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Sandhu U, Osborn AR, Dang DH, Murphy DA, Langenbucher A, Wendelstein JA, Riaz KM. Refractive Astigmatism Outcomes of Femtosecond Laser-Assisted Arcuate Keratotomies Combined with Femtosecond Laser-Assisted Cataract Surgery: Two-Year Results. Curr Eye Res 2024; 49:961-971. [PMID: 38780904 DOI: 10.1080/02713683.2024.2353268] [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: 01/09/2024] [Revised: 03/30/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To evaluate the effectiveness and stability of refractive astigmatism reduction after penetrating femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery. METHODS Non-randomized retrospective data analysis of all patients that underwent femtosecond laser-assisted cataract surgery with femtosecond laser-assisted arcuate keratotomy over a 4-year period with a non-toric monofocal intraocular lens (2017-2021) at a tertiary care academic center. Postoperative visual acuity, manifest refraction, and predicted residual refractive error were also recorded at 1 month, 3-6 months, 12-18 months, and 2 years postoperatively. Preoperative keratometric astigmatism was compared to postoperative refractive astigmatism using vector calculations and the ASCRS double-angle plot tool. RESULTS This study comprised 266 eyes (179 patients) that met inclusion criteria. The mean preoperative keratometric astigmatism magnitude was 0.99 ± 0.53 D. At 1 month, 3-6 months, 12-18 months, and 2 years postoperatively, the mean refractive cylinder was 0.49 ± 0.45 D, 0.49 ± 0.45 D, 0.55 ± 0.54 D, and 0.52 ± 0.46 D, respectively. Horizontal against-the-rule astigmatism showed a higher tendency toward undercorrection than vertical with-the-rule astigmatism, which had a slightly higher tendency toward overcorrection. With-the-rule astigmatism had smaller difference vectors between target-induced astigmatism and surgically induced astigmatism. CONCLUSIONS Femtosecond laser-assisted arcuate keratotomy performed at the time of femtosecond laser-assisted cataract surgery was an effective option for correcting low-to-moderate corneal astigmatism for up to 2 years.
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Affiliation(s)
- Umar Sandhu
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Andrew R Osborn
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
- Missouri Eye Institute, Springfield, MO, USA
| | - Deanna H Dang
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - David A Murphy
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
| | - Jascha A Wendelstein
- Institute of Experimental Ophthalmology, Saarland University, Homburg, Germany
- Department for Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
- Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Zurich, Switzerland
| | - Kamran M Riaz
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA
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Ding X, Zhang F, Li S. Modified femtosecond laser-assisted arcuate keratotomy for managing low corneal astigmatism using trifocal intraocular lens implantation in Chinese cataract patients. Lasers Med Sci 2024; 39:178. [PMID: 38990392 DOI: 10.1007/s10103-024-04131-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
To evaluate the visual outcome and astigmatic correction following trifocal intraocular lens (IOL) implantation using the modified femtosecond laser-assisted arcuate keratotomy (FSAK) in Chinese cataract patients with low astigmatism. This retrospective study included consecutive cataract patients with regular corneal astigmatism ranging from 0.75 to 1.5 D who underwent FSAK combined with the trifocal IOL implantation between November 2020 and September 2022. Monocular uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, and refractive data were collected at the 3-month follow-up. The pre- and post-operative high-order aberrations (HOAs) were recorded. The variation in astigmatism was analyzed using Alpins vector analysis. A total of 27 eyes from 23 patients were analyzed. The monocular uncorrected distance visual acuity (UDVA) (5 m) at the 3-month follow-up was 0.04 ± 0.09 logarithm of the minimum angle of resolution (logMAR), which was significantly improved compared with the preoperative value of 0.95 ± 0.51 logMAR (P <.001). The corneal astigmatism was significantly reduced from 1.24 ± 0.42 D to 0.49 ± 0.34 D (P <.001). The target-induced astigmatism (TIA) was 1.25 ± 0.43 D, the surgically induced astigmatism (SIA) was 1.16 ± 0.52 D, and the difference vector (DV) was 0.5 ± 0.34 D. The magnitude of error (ME) (difference between SIA and TIA) was -0.1 ± 0.41 D, and the correction index (CI) (ratio of SIA to TIA) was 0.93 ± 0.36. The angle of error was 3.92° ± 16.90°. Total HOA was reduced from 0.89 ± 1.11 to 0.41 ± 0.55 (P = 0.184), and the corneal HOA was lowered from 0.17 ± 0.18 to 0.10 ± 0.10 (P = 0.129). Implantation of trifocal IOL following the modified FSAK in Chinese cataract patients exhibited excellent visual efficacy and effectively reduced corneal astigmatism.
