2 mm incision cataract surgery were involved. A total of 38 eyes were categorized as the intact incision group, and 54 eyes were the defective incision group. Pre- and postoperative (1 month and 6 months) corneal astigmatism and HOAs on anterior and posterior corneal surfaces, corneal volume, and corneal thickness (CT) were measured using Pentacam. The CCI features including incision length (IL), incision angles, distance from incision to central cornea (Dis-En/Ex), and CT at incision site were quantified using AS-OCT. RESULTS The defective incision group showed shorter IL and larger incision angles [false discovery rate (FDR) - p < 0.05]. Changes in CT at incision site were more pronounced for the defective incision group (FDR - p < 0.05). Some SIA parameters were related to the certain specific CCI features, especially IL (FDR - p < 0.05). Both groups exhibited significant increased 6 mm posterior corneal tHOAs at 1 month (Bonferroni corrected - p < 0.01) and the defective incision group showed increased 6 mm posterior tHOAs at 6 months (Bonferroni corrected - p = 0.023). There were characteristic correlations between Zernike terms and CCI features including IL, CT, Dis-En/Ex, and incision angles at 1 month, especially over 6 mm zone. CONCLUSION The CCI deformities can affect corneal recovery and induce more HOAs at 1 month postoperatively. Such effects became minor, but could persist until 6 months. The IL combined with Angle-En/Ex was important factor influencing CCI integrity and corneal optical quality.
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Affiliation(s)
- Qin He
- The Department of Ophthalmology First Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Jiani Huang
- The Department of Ophthalmology First Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Xiaoying He
- The Department of Ophthalmology First Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Wangshu Yu
- The Department of Ophthalmology First Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
| | - Maurice Yap
- School of Optometry The Hong Kong Polytechnic University Hong Kong China
| | - Wei Han
- The Department of Ophthalmology First Affiliated Hospital School of Medicine Zhejiang University Hangzhou China
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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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Abstract
PURPOSE OF REVIEW There are several different approaches to handling regular and irregular astigmatism during cataract surgery, but still much debate on which solutions are most effective given unique patient circumstances. In this review, we examine recent literature and studies to highlight some of the most effective ways to plan preoperatively, manage regular and irregular astigmatism during cataract surgery, as well as managing postoperative complications. RECENT FINDINGS Recent developments in technology have provided increased courses of action for astigmatism management during cataract surgery. Additional options of toric IOLs with presbyopic platforms, light adjustable lenses, intraocular pinhole lenses, online technological tools and platforms, wavefront or topographic laser technology, and phototherapeutic keratectomy are all effective solutions to managing regular and irregular astigmatism. In this review, we will explore optimal approaches for unique situations. SUMMARY With increased technology, research, and methods, correcting regular and irregular astigmatism during cataract surgery is achievable in most patients. With in-depth preoperative planning, analysis of patient-specific factors, and a tailored approach, surgeons can obtain excellent uncorrected vision for patients.
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Wang Y, Zhang J, Qin M, Miao J, Chen W, Huang Y, Wu J, Guan Y, Guan H. Comparison of optical quality and distinct macular thickness in femtosecond laser-assisted versus phacoemulsification cataract surgery. BMC Ophthalmol 2020; 20:42. [PMID: 32007086 PMCID: PMC6995244 DOI: 10.1186/s12886-020-1319-3] [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: 09/03/2019] [Accepted: 01/17/2020] [Indexed: 11/12/2022] Open
Abstract
Background Optical quality and macular thickness changing optical quality is rarely reported after femtosecond laser-assisted cataract surgery (FLACS). In current research, we evaluated optical quality recovery and distinct macular thickness changes after FLACS and phacoemulsification cataract surgery (PCS). Methods A total of 100 cataract patients (100 eyes) were included (50 eyes for the FLACS group and 50 eyes for the PCS group). Modulation transfer function (MTF), point spread function (PSF) and dysfunctional lens index (DLI) were measured by a ray-tracing aberrometer (iTrace). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were also assessed pre-operation,1 week and 1 month after surgery. The MTF values at spatial frequencies of 5, 10, 15, 20, 25 and 30 cycles/degree (c/d) were selected. We used optical coherence tomography (OCT) to assess the macular thickness of different regions pre-operatively and1month after the surgery. Results In PCS group, we found the statistically significant differences between pre-operation and post-operation in DLI (p < 0.0001), PSF (strehl ratio, SR) (p = 0.027) and MTF (p = 0.028), but not intraocular pressure (IOP) (p = 0.857). The differences between pre-operation and post-operation for DLI (p = 0.031), SR (p = 0.01) and IOP (p = 0.03), but not MTF (p = 0.128) were also found in FLACS group. The differences were statistically significant when the spatial frequencies were at 5, 10 and 25 (p = 0.013, 0.031 and 0.048) between pre-operation and post-operation in PCS group but not FLACS group at 1 month. In PCS group, we found the differences between pre-operation and post-operation in nasal inter macular ring thickness (NIMRT) (p = 0.03), foveal volume (FV) (p = 0.034) and average retinal thickness (ART) (p = 0.025) but not FLACS group at 1 month. Conclusion FLACS is safe that did not cause significant increase of macular thickness in current study. However, it also cannot produce better optical quality. In contrast, PCS can produce macular thickness changes, but better optical quality recovery. The slightly retinal change may not affect optical quality.
