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Qu H, Abulimiti A, Liang J, Zhou S, Wu Z, Chen Y, Ju R, Wang Z, Xu R, Chen X. Comparison of short-term clinical outcomes of a diffractive trifocal intraocular lens with phacoemulsification and femtosecond laser assisted cataract surgery. BMC Ophthalmol 2024; 24:189. [PMID: 38658894 PMCID: PMC11040763 DOI: 10.1186/s12886-024-03440-7] [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: 12/25/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS). SETTING Department of Ophthalmology, Shanghai Aier Eye Hospital, China. DESIGN A retrospective, observational study. METHODS Patients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months. RESULTS 101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group. CONCLUSIONS Panoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient's corneal astigmatism.
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Affiliation(s)
- Haokun Qu
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
- Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Adilamu Abulimiti
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China
| | - Jianheng Liang
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Suowang Zhou
- Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Zheming Wu
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Yun Chen
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Ruihong Ju
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Zheng Wang
- Aier Eye Hospital, Jinan University, No. 191, Huanshi Middle Road, Yuexiu District, Guangzhou, Guangdong, China
- Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Rong Xu
- Hankou Aier Eye Hospital, Wuhan, China
| | - Xu Chen
- Jinan University, No.601, Huangpu Road West, Guangzhou, China.
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China.
- Department of Ophthalmology, Shanghai Aier Qingliang Eye Hospital, Qingpu, Shanghai, China.
- Department of Ophthalmology & Optometry, SinoUnited Health Clinic, Shanghai, China.
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Zhang X, Xu W, Shentu X, Chen P, Yu Y, Lai K, Li J, Wang W, Chen X, Yao K. Incidence and analysis of intraoperative complications in femtosecond laser-assisted cataract surgery: a large-scale cohort study to establish the learning curve. Br J Ophthalmol 2024:bjo-2023-323897. [PMID: 38589209 DOI: 10.1136/bjo-2023-323897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 03/10/2024] [Indexed: 04/10/2024]
Abstract
AIMS To assess the safety of femtosecond laser-assisted cataract surgery (FLACS) based on surgical parameters and intraoperative complications analysis and to determine the length of the learning curve for FLACS. METHODS A prospective consecutive cohort study was conducted on Chinese patients who underwent either FLACS (3289 cases) or contemporaneous conventional phacoemulsification cataract surgery (2130 cases). The laser group was divided into four subgroups in chronological order. We recorded intraoperative complication incidences and compared with surgical parameters between groups. Subgroup analysis was conducted to explore the learning curve of FLACS. RESULTS The laser group had a 4.93% incidence of incomplete capsulotomies and a 1.22% incidence of anterior capsule tears. Subgroup analysis showed significant differences in 8 aspects between the first 250 cases (50 cases per surgeon) and the last 2539 cases, but only 2 aspects differed between the second 250 cases (50 cases per surgeon) and the last 2539 cases. There were no significant differences between the third 250 cases (50 cases per surgeon) and the last 2539 cases. CONCLUSIONS The intraoperative complications of FLACS were reported, and the learning curve is associated with a significant reduction in the incidence of intraoperative complications. The length of the basic learning curve of FLACS is 100 cases, and the length of the advanced learning curve was 150 cases. This study demonstrated that FLACS is characterised by a relatively straightforward and secure operative technique.
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Affiliation(s)
- Xiaobo Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wen Xu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xingchao Shentu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yibo Yu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kairan Lai
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiayong Li
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Wang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinyi Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ke Yao
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Lee YW, Cho KS, Hyon JY, Han SB. Application of Femtosecond Laser in Challenging Cataract Cases. Asia Pac J Ophthalmol (Phila) 2023; 12:477-485. [PMID: 37844256 DOI: 10.1097/apo.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 10/18/2023] Open
Abstract
Femtosecond laser can provide precise and customized incision of ocular tissue with excellent accuracy and predictability. Thus, femtosecond laser-assisted cataract surgery (FLACS) can theoretically enhance the safety and efficacy of cataract surgery by providing reproducible and reliable clear corneal incision, limbal relaxing incision, anterior capsulotomy, and lens fragmentation. However, thus far, the superiority of the anatomical and visual outcomes of FLACS over those of conventional cataract surgery have been unclear. Nevertheless, studies have indicated that FLACS can potentially be helpful in improving the safety of cataract surgery in challenging situations, such as zonular weakness, preexisting capsular tear, white cataract, shallow anterior chamber, and pediatric cataracts, which may contribute to enhanced visual and anatomical outcomes. In this review, we provide a summary of the application of femtosecond laser in general cataract cases. In addition, we introduce the application of FLACS in the abovementioned challenging situations and discuss the results of studies regarding the safety and outcome of FLACS in these challenging cases.