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Affiliation(s)
- Xue Ding
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China
| | - Fan Zhang
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China
| | - Shaowei Li
- Beijing Aier-Intech Eye Hospital, Beijing, 100021, China.
- Aier Academy of Ophthalmology, Central South University, Changsha, 410004, China.
- Institute of Corneatology in Aier Eye Hospital, Beijing, 100021, China.
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Yen WT, Weng TH, Lin TY, Tai MC, Chen YH, Chang YM. Femtosecond laser-assisted astigmatic keratotomy versus toric IOL implantation for correcting astigmatism in cataract patients: a systematic review and meta-analysis with trial sequential analysis. Br J Ophthalmol 2024:bjo-2024-325195. [PMID: 38575199 DOI: 10.1136/bjo-2024-325195] [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: 01/10/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
AIMS To compare the refractive and visual outcomes of femtosecond laser-assisted astigmatic keratotomy (FSAK) and toric intraocular lens (IOL) implantation for correcting astigmatism in cataract patients. METHODS Studies were retrieved from the Ovid-Medline, EMBASE, Cochrane Central Register of Controlled Trials and Scopus which compared FSAK and toric IOL for astigmatism correction in cataract patients. Outcome measures included postoperative refractive cylinder, correction index, uncorrected distance visual acuity (UDVA), the proportion of patients achieving a residual refractive cylinder of 1.00 dioptre or less, target-induced astigmatism (TIA) and surgically induced astigmatism (SIA). The trial sequential analysis (TSA) was used to collect firm evidence supporting our conclusion. RESULTS 9 studies encompassing 590 participants were analysed. The meta-analysis revealed that toric IOLs could result in less postoperative refractive cylinder and provide better UDVA compared with FSAK. The TSA disclosed strong evidence of lower postoperative refractive cylinder in the toric IOL group compared with that of the FSAK group. FSAK showed a smaller correction index and lower mean TIA and SIA compared with toric IOLs. CONCLUSIONS For cataract patients, both FSAK and toric IOLs are effective methods for correcting astigmatism. However, toric IOLs offer less postoperative astigmatism and result in better postoperative UDVA compared with FSAK. In vector analysis of astigmatism, toric IOLs can also produce higher TIA and SIA. Additionally, neither method is associated with severe untreatable complications. Therefore, the conclusion is that toric IOLs are the preferred choice for astigmatism correction in cataract patients and FSAK serves as a viable alternative when toric IOLs are contraindicated.
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Affiliation(s)
- Wei-Ting Yen
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital, Taipei City, Taiwan
- National Defense Medical Center, Taipei City, Taiwan
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Racaniello GF, Balenzano G, Arduino I, Iacobazzi RM, Lopalco A, Lopedota AA, Sigurdsson HH, Denora N. Chitosan and Anionic Solubility Enhancer Sulfobutylether-β-Cyclodextrin-Based Nanoparticles as Dexamethasone Ophthalmic Delivery System for Anti-Inflammatory Therapy. Pharmaceutics 2024; 16:277. [PMID: 38399331 PMCID: PMC10893235 DOI: 10.3390/pharmaceutics16020277] [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: 01/12/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Cataract surgery interventions are constantly increasing, particularly among adult and elderly patients. This type of surgery can lead to inflammatory states of the ocular anterior segment (AS), usually healed via postoperative treatment with dexamethasone (DEX)-containing eye drops. The application of eye drops is challenging due to the high number of daily administrations. In this study, mucoadhesive nanoparticles (NPs) were formulated to improve the residence time of DEX on the corneal mucosa, enhancing the drug's solubility and bioavailability. The NPs were generated using an ionotropic gelation technique, exploiting the interaction between the cationic group of chitosan (CS) and the anionic group of sulfobutylether-β-cyclodextrin (SBE-β-CD). The formation of the inclusion complex and its stoichiometry were studied through phase solubility studies, Job's plot method, and Bi-directional transport studies on MDCKII-MDR1. The obtained NPs showed good chemical and physical characteristics suitable for drug loading and subsequent testing on animal mucosa. The DEX-loaded CS/SBE-β-CD NPs exhibited a prolonged residence time on animal mucosa and demonstrated enhanced drug permeability through the corneal membrane, showing a sustained release profile. The developed NPs posed no irritation or toxicity concerns upon local administration, making them an optimal and innovative drug delivery system for inflammatory AS diseases treatment.