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Affiliation(s)
- Yong Wang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China.,Nantong University, Nantong, Jiangsu, China
| | - Jinling Zhang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Miaomiao Qin
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Jianguo Miao
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Wei Chen
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Yemeng Huang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Jian Wu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Yu Guan
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Huaijin Guan
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China.
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Lai KR, Zhang XB, Yu YH, Yao K. Comparative clinical outcomes of Tecnis toric IOL implantation in femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery. Int J Ophthalmol 2020; 13:49-53. [PMID: 31956569 DOI: 10.18240/ijo.2020.01.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/14/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the short-term visual outcomes, residual refractive cylinder, and rotation stability after Tecnis toric intraocular lens (IOL) implantation during femtosecond laser-assisted cataract surgery (Femto phaco) and conventional phacoemulsification surgery (Conventional phaco). METHODS In a prospective cohort study, Conventional phaco and Femto phaco (anterior capsulotomy and lens fragmentation by a femtosecond laser) with Tecnis toric IOL implantation were performed in 40 eyes from 36 patients and 37 eyes from 33 patients, respectively. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest refraction were assessed during 1d, 1wk, and 1mo follow-ups. The orientation of the Tecnis Toric IOL was evaluated during 1wk and 1mo follow-ups. RESULTS There were no significant differences in UDCA or CDVA between two groups at 1mo postoperatively, though relatively more subjects had UDVA values of 20/25 or better in Femto phaco group than in the Conventional group (P>0.05). A lower but not significantly lower rate of having more than 5° of IOL rotation was observed in Femto phaco group at the 1-month follow-up, while a significant lower rate of residual astigmatism of ≤1 D was observed in Femto phaco group. CONCLUSION The Femto phaco group has significantly more subjects with the residual astigmatism of ≤1 D, but there are no significant differences in rotation stability and visual outcomes as compared with the Conventional phaco group after the application of the Tecnis toric IOL in this cohort.
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Affiliation(s)
- Kai-Ran Lai
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Xiao-Bo Zhang
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yin-Hui Yu
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Ke Yao
- Eye Center, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Chlasta-Twardzik E, Nowińska A, Wylęgała E. Comparison of the selected parameters of the anterior segment of the eye between femtosecond laser-assisted cataract surgery, microincision cataract surgery, and conventional phacoemulsification: A case-control study. Medicine (Baltimore) 2019; 98:e18340. [PMID: 31876707 PMCID: PMC6946246 DOI: 10.1097/md.0000000000018340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/17/2019] [Accepted: 11/13/2019] [Indexed: 11/26/2022] Open
Abstract
The purpose of our study was to compare the selected parameters of the anterior segment of the eye in patients after femtosecond laser-assisted cataract surgery (FLACS) with the results of microincision cataract surgery (MICS) and conventional phacoemulsification surgery (CPS). This single-center prospective randomized comparative observational study included 87 patients. Patients were randomly selected into group A (FLACS), group B (MICS) and group C (control group). All the surgeries were performed by the same experienced surgeon. Preoperative and postoperative parameters were evaluated: best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss percentage (ECL%), central corneal thickness (CCT), central anterior and posterior corneal astigmatism induction, posterior corneal elevation map were measured. Intraoperative parameters: effective phacoemulsification time (EPT), balanced salt solution use (BSS use), total surgical time and suction time were analyzed. Examination was performed preoperatively and on the first, seventh day, one and six months postoperatively. The follow up period was 6 months. There was no statistically significant difference in BCVA, central anterior and posterior astigmatism induction between studied groups. The ECL% was statistically significant lower in the group A on the 7th day, 1 month and 6-months postoperatively (P < .05). The CCT was statistically significant lower in the group A and in the group B than in the group C on the 7th postoperative day (P = .002). However, in the 6 months follow-up there was no statistically significant difference in the CCT between studied groups (P = .133). We observed statistically significant difference in change of the posterior corneal elevation map at the periphery assessed within the 90° to 120°meridian range between group A, group B and group C at every timepoint postoperatively (P < .05). The EPT and BSS use were statistically significant lower whilst total surgery time was statistically significant higher in the FLACS group (P < .05). To conclude in the 6 months follow-up there was statistically significant difference found between eyes undergoing FLACS, MICS and CPS with respect to the posterior corneal elevation map assessed within the studied range, ECL%, EPT, BSS use and total surgery time. Postoperative BCVA, central anterior and posterior astigmatism induction, CCT were comparable between studied groups.
