Femtosecond laser assisted cataract surgery followed by coaxial phacoemulsification or microincisional cataract surgery: differences and advantages

Development of an anti-oxidative intraocular irrigating solution based on reactive persulfides

Anti-oxidative intraocular irrigating solutions (IISs) based on reactive persulfides, such as oxidized glutathione disulfide (GSSG), are commonly used worldwide. However, even with GSSG-based IISs, it has been shown that oxidative stress can occur during surgery, posing a risk to intraocular tissues. This study compared two IISs: one containing GSSG and one containing an oxidized glutathione trisulfide (GSSSG). Experimental in vivo irrigation with the IISs in rabbits showed that there was less leakage into the anterior chamber of rabbit serum albumin during perfusion with a 300-μM GSSSG IIS than with a 300-μM GSSG IIS. Experimental in vivo cataract surgery in rabbits showed that aqueous flare was suppressed 3 days after surgery with a 600-μM GSSSG IIS, but not with a 300-μM GSSSG or 300-μM GSSG IIS. Furthermore, an in vitro experiment, without any live tissue, showed that reactive oxygen species were suppressed more strongly with a 600-μM GSSSG IIS than with a 300-μM GSSG IIS. Thus, this study found that novel IISs based on GSSSG had anti-inflammatory and anti-oxidative effects during and after intraocular surgery and may decrease the rate of complications after surgery.

Challenges during femtosecond laser assisted cataract surgery with posterior chamber phakic intraocular lens

Femtosecond laser-assisted cataract surgery was performed in a patient with high myopia, who had undergone posterior chamber phakic intraocular lens surgery (Implantable Collamer Lens, ICL). During docking the machine erroneously focused the laser on the anterior surface of ICL and laser for lens fragmentation was also defocused, which were correctly positioned before laser delivery. During laser application for capsulotomy, air bubbles were entrapped under the ICL prohibiting lens fragmentation. One must be careful during focusing the laser in eyes with ICL. Additionally, gas bubbles under the ICL may lead to difficulties in completion of nuclear disassembly.

Bimanual femtosecond laser-assisted cataract surgery compared to standard bimanual phacoemulsification: A case–control study

Purpose:

To evaluate the efficacy and safety of bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions compared to standard bimanual phacoemulsification (bimanual microincision cataract surgery).

Design:

Prospective, non-randomized comparative case series.

Methods:

Bimanual femtosecond laser-assisted cataract surgery with microincisions was performed on 80 eyes (Group A) with the low-energy Ziemer LDV Z8; a matched case–control series of 80 eyes performed with standard bimanual microincision cataract surgery technique was selected for comparison (Group B). All interventions were performed by the same experienced surgeon. Intraoperative parameters were recorded as well as intra- and postoperative complications. Best corrected visual acuity, surgically induced astigmatism, central corneal thickness and endothelial cell count were evaluated before surgery and at 1 and 3 months post intervention.

Results:

The mean effective phaco times were 3.79 ± 2.19 s (Group A) and 4.49 ± 1.84 s (Group B) (p = 0.041). No major intra- or postoperative complications occurred. An overall significant mean best corrected visual acuity improvement was noted at 3 months, but was not statistically different between the groups. No significant changes were observed for surgically induced astigmatism or corneal pachymetry. A significant loss of endothelial cell count in both groups was detected at 3 months, with Group A reporting a significantly lower endothelial cell count loss compared to Group B (p = 0.009).

Conclusion:

Bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions by an expert surgeon was proven to be safe and effective in this study. This technique has advantages compared with standard bimanual microincision cataract surgery in terms of endothelial preservation.

Current and effective advantages of femto phacoemulsification

PURPOSE OF REVIEW

The purpose is to review the current and effective advantages of femtosecond laser-assisted cataract surgery (FLACS).

RECENT FINDINGS

FLACS has advantages over manual phacoemulsification in its precision, and predictability and may be especially advantageous in difficult situations such as shallow anterior chamber, subluxated cataracts, white cataracts, and so on. However, the femtosecond capsulorhexis may not be as strong as a manual rhexis. Laser-induced miosis is also a potential disadvantage.