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Affiliation(s)
- Giuseppe Francesco Racaniello
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Gennaro Balenzano
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Ilaria Arduino
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Rosa Maria Iacobazzi
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Antonio Lopalco
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | - Angela Assunta Lopedota
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
| | | | - Nunzio Denora
- Department of Pharmacy–Pharmaceutical Sciences, University of Bari “Aldo Moro”, 70125 Bari, Italy; (G.F.R.); (G.B.); (I.A.); (R.M.I.); (A.L.); (A.A.L.)
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Salgado RMPC, Torres PFAAS, Marinho AAP. Update on Femtosecond Laser-Assisted Cataract Surgery: A Review. Clin Ophthalmol 2024; 18:459-472. [PMID: 38375440 PMCID: PMC10875176 DOI: 10.2147/opth.s453040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024] Open
Abstract
The advent of femtosecond lasers has resulted in a new standard in cataract surgery, intended to overmatch the paradigm of conventional phacoemulsification. Femtosecond laser-assisted cataract surgery (FLACS) enables a higher level of reproducibility, precision, accuracy, and customization when performing several steps of cataract (or lens) surgery. Capsulotomy, corneal incisions, lens fragmentation, and arcuate incisions are the main procedures performed using FLACS. As the demand for better refractive outcomes and spectacle independence increases, the features of FLACS are highly relevant, especially when considering the implantation of premium intraocular lenses, such as toric, enhanced depth-of-focus, or multifocal lenses. The present article reviews the state of the art of femtosecond laser-assisted cataract (lens) surgery, contemplating the advantages and limitations of the two types of femtosecond laser pulses available (high and low energy) by evaluating their reported outcomes and complications.
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Affiliation(s)
- Ramiro M P C Salgado
- Departamento de Oftalmologia do Hospital da Arrábida, Hospital de Santo António, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Paulo F A A S Torres
- Departamento de Oftalmologia do Hospital da Prelada, Universidade do Porto, Porto, Portugal
| | - Antonio A P Marinho
- Departamento de Oftalmologia do Hospital da Luz Arrábida, Universidade do Porto, Porto, Portugal
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Narang R, Agarwal A. Refractive cataract surgery. Curr Opin Ophthalmol 2024; 35:23-27. [PMID: 37962881 DOI: 10.1097/icu.0000000000001005] [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: 11/15/2023]
Abstract
PURPOSE OF REVIEW The aim of this study to provide an overview of recent publications and opinions in refractive cataract surgery. RECENT FINDINGS With the advent of intraocular lenses (IOLs) on different platforms, the surgeon has a wide arena of types of IOL to choose, depending on the patient's visual requirement. Optimization of the tear film, integrating tomography and topography devices for appropriate keratometry values, biometry, use of advanced formulas for IOL power calculation and application of newer IOLs can help achieve target refraction in cases scheduled for cataract surgery. Intraoperative aberrometry can be a useful aid for cataract surgery in postrefractive cases and can help minimize residual postoperative astigmatism. SUMMARY Evolvement and rapid advancement of technology allows to impart desired refractive outcomes in most of the cases postcataract surgery. Appropriate preoperative and intraoperative factors should be considered to achieve the desired postoperative outcome.