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Pereira A, Somani S, Tam ES, Chiu H, Maini R. Comparison of Surgically Induced Astigmatism and Corneal Morphological Features Between Femtosecond Laser and Manual Clear Corneal Incisions. J Refract Surg 2019; 35:796-802. [PMID: 31830296 DOI: 10.3928/1081597x-20191024-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/23/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess corneal morphologic changes and surgically induced astigmatism (SIA) following clear corneal incisions (CCIs) created manually or with the Catalys femtosecond laser (Johnson & Johnson Vision, Santa Ana, CA). METHODS In this retrospective cohort analysis, patients undergoing femtosecond laser-assisted cataract surgery (FLACS) or manual cataract surgery between June and September 2018 from a single surgical center in Toronto, Canada, were considered for inclusion. Postoperative corneal astigmatism values were compared to preoperative astigmatism indices to determine the SIA at the postoperative 3-month (POM3) mark using the Alpins vector method. Secondary outcomes included postoperative corrected distance visual acuity (CDVA), central corneal thickness (CCT), and CCI morphology parameters. RESULTS Refractive outcomes from 104 eyes of 61 patients (54 eyes in the manual group and 50 eyes in the FLACS group) were included. There was no significant difference in POM3 SIA (manual: 0.45 ± 0.28 diopters [D], FLACS: 0.57 ± 0.46 D, P = .11); however, a significantly larger SIA was noted in the FLACS cohort at postoperative 1 week (P = .02) and 1 month (P = .04). FLACS led to a significantly smaller POM3 CCI thickness (P = .006), and CCI position was comparable between the two techniques (P = .44). There were no significant differences between groups in CDVA (P = .19), CCT thickness (P = .20), or phacoemulsification time (P = .59). CONCLUSIONS There was no significant difference in SIA between FLACS and manual cataract surgery at POM3. With a significantly smaller CCI thickness seen in FLACS cases, and a comparable CCI position, the reason for the increased SIA following laser CCIs in the early postoperative period was unclear. [J Refract Surg. 2019;35(12):796-802.].
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Villegas EA, Alcón E, Rubio E, Marín JM, Artal P. One-year follow-up of changes in refraction and aberrations induced by corneal incision. PLoS One 2019; 14:e0224823. [PMID: 31738783 PMCID: PMC6860439 DOI: 10.1371/journal.pone.0224823] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/22/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the surgically induced changes in refraction (sphere and astigmatism) and higher order aberrations by corneal incision for one year. Setting University Hospital “Virgen de la Arrixaca”, Murcia, Spain. Design Retrospective interventional case series. Methods Corneal power, astigmatism and higher order aberrations (HOA) were calculated from corneal topography measured in 27 eyes prior to surgery and at 2 weeks, 1, 2, 3 and 6 months and 1 year following cataract surgery with 3.2-mm corneal incision. At every stage, optical changes were calculated as the difference between pre- and post-surgery data (in each follow-up) using the formulas of obliquely crossed cylinders for the refraction and Zernikes coefficients for HOA. Results At 2 weeks after surgery the mean corneal values of induced sphere, cylinder and the root mean square (RMS) of HOA were +0.54±0.27 D, -0.77±0.32 D and 0.15 microns respectively. These parameters decreased significantly (p-values between 0 and 0.01) at 3 months to +0.33±0.27 D sphere, -0.50±0.24 D cylinder and 0.10±0.05 microns HOA and were stable at the next follow-ups. Induced spherical equivalent was around zero at all visits. The changes in HOA were mainly due to trefoil aberration. Conclusions Linear corneal incisions do not change the spherical power but can induce significant values of astigmatism and trefoil aberration in the cornea. However, these changes revert fully or partially to preoperative values by the third month after surgery and remain stable with time.