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Affiliation(s)
- Yong Woo Lee
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon Province, Korea
| | - Kyu Seong Cho
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon Province, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi Province, Korea
| | - Sang Beom Han
- Department of Ophthalmology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Gangwon Province, Korea
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Zhou KJ, Huang Y, Wang Y, Pan AP, Shao X, Tu RX, Yu AY. Safety and efficacy of cataract surgery performed with a low-energy femtosecond laser compared with conventional phacoemulsification in Chinese patients: a randomized clinical trial. EYE AND VISION (LONDON, ENGLAND) 2023; 10:31. [PMID: 37393278 DOI: 10.1186/s40662-023-00347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/22/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND To compare the safety and efficacy of femtosecond laser-assisted cataract surgery (FLACS) performed with the low-energy FEMTO LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) laser compared with conventional phacoemulsification (CP) in Chinese patients. METHODS This prospective, multicenter, interventional study included 126 patients who were randomized (1:1) to undergo either FLACS or CP followed by intraocular lens (IOL) implantation between January 2019 and April 2020. The primary endpoint included the comparison of the endothelial cell loss (ECL) between the two groups at 3 months. Secondary endpoints included the comparison of cumulative dissipated energy (CDE), change in central corneal thickness (CCT) from baseline, and postoperative uncorrected and corrected distance visual acuities (UDVA and CDVA) in the two groups. RESULTS At all postoperative time points, the FLACS group was found to be non-inferior to CP for the mean ECL (- 409.3 versus - 436.9 cells/mm2 at 3 months) and mean CDE (4.1 versus 4.5 percent-seconds). The increase in CCT was significantly lower in the FLACS group compared with the CP group at Day 7 (4.9 versus 9.2 µm; P = 0.04); however, the difference was not statistically significant at 1 and 3 months. Postoperatively, mean UDVA and CDVA were comparable between the two groups. No intraoperative complications occurred. CONCLUSIONS Cataract surgery performed with a low-energy femtosecond laser was non-inferior to CP; however, the FLACS group had a statistically significantly lower increase in CCT at Day 7 compared with CP. Trial registration This trial is registered at ClinicalTrials.gov on May 15, 2019, with trial registration number: NCT03953053.
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Affiliation(s)
- Kai-Jing Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Yusen Huang
- Qingdao Eye Hospital of Shandong First Medical University, Shandong, China
| | - Yong Wang
- Aier Eye Hospital of Wuhan University, Wuhan, China
| | - An-Peng Pan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Xu Shao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - Rui-Xue Tu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China
| | - A-Yong Yu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, 325000, Zhejiang, China.
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Devience EX, Awidi A, Kalarn S, DeVience S, Bui B, Munir WM, Kaleem MA, Im L, Jeng BH, Daoud Y, Saeedi OJ. Predictors of intraocular pressure reduction after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a prospective trial. Int Ophthalmol 2023; 43:285-292. [PMID: 35870049 DOI: 10.1007/s10792-022-02427-x] [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: 12/05/2021] [Accepted: 07/04/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the association between postoperative intraocular pressure (IOP) reduction and phacoemulsification parameters in patients who underwent both conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS). METHODS This was a prospective multicenter comparative study that enrolled 90 participants who underwent cataract surgery at the University of Maryland Medical System and the Wilmer Eye Institute. Patients underwent FLACS in one eye and CPS in the fellow eye. IOP was measured prior to surgery and monitored through six months postoperatively. Demographic, clinical, biometric, and intraoperative variables including cumulative dissipated energy (CDE), aspiration time, and phacoemulsification time were analyzed for any significant association with postoperative IOP. Postoperative IOP reduction was the primary outcome variable. A secondary goal of the study was to determine differences in postoperative IOP reduction between CPS and FLACS cohorts. RESULTS In total, 157 non-glaucomatous eyes were included. Using multivariable analysis, we found preoperative IOP to be consistently associated with postoperative IOP reduction in the entire cohort. At the 6-month follow-up visit, there was a 12.4% reduction in IOP (-2.2 ± 3.4 mm Hg) seen, with no statistically significant difference between FLACS and CPS (12.3% ± 19.4% vs 12.5% ± 19.3%, respectively, p = 0.32). FLACS reduced the CDE required for phacoemulsification (6.6 ± 4.4%-seconds vs 8.6 ± 6.9%-seconds, respectively, p < 0.05). CDE was a predictor of IOP response at 6 months, but subgroup analysis revealed that this trend was driven by seven eyes requiring high CDE, and for the majority of eyes, CDE did not influence the size of the decrease. The seven eyes experiencing highest CDE were less likely to show IOP reduction at 6 months. CONCLUSION Both FLACS and CPS resulted in similar and significant IOP reductions through 6 months after surgery. Preoperative IOP was significantly associated with IOP reduction, and CDE generally did not influence the size of the decrease.
