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Stewart S, Liu YC, Setiawan M, Lin MTY, Lee IXY, Sim N, Htoon HM, Ong HS, Mehta JS. The Effects of High Energy Capsulotomy on Aqueous Cytokine Profiles and Pupil Size During Femtosecond Laser-Assisted Cataract Surgery. J Refract Surg 2022; 38:587-594. [PMID: 36098390 DOI: 10.3928/1081597x-20220808-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess whether aqueous cytokine profiles and pupil size are altered when high capsulotomy energy is used in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS), and if preoperative use of a topical non-steroidal anti-inflammatory drug (NSAID) has an effect on this. METHODS This prospective study recruited 83 eyes (63 patients) that were allocated to four treatment groups: conventional phacoemulsification (n = 20 eyes); FLACS with 90% capsulotomy energy without NSAID pretreatment (n = 20 eyes); FLACS with 90% capsulotomy energy with NSAID pre-treatment (n = 21 eyes); and FLACS with 150% capsulotomy energy with NSAID pretreatment (n = 22 eyes). Aqueous humor was collected before and after phacoemulsification to assess cytokine profiles. Pupil size was measured before and after laser capsulotomy. RESULTS FLACS increased aqueous concentrations of pros-taglandin E2 (PGE2), interferon γ (IFN-γ), and interleukin 6 (IL-6) compared to conventional phacoemulsification. However, when increasing capsulotomy energy from 90% to 150% (with topical NSAID pretreatment), there was no significant increase in aqueous concentrations of PGE2 (37.7 ± 21.7 vs 33.6 ± 27.6 pg/mL, P = .99), IFN-γ (3.6 ± 1.1 vs 3.6 ± 0.8 pg/mL, P = .99), or IL-6 (7.1 ± 2.9 vs 6.3 ± 2.4 pg/mL, P = .99). For 90% and 150% capsulotomy energy, there was significant miosis following laser capsulotomy. Increased PGE2 concentration was significantly correlated with a reduction in pupil area (r = -0.58, P < .001) and pupil diameter (r = -0.57, P < .001). However, when a topical NSAID was given preoperatively, there was no difference in the degree of miosis between the 90% and 150% capsulotomy energy groups. CONCLUSIONS Pretreatment with a topical NSAID prevented a rise in PGE2, IFN-γ, and IL-6 levels and excessive miosis when a higher capsulotomy energy was used. When a topical NSAID is used preoperatively, it is safe to use higher capsulotomy energy settings (with a low pulse energy femtosecond laser system) to achieve a satisfactory capsulotomy. [J Refract Surg. 2022;38(9):587-594.].
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Chung HS, Lee J, Lee H, Kim JY, Tchah H. Evaluation of the Optical Aspects of the Ophthalmic Viscosurgical Device During Femtosecond Laser-Assisted Cataract Surgery. Transl Vis Sci Technol 2022; 11:2. [PMID: 35506930 PMCID: PMC9078068 DOI: 10.1167/tvst.11.5.2] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose In femtosecond laser-assisted cataract surgery (FLACS), capsulorhexis can be performed with an ophthalmic viscosurgical device (OVD) filled in the anterior chamber. We aimed to investigate changes in the laser properties in various optical aspects, such as focal shifting, reflection, and absorption associated with OVD. Methods Simulation was achieved by calculating the laser power attenuation due to reflection and spot size change using the Gullstrand eye model. Additionally, we calculated the absorption coefficient by measuring the laser power passing through the OVD with a laser meter and evaluated the effect of absorption by the OVD. Results In our simulation, power attenuation due to reflection was a maximum of 0.07%, and power attenuation was 0.08% even when considering the change according to the incident angle. Power attenuation due to the change of the spot size at the focus was 0.005%. Owing to the absorption of the OVD, a power increase of up to 13.5% was required for an anterior chamber depth of 3.0 mm to obtain the same effect as the aqueous humor. Conclusions The main reason for laser power attenuation associated with OVD was laser absorption through the OVD, and could also be caused by laser cavitation bubbles. To complete a safe capsulotomy during FLACS, the laser power should be increased appropriately, considering the absorption by the OVD in the anterior chamber. Translational Relevance The study results can be applied to calculate the optimal femtosecond laser energy to achieve complete capsulotomy during FLACS in the presence of anterior chamber OVD.