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Affiliation(s)
- Rhea Narang
- SMT. NHL Medical College, Ahmedabad, Gujarat
| | - Ashvin Agarwal
- Dr Agarwal's Eye Hospital & Research Centre, Chennai, Tamil Nadu, India
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Hu ZX, Sima J, Cao JG, Ke Y, Zhang YY, Guo QT, He YP, Liao HX, Tan X, Qin B, Li L. Symmetrical femtosecond laser arc incision in correcting corneal astigmatism in cataract patients. Int J Ophthalmol 2023; 16:1996-2003. [PMID: 38111947 PMCID: PMC10700070 DOI: 10.18240/ijo.2023.12.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/18/2023] [Indexed: 12/20/2023] Open
Abstract
AIM To evaluate the effect of symmetrical arc incision correcting corneal astigmatism in femtosecond laser-assisted phacoemulsification (FLACS). METHODS This study enrolled patients with cataract combined with regular corneal astigmatism of >0.75 D, who underwent FLACS. Symmetrical arc incision was set at 8 mm diameter and 85% depth. The follow-up time was 3-24mo (4.92±3.49mo). Pentacam recorded the corneal astigmatism and higher-order aberration at pre-operation and post-operation. The changes in corneal astigmatism were analyzed by Alpins method. The correlation of astigmatism type, age, corneal horizontal diameter, corneal thickness, arc incision length, and correction index (CI) was analyzed, and the residual corneal astigmatism was compared with the residual whole eye astigmatism. RESULTS Totally 79 patients (102 eyes) were enrolled, 10 patients had corneal epithelial injury, 1 patient occurred corneal epithelial hyperplasia. The corneal astigmatism was 1.23±0.38 D pre-operation, and decreased to 0.76±0.39 D post-operation (t=10.146, P=0.000). Corneal high-order aberration was 0.17±0.08 µm pre-operation and 0.24±0.11 µm post-operation (t=-5.186, P=0.000). The residual corneal astigmatism and residual whole eye astigmatism were no significant difference (t=-0.347, P=0.729). Using Alpin's method, the following were determined: target-induced astigmatism (TIA) =1.23±0.38 D, surgery-induced astigmatism (SIA) =0.77±0.45 D, difference vector (DV)=0.77±0.39 D, and CI=0.54±0.28. Age, astigmatism size, corneal horizontal diameter, corneal thickness, and arc incision length were not correlated with CI. The CI for against the rule astigmatism (ATR) was better than that for with the rule astigmatism (WTR; P=0.001). CONCLUSION Femtosecond laser-assisted astigmatic keratotomy has better CI of ATR, but increase higher-order corneal aberration. CI is not ideal, it's not a perfect choice if we pursue ideal correction effect.
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Affiliation(s)
- Zun-Xia Hu
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Jing Sima
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Jia-Guo Cao
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Yan Ke
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Ying-Ying Zhang
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Qiong-Tian Guo
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Yu-Ping He
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Hong-Xia Liao
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Xiao Tan
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Bo Qin
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
| | - Li Li
- Aier Eye Hospital, Jinan University, Shenzhen 518032, Guangdong Province, China
- Nanning Aier Eye Hospital, Nanning 530012, Guangxi Zhuang Autonomous Region, China
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Zheng J, He L, Zhong J. Effect of femtosecond laser-assisted arcuate keratotomy versus toric intraocular lens implantation on correction of astigmatism in cataract surgery: a systematic review and meta-analysis. Lasers Med Sci 2023; 38:225. [PMID: 37773468 DOI: 10.1007/s10103-023-03893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/21/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To compare the efficacy of femtosecond laser-assisted arcuate keratotomy (FSAK) combined with non-toric intraocular lens (IOL) implantation versus Toric IOL (TIOL) implantation in correcting corneal astigmatism in cataract patients. METHODS Relevant literature was searched in databases including PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and SinoMed. Data from the included studies were extracted. A meta-analysis was conducted to compare the correction performance of FSAK combined with non-toric IOL implantation and TIOL implantation using postoperative refractive astigmatism, correction index, and uncorrected distance visual acuity (UDVA) outcomes. Publication bias assessment and sensitivity analysis were also performed. RESULTS Five comparative studies were ultimately included in the meta-analysis. The TIOL group had smaller postoperative refractive astigmatism and a greater correction index compared to the FSAK group. The mean differences in postoperative refractive astigmatism and correction index between the two groups were - 0.19D (95% CI = 0.12 to 0.26, P < 0.01, I2 = 7%) and - 0.09 (95% CI = - 0.18 to 0.00, P = 0.04, I2 = 0%), respectively. We found no statistically significant difference in UDVA between the two groups (95% CI = - 0.01 to 0.11, P = 0.09, I2 = 70%). CONCLUSIONS FSAK combined with non-toric IOL implantation was found to be less effective than TIOL implantation in correcting preoperative corneal astigmatism in cataract patients. The difference in the effectiveness of astigmatism correction between the two surgical methods seems to diminish, as the degree of preoperative corneal astigmatism decreases.
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Affiliation(s)
- Jiang Zheng
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China
| | - Lun He
- Department of Ophthalmology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510260, China
| | - Jingxiang Zhong
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, China.