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Affiliation(s)
| | - Abdelhalim Awidi
- Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA
| | - Sachin Kalarn
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | | | - Brendan Bui
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Wuqaas M Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Mona A Kaleem
- Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA
| | - Lily Im
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Bennie H Jeng
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA
| | - Yassine Daoud
- Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA
| | - Osamah J Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA.
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Furino C, Niro A, Reibaldi M, Boscia F, Alessio G. Dexamethasone intravitreal implant along with femtosecond laser assisted cataract surgery in patients with diabetic macular edema and cataract. Eur J Ophthalmol 2022; 33:1425-1433. [PMID: 36567493 DOI: 10.1177/11206721221146328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the safety and efficacy of intraoperative dexamethasone intravitreal (DEX) implant in patients with diabetic macular edema (DME) undergoing femtosecond laser assisted cataract surgery (FLACS). METHODS In this single-center retrospective study, the charts of patients who underwent combined FLACS and DEX implant in the previous three months were reviewed. Primary outcome measures were ocular complications; secondary outcome measures were the change of best-corrected visual acuity (BCVA) and central retinal thickness (CRT). RESULTS 20 eyes of 20 patients were included. None developed intraoperative or postoperative complications. Mean BCVA was 20/120 (logMAR, 0.78 ± 0.31) at baseline and improved significantly to 20/63 (logMAR, 0.52 ± 0.24; p = 0.01), 20/58 (LogMAR, 0.48 ± 0.28; p < 0.001) and to 20/58 (LogMAR, 0.48 ± 0.31; p < 0.001) at month 1,2 and 3, respectively. A mean improvement of 0.30 LogMAR was recorded at month 1 and 3. Mean CRT decreased significantly from 416.6 ± 76.1 μm at baseline to 322.4 ± 46.4 μm (p < 0.001), to 300.7 ± 29.7 μm (p < 0.001), and to 319.8 ± 54.7 μm (p < 0.001) at month 1,2 and 3, respectively. Comparing to the 1-month follow-up, the largest mean reduction in CRT (112.4 ± 68.9 µm) was observed at month 2 (p = 0.001). Fourteen patients (70%) had an improvement of CRT over the first 2 months followed by a recurrence of edema at month 3. CONCLUSION DEX implant following FLACS seems to be a safe and effective approach for patients with coexisting cataract and DME.
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Affiliation(s)
- Claudio Furino
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS. ANNUNZIATA", 170130ASL TA, Taranto, Italy
| | | | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, 9295University of Bari, Bari, Italy
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Xu J, Chen X, Wang H, Yao K. Safety of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification for cataract: A meta-analysis and systematic review. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100027. [PMID: 37846222 PMCID: PMC10577854 DOI: 10.1016/j.aopr.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 10/18/2023]
Abstract
Purpose To compare the complications of femtosecond laser-assisted cataract surgery (FLACS) with those of conventional phacoemulsification surgery (CPS) for age-related cataracts. Methods PubMed, Cochrane Library, and EMBASE were systematically searched for studies comparing FLACS and CPS. Outcomes were operative complications, including the intraoperative capsule tear, postoperative corneal edema, macular edema, uncontrolled IOP, etc. The effect measures were weighted with odds ratios with 95% CIs. Results Nineteen RCTs and 18 cohort studies, including 24,806 eyes (11,375 of the FLACS group and 13,431 of the CPS group), were identified. There were no significant differences between the two groups in anterior capsule tear, corneal edema, macular edema, uncontrolled IOP, vitreous loss, posterior vitreous detachment, etc. Posterior capsule tear rate showed a significantly lower in RCT subgroups (P = 0.04) and without differences in total (P = 0.63). Significant differences were observed in the incidence of descemet membrane tear/trauma (P = 0.02) and IFIS/iris trauma (P = 0.04. Additionally, The FLACS specific complications showed a significantly higher rate of miosis (P < 0.0001), corneal epithelial defect (P = 0.001), corneal haze (P = 0.002), and subconjunctival hemorrhage (P = 0.01). Conclusions FLACS maintains the same safety compared with CPS in terms of all intraoperative and postoperative complications. Although FLACS did show a statistically significant difference for several FLACS specific complications, it would not influence the visual outcome and heal itself.