SUMMARY

There may be increased surgeon confidence and patient satisfaction with FLACS and it may be friendlier to the internal structures of the eye. However, it is not superior to manual phacoemulsification in terms of primary outcomes such as visual and refractive outcomes or overall complications. Further refinements in technology may be needed to give it distinct advantages over manual phacoemulsification and to make it the norm in cataract surgery.

Determinants of Visual Outcomes in Femtosecond Laser Assisted Cataract Surgery and Phacoemulsification: A Nested Case Control Study

PURPOSE

We present the visual outcomes 6 weeks following Femtosecond laser assisted cataract surgery (FLACS) and conventional phacoemulsification cataract extraction (CE) cataract surgeries in 2013.

MATERIALS AND METHODS

This was a review of health record type of study. Eyes operated by FLACS and an equal number of conventional phacoemulsification (CE) on the same day by same surgeon were included in the study. Demographics, preoperative status, operative details and the best-corrected visual acuity (BCVA) at 6-8 weeks following surgery were noted. BCVA of >20/60 was considered as excellent. The rate and determinants of excellent vision were calculated.

RESULT

Study population comprised of 154 eyes. Both FLACS and CL groups had 77 eyes. Visual acuity at 6-8 weeks was excellent in 44 (60%) eyes of FLACS group and 36 (40%) eyes of CE. Visual outcome following FLACS and conventional surgery was not different (Odd's ratio [OR] 1.5 [95% confidence intervals [CI]: 0.8-2.9]). Operating surgeon did not significantly influence the visual outcomes following FLACS (OR = 1.6) and CE (OR = 0.4). Association of the grade of lens opacities to the visual outcome was not affected by type of surgery (χ(2) = 0.5, P = 0.2). The duration of surgery in CE and FLACS groups was not significantly different (-3.2 min [95% CI: -13; 6.6]).

CONCLUSION

Visual outcomes at 6-8 weeks following CE were not different from FLACS. Visual outcomes following FLACS and CE were not influenced by the operating surgeon or severity of the cataract. The time required for FLACS was greater than that required for CE.

[Femtosecond laser-assisted cataract surgery]

Femtosecond laser-assisted cataract surgery is a major technological innovation. The femtosecond laser, during a pretreatment step, helps to prepare the patient's eye for the surgery proper by creating corneal incisions, anterior capsulotomy and lens fragmentation in an automated fashion. Thus, these steps can be performed with precision and reproducibility, and lens fragmentation reduces the amount of ultrasound required during surgery. Drawbacks of this technology are a longer operating time, a more demanding surgical procedure and a much higher cost for patients and surgical centers. New models of organization in the operating room, patient flow, and financial systems have to be designed to adapt this procedure to our practice. The benefits of this technology should make it an essential tool in the future, provided that cataract surgery can be reconsidered logistically and economically.

Histologic Evaluation of in vivo Femtosecond Laser–Generated Capsulotomies Reveals a Potential Cause for Radial Capsular Tears

Purpose

To compare histologically the size and appearance of capsule disks after femtosecond laser–assisted cataract surgery and conventional cataract surgery.

Methods

In 100 eyes of 100 patients with visually significant cataracts, a femtosecond laser capsulotomy or a capsulorhexis with an aimed diameter of 5.0 mm was performed by one experienced surgeon. The diameter, area, circularity, and cut quality was histologically examined with light microscopy and scanning electron microscopy.

Results

The mean diameter of the manual and the femtosecond laser capsule disk group were not statistically significantly different (manual 4.91 ± 0.34; femtosecond: 4.93 ± 0.03; p = 0.58). The mean area of the capsule disks was 18.85 ± 2.69 mm2 in the manual and 19.03 ± 0.26 mm2 in the femtosecond group (p = 0.64). The capsules of the femtosecond group (0.95 ± 0.02) were significantly more circular than the ones of the manual group (0.81 ± 0.07; p<0.0001). The femtosecond laser capsule disks displayed a more saw blade–like structure created through the single laser spots. The histologic examination combined with prospective video analysis revealed respiratory movement of the eye during the capsulotomy as a potential risk factor for redial tears.

Conclusions

Femtosecond laser can perform a capsulotomy with high reliability. In comparison to a highly experienced cataract surgeon, the achieved results in size are similar. In terms of circularity, the femtosecond laser was superior the manual procedure. Better refractive outcomes based on a 360°-degree optic overlap seem to be possible, especially for less experienced surgeons.