- The Sixth Affiliated Hospital of Jinan University, Jinan University, Dongguan, 523129, China.
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Kecik M, Schweitzer C. Femtosecond laser-assisted cataract surgery: Update and perspectives. Front Med (Lausanne) 2023; 10:1131314. [PMID: 36936227 PMCID: PMC10017866 DOI: 10.3389/fmed.2023.1131314] [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: 12/24/2022] [Accepted: 02/07/2023] [Indexed: 03/06/2023] Open
Abstract
Cataract surgery is among the most frequently performed surgical procedures worldwide and has a tremendous impact on patients' quality of life. Phacoemulsification (PCS) is accepted as a standard of care; its technique has continuously evolved and already achieved good anatomical, visual, and refractive outcomes. Lasers in ophthalmology are widely used in clinical practice, femtosecond lasers (FSLs) for corneal surgery in particular. It was natural to assess the usefulness of FSL in cataract surgery as this technology was within reach. Indeed, precise and reproducible cuttings provided by FSL platforms could improve standardization of care and limit the risk associated with the human element in surgery and provide a step toward robot-assisted surgery. After docking and planning the procedure, femtosecond lasers are used to perform corneal incisions, capsulorhexis, lens fragmentation, and arcuate incisions in an automated manner. A well-constructed corneal incision is primordial as it offers safety during the procedure, self-seals afterward, and influences the refractive outcome. Capsulorhexis size, centration, and resistance to shearing influence the surgery, intraocular lens (IOL) centration and stability, and posterior capsular opacification formation. Lens fragmentation is where most of the energy is delivered into the eye, and its amount influences endothelial cell damage and potential damage to other ocular structures. The arcuate incisions offer an additional opportunity to influence postoperative astigmatism. Femtosecond laser-assisted cataract surgery (FLACS) has been a topic of research in many studies and clinical trials that attempted to assess its potential benefits and cost-effectiveness over PCS and is the subject of this mini-review.
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Affiliation(s)
- Mateusz Kecik
- Department of Ophthalmology, Hopitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Cedric Schweitzer
- Department of Ophthalmology, CHU Bordeaux, Bordeaux, France
- INSERM, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, Univ. Bordeaux, Bordeaux, France
- *Correspondence: Cedric Schweitzer
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Clinical Outcomes after Bilateral Implantation of Trifocal Diffractive Intraocular Lenses and Extended Depth of Focus Intraocular Lenses. J Clin Med 2022; 11:jcm11195729. [PMID: 36233597 PMCID: PMC9571716 DOI: 10.3390/jcm11195729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
The purpose of this retrospective study is to investigate clinical outcomes of bilateral implantation of diffractive trifocal intraocular lenses (IOLs) and extended depth of focus IOLs in Koreans. The clinical outcomes of cataract surgery with bilateral implantation of PanOptix, FineVision, Symfony, and MiniWell were evaluated. Uncorrected distant, intermediate (80 cm, 60 cm), near (40 cm) visual acuity, defocus curve, manifest refraction, contrast sensitivity, and higher-order aberrations, quality of vision, spectacle independence, and subjective satisfaction at postoperative 3 months were assessed. A total of 136 eyes in 68 patients were included in the analyses. PanOptix and FineVision performed better visual acuity compared to Symfony and MiniWell at 40 cm distance. Defocus curve showed broad range of vision in PanOptix and FineVision with visual acuity of more than 0.1 logarithm of the minimum angle of resolution at −2.5 diopter (D) of defocus power, while Symfony and MiniWell presented excellent intermediate vision without a dip at defocus power of −0.5 D to −1.0 D. Glare, halo, and starburst were significantly less in MiniWell compared to others. In conclusion, all four IOLs presented satisfactory clinical outcomes. PanOptix and FineVision provided good near and intermediate vision, while Symfony and MiniWell provided good intermediate vision. MiniWell induced little dysphotopsia.
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Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes. J Clin Med 2022; 11:jcm11144221. [PMID: 35887985 PMCID: PMC9316233 DOI: 10.3390/jcm11144221] [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: 05/16/2022] [Revised: 07/06/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was −9.59 ± 2.36 D. At the final follow-up, the mean astigmatism decreased to −5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty.