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Affiliation(s)
| | | | | | - Ke Yao
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
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Pirogova ES, Fabrikantov OL, Nikolashin SI. [Femtolaser-assisted phacoemulsification of intumescent cataract]. Vestn Oftalmol 2022; 138:13-22. [PMID: 35234416 DOI: 10.17116/oftalma202213801113] [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: 11/18/2022]
Abstract
PURPOSE To optimize the technique of intumescent cataract phacoemulsification by involving the use of femtosecond lasers. MATERIAL AND METHODS Group 1 included 29 patients (30 eyes) with mature intumescent cataract, who underwent femtolaser-assisted phacoemulsification using a new, optimized technique. Group 2 included 20 patients (20 eyes), in whom the femtolaser stage was performed using the standard technique. Patients of groups 1 and 2 were almost identical in all preoperative parameters. The optimized femto-capsulorhexis technique included: preoperative assessment of intralenticular pressure, staining of the anterior capsule of the swelling lens with trypan blue, introduction of a viscoelastic with high molecular weight into the anterior chamber to balance intraocular and intralenticular pressures, increasing the laser energy when performing anterior capsulorhexis up to 10 mJ. RESULTS In group 1, there was a non-penetration of the anterior capsule in 2 eyes, in one of them in the 30° sector, in the second - in the 45° sector. Leakage of lens material into the anterior chamber and the floating anterior capsule were not observed in patients of group 1. In group 2, non-penetration of the anterior capsule was observed in 6 eyes, in the 45-60° sector - in 2 eyes, in the 90° sector - in 3 eyes, in the 180° sector - in 1 eye. Floating anterior capsule was observed in 5 cases. Leakage of lens material into the anterior chamber was observed in 9 eyes. CONCLUSION The optimized technique of femtolaser-assisted intumescent cataract phacoemulsification eliminates leakage of lens material into the anterior chamber and allows performing anterior capsulorhexis of given size and shape.
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Affiliation(s)
- E S Pirogova
- Tambov branch of the S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Tambov, Russia
| | - O L Fabrikantov
- Tambov branch of the S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Tambov, Russia.,Tambov State University named after G.R. Derzhavin, Tambov, Russia
| | - S I Nikolashin
- Tambov branch of the S.N. Fedorov National Medical Research Center «MNTK «Eye Microsurgery», Tambov, Russia.,Tambov State University named after G.R. Derzhavin, Tambov, Russia
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Gigliola S, Sborgia G, Niro A, Palmisano C, Puzo P, Giuliani G, Sborgia L, Sisto D, Pastore V, Furino C, Donghia R, Sborgia A, Boscia F, Alessio G. Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery. Int J Ophthalmol 2021; 14:1868-1875. [PMID: 34926201 DOI: 10.18240/ijo.2021.12.09] [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: 04/06/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare perioperative parameters of one-handed rotational phacoemulsification technique (one-handed phaco-roll) with each of other two techniques, "Divide et Conquer" and femtosecond laser-assisted cataract surgery (FLACS). METHODS In this retrospective and comparative cohort study, eyes with uncomplicated cataract (nuclear density grade 2 to 3) treated routinely with one-handed phaco-roll (n=23; Group 1) or "Divide et Conquer" (n=23; Group 2) or FLACS (n=23; Group 3) were enrolled. Intraoperative parameters including effective phaco-time (EPt), ultrasound time (USt), aspiration time, surgical time, phacoemulsification (phaco)-power, balanced salt solution (BSS) use, cumulative dissipated energy (CDE) were recorded and compared. Clinical outcomes including best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT) and central macular thickness (CMT), were assessed and compared pre-operatively and at 1mo after surgery. RESULTS Aspiration and surgical time, and BSS used were lower in Group 1 (P<0.01) than other groups. EPt, phaco-power and CDE were lower in Group 1 (P<0.05) than Group 2 but not significantly different from Group 3. In Group 1, USt was lower (P<0.05) than Group 2 but higher (P<0.05) than Group 3. BCVA improved in all groups without significant difference between Group 1 and the other ones. No significant differences regarding all post-operative morphologic outcomes (ECD, ECL, CCT, CMT) were reported. No clinical complications occurred. CONCLUSION One-handed phaco-roll seems to be less time-consuming than "Divide et Conquer" and FLACS and less energy-consuming than "Divide et Conquer". Furthermore, one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques.