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Affiliation(s)
- Eloy A. Villegas
- Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain
- * E-mail:
| | - Encarna Alcón
- Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain
| | - Elena Rubio
- Servicio de Oftalmología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - José María Marín
- Servicio de Oftalmología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Pablo Artal
- Laboratorio de Óptica, Universidad de Murcia, Murcia, Spain
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Xiang W, Chen W, Liu R, Chen H, Yang C, Zhong L, Zhang S, Chen W. Ocular Cyclorotation and Corneal Axial Misalignment in Femtosecond Laser-Assisted Cataract Surgery. Curr Eye Res 2019; 44:1313-1318. [PMID: 31296058 DOI: 10.1080/02713683.2019.1638943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To explore ocular cyclorotation and the source of corneal axial misalignment during femtosecond laser-assisted cataract surgery (FLACS).Methods: Forty-five sequential patients (50 eyes) who had undergone FLACS (LenSx Laser System, Alcon Inc) were recruited. We took screenshots from videos of FLACS to analyze ocular cyclorotation and the real angle between primary incision and secondary incision (RAPS). In addition, crystalline lens tilt and theoretic angle between the primary and secondary incisions (TAPS) was also calculated.Results: The mean absolute value of ocular cyclorotation was 8.03 ± 4.48 degrees (0-19.1 degrees). The crystalline lens tilt was 3.30 ± 1.44 degrees (0.93-6.44 degrees). And the mean preoperative uncorrected visual acuity was 0.89 ± 0.50 LogMAR units. Pearson bivariate correlation analysis showed significant positive correlation between ocular cyclorotation with crystalline lens tilt (r = 0.37, p = .008), and ocular cyclorotation negatively correlated with axial length (r = -0.29, p = .038). In addition, the TAPS was 89.78 ± 1.45 degrees, and the RAPS was 85.68 ± 2.04 degrees. The angle error was 4.11 ± 1.28 degrees (p<0.001).Conclusions: Ocular cyclorotation commonly occurred during FLACS. In addition, increased axial length was associated with less ocular cyclorotation and increased crystalline lens tilt was related to more ocular cyclorotation. Importantly, machinery systemic errors during corneal astigmatism correction by arcuate incision in FLACS should be taken into consideration.
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Affiliation(s)
- Wu Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rongjiao Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Chunyan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Liting Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shaochong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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Lee BS, Chang DF. Femtosecond Laser-Assisted Cataract Surgery vs. Phacoemulsification: Overall Safety and the Effect on the Corneal Endothelium. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wang W, Ni S, Li X, Chen X, Zhu Y, Xu W. Femtosecond laser-assisted cataract surgery with implantation of a diffractive trifocal intraocular lens after laser in situ keratomileusis: a case report. BMC Ophthalmol 2018; 18:160. [PMID: 29970067 PMCID: PMC6029048 DOI: 10.1186/s12886-018-0834-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background We report for the first time, a case of femtosecond laser-assisted cataract surgery (FLACS) with implantation of a diffractive trifocal intraocular lens (IOL) after laser in situ keratomileusis (LASIK). Case presentation A 60-year-old man underwent FLACS uneventfully 15 years after myopic LASIK. An AT Lisa tri 839MP IOL was implanted with the expectation of spectacle independence. The Haigis-L formula was chosen for calculation of the IOL power and it provided reliable results. Three months postoperatively, the uncorrected visual acuities were 0.00 logMAR for distance, 0.10 logMAR for intermediate, and 0.10 logMAR for near. Conclusions This case suggested that FLACS presents a feasible surgical technique for post-LASIK eyes and that implantation of trifocal IOL can achieve good visual performance in strictly selected cases after myopic LASIK.
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Affiliation(s)
- Wei Wang
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, China
| | - Shuang Ni
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, China
| | - Xi Li
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, China
| | - Xiang Chen
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, China
| | - Yanan Zhu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, China
| | - Wen Xu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, China.
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