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Hernandez R, Almenara C, Soriano D, Idoipe M, Larrosa JM, Pablo LE, Garcia-Martin E. Toric intraocular lens implantation vs. femtosecond laser-assisted arcuate keratotomy for correction of moderate astigmatism in cataract surgery. J Cataract Refract Surg 2021; 48:887-893. [PMID: 34935711 DOI: 10.1097/j.jcrs.0000000000000879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare toric intraocular lens (TIOL) implantation and femtosecond laser-assisted arcuate keratotomy (FSAK) during phacoemulsification surgery in correction of moderate astigmatism. SETTING Clinical research study. DESIGN Prospective randomized comparison study. METHODS Patients with age-related cataract and moderate preoperative corneal astigmatism of 1.25 to 3.0 diopters (D) were randomized into a TIOL implant group and an FSAK group with symmetrical paired corneal arcuate keratotomies. The preoperative evaluation included corrected distance visual acuity (CDVA), corneal topography, autokeratometry and ocular biometry. Postoperative examinations were performed at 1 and 3 months and included CDVA and uncorrected distance visual acuity (UDVA), manifest refraction, autokeratometry and corneal topography. Vector analysis of astigmatic changes was performed using the Alpins vector method. RESULTS This study comprised 75 eyes from 67 patients. Mean residual refractive astigmatism at 3 months was -0.63 ± 0.55 D in the TIOL group and -0.90 ± 0.53 D in the FSAK group (P = 0.037) and was ≤ 1.00 D in 32 eyes (84%) and 25 eyes (64%), respectively. There were no statistically significant differences in difference vector (DV), angle error (AE), magnitude error (ME) or correction index (CI) in the 3-month follow-up. The index of success (IS) was 0.32 ± 0.33 D in the TIOL group and 0.48 ± 0.29 D in the FSAK group (P = 0.029). CONCLUSION TIOL implantation showed better results in correcting moderate astigmatism. Despite this, FSAK is shown to be a safe technique for reducing astigmatism.
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Affiliation(s)
- Ruben Hernandez
- Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza, Spain. Miguel Servet Ophthalmology Research Group (GIMSO), Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
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Chen X, Xu J, Chen X, Yao K. Cataract: Advances in surgery and whether surgery remains the only treatment in future. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100008. [PMID: 37846393 PMCID: PMC10577864 DOI: 10.1016/j.aopr.2021.100008] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/27/2021] [Accepted: 10/12/2021] [Indexed: 10/18/2023]
Abstract
Background Cataract is the world's leading eye disease that causes blindness. The prevalence of cataract aged 40 years and older is approximately 11.8%-18.8%. Currently, surgery is the only way to treat cataracts. Main Text From early intracapsular cataract extraction to extracapsular cataract extraction, to current phacoemulsification cataract surgery, the incision ranges from 12 to 3 mm, and sometimes to even 1.8 mm or less, and the revolution in cataract surgery is ongoing. Cataract surgery has transformed from vision recovery to refractive surgery, leading to the era of refractive cataract surgery, and premium intraocular lenses (IOLs) such as toric IOLs, multifocal IOLs, and extended depth-of-focus IOLs are being increasingly used to meet the individual needs of patients. With its advantages of providing better visual acuity and causing fewer complications, phacoemulsification is currently the mainstream cataract surgery technique worldwide. However, patient expectations for the safety and accuracy of the operation are continually increasing. Femtosecond laser-assisted cataract surgery (FLACS) has entered the public's field of vision. FLACS is a combination of new laser technology and artificial intelligence to replace fine manual clear corneal incision, capsulorhexis, and nuclear pre-fragmentation, providing new alternative technologies for patients and ophthalmologists. As FLACS matures, it is being increasingly applied in complex cases; however, some think it is not cost-effective. Although more than 26 million cataract surgeries are performed each year, there is still a gap in the prevalence of cataracts, especially in developing countries. Although cataract surgery is a nearly ideal procedure and complications are manageable, both patients and doctors dream of using drugs to cure cataracts. Is surgery really the only way to treat cataracts in the future? It has been verified by animal experiments that lanosterol therapy in rabbits and dogs could make cataract severity alleviated and lens transparency partially recovered. Although there is still much to learn about cataract reversal, this groundbreaking work provided a new strategy for the prevention and treatment of cataracts. Conclusions Although cataract surgery is nearly ideal, it is still insufficient, we expect the prospects for cataract drugs to be bright.
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Affiliation(s)
- Xinyi Chen
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Jingjie Xu
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Xiangjun Chen
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
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