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Affiliation(s)
- Samuele Gigliola
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Giancarlo Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS. Annunziata", ASL Taranto, Taranto 74121, Italy
| | - Carmela Palmisano
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Pasquale Puzo
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Gianluigi Giuliani
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Luigi Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Dario Sisto
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Valentina Pastore
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Claudio Furino
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Rossella Donghia
- National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte 70013, Italy
| | - Alessandra Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, Bari 70124, Italy
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Study of the efficiency and workflow of femtosecond laser-assisted cataract surgery in a Spanish public hospital. J Fr Ophtalmol 2021; 44:1190-1201. [PMID: 34275664 DOI: 10.1016/j.jfo.2021.01.030] [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: 09/24/2020] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND To assess the time-efficiency of a designated operating room (OR) workflow in the introduction of femtosecond laser-assisted cataract surgery (FLACS, LenSx, Alcon®). The study was carried out in a public hospital a with high-volume of procedures. METHODS We performed this prospective, controlled, surgical intervention study in the ophthalmology department of a Spanish tertiary referral public hospital. A total of 167 eyes were enrolled, including 62 eyes undergoing conventional phacoemulsification surgery. In phase I, patients were assigned either to FLACS-I (n=63) or conventional phacoemulsification surgery (n=62). One surgeon operated the femtosecond laser, and another completed the procedure, while a third performed conventional phacoemulsification. In the second phase (FLACS-II), all the surgeries were FLACS (n=42). One surgeon performed the FLACS procedure, and two different surgeons completed the surgeries in separate ORs. Surgical and turnover times of all the patients were recorded. RESULTS Preparation time was statistically significantly lower in FLACS-I and FLACS-II (P<0.001), whereas the duration of the cataract procedure per se was higher in FLACS-II compared to conventional phacoemulsification (P=0.03). Phacoemulsification energy was higher in FLACS-II compared to FLACS-I (P=0.01), whereas laser-related surgical time was lower (P=0.001). Surgical complications and total surgical time showed no statistically significant differences between any of the three groups. CONCLUSIONS This study suggests a time-efficient and suitable workflow model for FLACS, considering the specific requirements and restrictions of a fully booked public hospital. Even so, we have shown that the FLACS procedure does not take longer than conventional phacoemulsification when following a detailed plan for OR workflow. In addition, our data reflect an improvement in FLACS surgical times with ongoing experience. TRIAL REGISTRATION NCT03931629 (retrospectively registered).
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Pohlmann D, Pilger D, Bertelmann E, von Sonnleithner C. Corneal higher-order aberrations after cataract surgery: Manual phacoemulsification versus femtosecond-laser assisted technique. Eur J Ophthalmol 2021; 31:2955-2961. [PMID: 33499651 PMCID: PMC8606799 DOI: 10.1177/1120672121990611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose: To compare and evaluate corneal higher-order aberrations (c-HOA) between conventional manual phacoemulsification (Phaco), femtosecond laser-assisted cataract surgery (FLACS), and femtosecond laser-assisted cataract surgery with astigmatic keratotomy (FSAK). Methods: In this retrospective single center study, 53 healthy individuals with cataract (73 eyes) underwent phacoemulsification with implantation of an intraocular lens. Three groups were formed: group A, Phaco (n = 27 eyes of 21 patients); group B, FLACS (n = 25 eyes of 15 patients); group C, FSAK (n = 21 eyes of 17 patients). An iTrace aberrometer (Tracey Technologies, Houston, TX, USA) was used to perform aberrometry with a pupil scan size of 5.0 mm. We used ANOVA analysis and the paired sample t-test for statistical analysis. Results: There was no difference in total c-HOA between the groups prior to surgery (F(2,66) = 2.2, p = 0.128), but some evidence for a difference between the groups after surgery (F(2,65) = 3.87, p = 0.025). After surgery, total c-HOA increased in all groups, but the greatest increase occurred FSAK. Conclusion: Manual phacoemulsification and femtosecond laser-assisted cataract surgery seem to have less impact on corneal higher-order aberrations than the combination of femtosecond laser-assisted cataract surgery with astigmatic keratotomy.
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Affiliation(s)
- Dominika Pohlmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pilger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eckart Bertelmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christoph von Sonnleithner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Chlasta-Twardzik E, Nowińska A, Wylęgała E. Corneal complication after femtosecond laser-assisted cataract surgery: A case report. Medicine (Baltimore) 2021; 100:e24013. [PMID: 33466143 PMCID: PMC7808488 DOI: 10.1097/md.0000000000024013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The femtosecond laser LDV Z 8 is unique, and the only femtosecond laser used in ophthalmic microsurgery, which is characterized by low-energy near-infrared (1030 nm) femtosecond single pulses in the nano-Joule range and a very high repetition rate in the MHz range. To the best of our knowledge, this is the first description of unintentional partial corneal incision in the anterior part of a stroma by the femtosecond laser. PATIENT CONCERNS A 79-year-old patient was referred to our clinic for cataract surgery. On admission, we diagnosed mature cataract of the left eye and pseudophakic of the right eye. The patient was qualified for the Femtosecond Laser-Assisted Cataract Surgery (FLACS). Unexpectedly during FLACS procedure after lens fragmentation the surgeon observed unexpected paracentral incision in the cornea. DIAGNOSIS The corneal incision line between 4 to 8 o'clock was observed. In vivo confocal microscopy was performed to assess the morphology and depth of the corneal wound. The corneal incision covered the epithelium, Bowman's membrane and stroma of the cornea reached a depth of 336 um. INTERVENTIONS The patient was under increased ophthalmologic controls; follow up with typical ophthalmic examinations and confocal microscopy was performed. OUTCOMES In 2-year follow-up period, this complication had no effect on postoperative visual function, the patient had no visual problems and obtained the final BCVA 5/5. There is no dislocation of the lens in 2 years follow-up. LESSONS Low pulse energy and high pulse frequency in the LDV Z8 causes a low traumatization of tissues. In a 2-year follow-up, the corneal incision line could be observed on the slit lamp examination without long-term visual consequences of this complication. In our opinion, the most likely cause of this complication was human error and lack of communication between medical personnel. The operation team should be alert and great caution must be exercised during the procedure and check the laser settings parameters carefully each time.