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Affiliation(s)
- Ho Seok Chung
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Jinho Lee
- The Research Institute of Natural Science and Department of Physics Education, Gyeongsang National University, Jinju, Korea
| | - Hun Lee
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
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Liu YC, Morales-Wong F, Patil M, Han SB, Lwin NC, Teo EPW, Ang HP, Yussof NZM, Mehta JS. Femtosecond laser-assisted corneal transplantation with a low-energy, liquid-interface system. Sci Rep 2022; 12:6959. [PMID: 35484198 PMCID: PMC9050694 DOI: 10.1038/s41598-022-11461-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Femtosecond laser-assisted keratoplasty has been proposed as a treatment option for corneal transplantation. In this study, we investigated and compared the outcomes of Ziemer Z8 femtosecond laser (FSL)-assisted penetrating keratoplasty (PK) using a liquid interface versus flat interface. Thirty fresh porcine eyes underwent FSL-assisted PK with the Z8 using different levels of energies (30%, 90% or 150%) and different interfaces (liquid or flat). The real-time intraocular pressure (IOP) changes, incision geometry, corneal endothelial damage, as well as the accuracy of laser cutting and tissue reaction, were performed and compared. We found that the overall average IOP at all laser trephination stages was significantly higher with the flat interface, regardless of the energy used (68.9 ± 15.0 mmHg versus 46.1 ± 16.6 mmHg; P < 0.001). The overall mean laser-cut angle was 86.2º ± 6.5º and 88.2º ± 1.0º, for the liquid and flat platform respectively, indicating minimal deviation from the programmed angle of 90º. When high energy (150%) was used, the endothelial denuded area was significantly greater with the flat interface than with liquid interface (386.1 ± 53.6 mm2 versus 139.0 ± 10.4 mm2P = 0.02). The FSL cutting did not cause obvious tissue reaction alongside the laser cut on histological evaluation. The results indicated a liquid interface is the preferable choice in FSL-assisted corneal transplantation.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore. .,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore. .,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore. .,Duke-NUS Graduate Medical School, Ophthalmology Academic Clinical Program, Singapore, Singapore.
| | - Fernando Morales-Wong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore.,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore.,Faculty of Medicine, University Hospital "Dr Jose Eleuterio Gonzalez", Autonomous University of Nuevo Leon, San Nicolás de los Garza, Mexico
| | - Moushmi Patil
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon-si, Republic of Korea
| | - Nyein C Lwin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Ericia Pei Wen Teo
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Heng Pei Ang
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Nur Zah M Yussof
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, The Academia, 20 College Road, Discovery Tower, Level 6, Singapore, 169856, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore, Singapore.,Duke-NUS Graduate Medical School, Ophthalmology Academic Clinical Program, Singapore, Singapore
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Abbas AA, Bu JJ, Chung J, Afshari NA. Recent developments in anterior capsulotomy for cataract surgery. Curr Opin Ophthalmol 2022; 33:47-52. [PMID: 34854828 DOI: 10.1097/icu.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Successful anterior capsulotomy is an important step in cataract surgery. This article reviews the various anterior capsulotomy techniques available to surgeons to optimize the step, including those that have become available since the introduction of femtosecond-laser-assisted cataract surgery (FLACS). Studies comparing the relative advantages of each technique will be emphasized. RECENT FINDINGS Manual continuous curvilinear capsulorhexis (CCC) and FLACS remain the two most widely studied techniques for achieving anterior capsulotomy. Each technique has been shown to be effective for a wide range of patients and cataract surgery complications. Meta-analyses have shown that FLACS provides similar results to manual CCC for long-term cataract surgery outcomes. Several alternative methods for anterior capsulotomy have been described, which aim to provide some of the advantages of laser capsulotomy at a lower cost; among these, precision pulse capsulotomy (PPC) and selective laser capsulotomy (SLC) have been investigated the most in the literature so far. SUMMARY Cataract surgeons have an increasing number of techniques for anterior capsulotomy available. Manual CCC and FLACS remain the most widely used, and most well studied. The latest techniques, PPC and SLC, have shown promise in the few studies performed since they were introduced.
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Affiliation(s)
- Anser A Abbas
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jennifer J Bu
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jinkwon Chung
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Natalie A Afshari
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
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