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Day AC, Burr JM, Bennett K, Hunter R, Bunce C, Doré CJ, Nanavaty MA, Balaggan KS, Wilkins MR. Femtosecond laser-assisted cataract surgery compared with phacoemulsification: the FACT non-inferiority RCT. Health Technol Assess 2021; 25:1-68. [PMID: 33511963 DOI: 10.3310/hta25060] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cataract surgery is one of the most common operations. Femtosecond laser-assisted cataract surgery (FLACS) is a technique that automates a number of operative steps. OBJECTIVES To compare FLACS with phacoemulsification cataract surgery (PCS). DESIGN Multicentre, outcome-masked, randomised controlled non-inferiority trial. SETTING Three collaborating NHS hospitals. PARTICIPANTS A total of 785 patients with age-related cataract in one or both eyes were randomised between May 2015 and September 2017. INTERVENTION FLACS (n = 392 participants) or PCS (n = 393 participants). MAIN OUTCOME MEASURES The primary outcome was uncorrected distance visual acuity in the study eye after 3 months, expressed as the logarithm of the minimum angle of resolution (logMAR): 0.00 logMAR (or 6/6 if expressed in Snellen) is normal (good visual acuity). Secondary outcomes included corrected distance visual acuity, refractive outcomes (within 0.5 dioptre and 1.0 dioptre of target), safety and patient-reported outcome measures at 3 and 12 months, and resource use. All trial follow-ups were performed by optometrists who were masked to the trial intervention. RESULTS A total of 353 (90%) participants allocated to the FLACS arm and 317 (81%) participants allocated to the PCS arm attended follow-up at 3 months. The mean uncorrected distance visual acuity was similar in both treatment arms [0.13 logMAR, standard deviation 0.23 logMAR, for FLACS, vs. 0.14 logMAR, standard deviation 0.27 logMAR, for PCS, with a difference of -0.01 logMAR (95% confidence interval -0.05 to 0.03 logMAR; p = 0.63)]. The mean corrected distance visual acuity values were again similar in both treatment arms (-0.01 logMAR, standard deviation 0.19 logMAR FLACS vs. 0.01 logMAR, standard deviation 0.21 logMAR PCS; p = 0.34). There were two posterior capsule tears in the PCS arm. There were no significant differences between the treatment arms for any secondary outcome at 3 months. At 12 months, the mean uncorrected distance visual acuity was 0.14 logMAR (standard deviation 0.22 logMAR) for FLACS and 0.17 logMAR (standard deviation 0.25 logMAR) for PCS, with a difference between the treatment arms of -0.03 logMAR (95% confidence interval -0.06 to 0.01 logMAR; p = 0.17). The mean corrected distance visual acuity was 0.003 logMAR (standard deviation 0.18 logMAR) for FLACS and 0.03 logMAR (standard deviation 0.23 logMAR) for PCS, with a difference of -0.03 logMAR (95% confidence interval -0.06 to 0.01 logMAR; p = 0.11). There were no significant differences between the arms for any other outcomes, with the exception of the mean binocular corrected distance visual acuity with a difference of -0.02 logMAR (95% confidence interval -0.05 to 0.00 logMAR) (p = 0.036), which favoured FLACS. There were no significant differences between the arms for any health, social care or societal costs. For the economic evaluation, the mean cost difference was £167.62 per patient higher for FLACS (95% of iterations between -£14.12 and £341.67) than for PCS. The mean QALY difference (FLACS minus PCS) was 0.001 (95% of iterations between -0.011 and 0.015), which equates to an incremental cost-effectiveness ratio (cost difference divided by QALY difference) of £167,620. LIMITATIONS Although the measurement of outcomes was carried out by optometrists who were masked to the treatment arm, the participants were not masked. CONCLUSIONS The evidence suggests that FLACS is not inferior to PCS in terms of vision after 3 months' follow-up, and there were no significant differences in patient-reported health and safety outcomes after 12 months' follow-up. In addition, the statistically significant difference in binocular corrected distance visual acuity was not clinically significant. FLACS is not cost-effective. FUTURE WORK To explore the possible differences in vision in patients without ocular co-pathology. TRIAL REGISTRATION Current Controlled Trials ISRCTN77602616. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 6. See the NIHR Journals Library website for further project information. Moorfields Eye Charity (grant references GR000233 and GR000449 for the endothelial cell counter and femtosecond laser used).
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Affiliation(s)
- Alexander C Day
- The National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Moorfields Eye Hospital, London, UK.,University College London (UCL) Institute of Ophthalmology, London, UK
| | - Jennifer M Burr
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Kate Bennett
- UCL Comprehensive Clinical Trials Unit (CCTU), London, UK
| | - Rachael Hunter
- UCL Comprehensive Clinical Trials Unit (CCTU), London, UK
| | - Catey Bunce
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | | | - Mayank A Nanavaty
- Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Kamaljit S Balaggan
- Wolverhampton and Midlands Eye Infirmary, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Mark R Wilkins
- The National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Moorfields Eye Hospital, London, UK
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Wu Y, Yan H, Yan W. Preloaded vs manually loaded IOL delivery systems in cataract surgery in the largest ambulatory surgery center of northwestern China: an efficiency analysis. BMC Ophthalmol 2020; 20:469. [PMID: 33261575 PMCID: PMC7708187 DOI: 10.1186/s12886-020-01721-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the efficiency of preloaded vs manually loaded IOL (P-IOL vs M-IOL, respectively) delivery systems in cataract surgery in the largest ambulatory surgery center of Northwestern China. METHODS A total of 200 cases were included in this prospective, observational study. Time and motion data were collected in a one- or two-operating room (1-OR or 2-OR, respectively) scenario. A model of the efficiency and revenue implications of introducing a preloaded delivery system for IOLs in cataract surgery was used to estimate the changes in cataract throughput and hospital revenue through transitioning from the M-IOL delivery system to the P-IOL system. RESULTS In the 1-OR scenario, the mean total case time was 16.9 min using P-IOL, which was a 7.7% reduction compared with M-IOL (P < 0.01). In the 2-OR scenario, the mean total surgeon time was 10.8 min using P-IOL, which was a 7.8% reduction compared with M-IOL (P < 0.05). By switching from M-IOL to P-IOL, annual throughput will increase by 5.2% (960 cases) in the 1-OR scenario and 7.7% (1440 cases) in the 2-OR scenario, accompany by an increase in revenue of approx. 284,352 USD in the 1-OR scenario and approx. 426,528 USD in the 2-OR scenario. CONCLUSION This report is the first of a comparison of two IOL delivery systems in China using different settings in the scenario. IOL delivery with preloaded systems is time saving in both the 1-OR scenario and the 2-OR scenario. Moreover, switching from the M-IOL delivery system to the P-IOL system holds potential to increase cataract throughput and hospital revenue.
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Affiliation(s)
- Yazhen Wu
- Xi'an Fourth Hospital, Shaanxi Eye Hospital, Affiliated Xi'an Fourth Hospital, Northwestern Polytechnical University, Xi'an, 710004, Shaanxi Province, China
| | - Hong Yan
- Xi'an Fourth Hospital, Shaanxi Eye Hospital, Affiliated Xi'an Fourth Hospital, Northwestern Polytechnical University, Xi'an, 710004, Shaanxi Province, China.
| | - Weijia Yan
- Department of Ophthalmology, University of Heidelberg, 69120, Heidelberg, Germany
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Khurana S, Gupta PC, Ram J. Spoons in the eye. Indian J Ophthalmol 2020; 68:3037. [PMID: 33229697 PMCID: PMC7856961 DOI: 10.4103/ijo.ijo_925_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Surbhi Khurana
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Chawla Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Assaf AH, Aziz BF. Ultrasound-Energy Consumption During Phases of Phacoemulsification of Nuclear Cataracts Using Femtosecond Laser: A Comparative Study. Clin Ophthalmol 2020; 14:2829-2835. [PMID: 33061267 PMCID: PMC7522599 DOI: 10.2147/opth.s257813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare ultrasound (US) energy utilized in different phases of nuclear cataract removal in femtosecond laser-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS) in relation to different nuclear densities. Methods A prospective nonrandomized comparative study was conducted at Ain Shams University and Al Watany Eye Hospital, Cairo, Egypt on 250 eyes with senile nuclear cataracts (NCs) of different nuclear densities (1-6). Eyes were divided into two groups - FLACS and CPS - and each group was subdivided according to cataract density into subgroups A (NC 1-2), B (NC 3-4) and C (NC 5-6). sextant-softened fragmentation patterns were assessed in the FLACS group and the quick-chop technique used in the CPS group. US energy required for nucleus cracking (EFX split) and for quadrant removal (EFX quadrant) was recorded. Results Total eyes included in the FLACS and CPS groups were 117 and 133, respectively. No significant differences between the groups for EFX quadrant and EFX split groups were observed (P=0.18 and P=0.49, respectively). For subgroup A, no significant difference was found between FLACS and CPS on EFX split (P=0.08) and EFX quadrant (P=0.49). For subgroup B, significantly lower values of EFX split (P=0.0001) and EFX quadrant (P<0.0001) were obtained with FLACS than CPS. For subgroup C, no significant difference was found for EFX split (P=0.86); however, EFX quadrant was significantly lower in the FLACS group (P=0.05). Conclusion FLACS lowers US energy utilized during quadrant removal at different nuclear densities, with highest significance in medium-density nuclear cataracts. Nucleus cracking by femtosecond laser is less effective in very hard cataracts. However, femtosecond-laser softening of hard nuclei is capable of of US-energy reduction during quadrant removal.
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Affiliation(s)
- Ahmed H Assaf
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Al Watany Eye Hospital, Cairo, Egypt
| | - Bassem F Aziz
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Al Watany Eye Hospital, Cairo, Egypt
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Van Nuffel S, Claeys MF, Claeys MH. Cystoid Macular Edema Following Cataract Surgery with Low-Energy Femtosecond Laser versus Conventional Phacoemulsification. Clin Ophthalmol 2020; 14:2873-2878. [PMID: 33061272 PMCID: PMC7524180 DOI: 10.2147/opth.s261565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare postoperative changes in central subfield macular thickness (CSMT) and prevalence of cystoid macular edema (CME) in patients undergoing cataract surgery with low-energy femtosecond laser versus standard phacoemulsification. Design This was a retrospective comparative real-world study. Methods Postoperative data of 252 eyes of 165 patients were collected: 138 eyes received low-energy femtosecond laser-assisted cataract surgery (FLACS) and 114 eyes underwent conventional phacoemulsification cataract surgery (CPCS). Postoperative changes in CSMT and prevalence of CME were compared between the two groups. Results There was a significant increase in mean CSMT from preoperative to postoperative values at 2.5 months in both the FLACS and CPCS group (p<0.001). Mean change (preoperation to 2.5 months postoperation) in CSMT was 6.2±11.5 µm in the FLACS group and 7.3±26.6 µm in the CPCS group, which was statistically significant but clinically not relevant. Comparison of mean changes in CSMT (preoperation to 2.5 months postoperation) between the FLACS and CPCS groups revealed no significant differences. The rate of pseudophakic CME (PCME) development was lower in the FLACS group (1.4%) than the CPCS group (4.4%; p=0.247). When using PREMED criteria to define clinically significant PCME, only 0.7% patients in the FLACS group and 1.8% in the CPCS group showed development of clinically significant PCME (p=0.586). Conclusion The mean change in CSMT and occurrence of postoperative CME was lower in the low-energy FLACS group than the standard-phacoemulsification group; however, the difference was not statistically significant.
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Affiliation(s)
| | - Matthias F Claeys
- Department of Ophthalmology, University Hospital Ghent, Ghent, Belgium
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Comparison of femtosecond laser–assisted cataract surgery and conventional cataract surgery: a meta-analysis and systematic review. J Cataract Refract Surg 2020; 46:1075-1085. [DOI: 10.1097/j.jcrs.0000000000000228] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Intraindividual comparison of cytokine and prostaglandin levels with and without low-energy, high-frequency femtosecond laser cataract pretreatment after single-dose topical NSAID application. J Cataract Refract Surg 2020; 46:1086-1091. [DOI: 10.1097/j.jcrs.0000000000000221] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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20
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Tăbăcaru B, Stanca S, Mocanu V, Zemba M, Stanca HT, Munteanu M. Intraoperative flap-related complications in FemtoLASIK surgeries performed with Visumax ® femtosecond laser: A ten-year Romanian experience. Exp Ther Med 2020; 20:2529-2535. [PMID: 32765745 PMCID: PMC7401922 DOI: 10.3892/etm.2020.8907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/05/2020] [Indexed: 12/19/2022] Open
Abstract
Incidence and clinical results of intraoperative flap and interface-related complications were investigated after Femtosecond-LASIK surgery, where flap creation was performed with VisuMax® femtosecond laser. A retrospective 10-year cohort study was conducted including all eyes treated for all refractive errors by Femtosecond-LASIK technique. All the flaps were made by the same refractive surgeon with the VisuMax® (Carl Zeiss Meditec) femtosecond laser. We report the intraoperative flap and interface-related complications in these eyes, also describing their management. The study included 4,032 eyes. Flap and interface-related complications were: opaque bubble layer (OBL) 21.18%, suction loss 1.29%, difficult docking 0.69%, difficult dissection of the flap 0.59%, bleeding from limbal blood vessels 0.35%, de-epithelialization of the flap 0.12%, and interface debris 0.025%. These situations were appropriately addressed, with favorable outcomes. Flap creation is an important step in LASIK surgery. The predictability and safety have improved since the flap incision is assisted by a femtosecond laser, but complications of the flap and interface can still occur during the flap creation. Refractive surgeons should be aware and properly manage any unusual situation.
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Affiliation(s)
- Bogdana Tăbăcaru
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Simona Stanca
- Department of Pediatrics, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Valeria Mocanu
- Department of Ophthalmology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihail Zemba
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Horia Tudor Stanca
- Department of Ophthalmology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mihnea Munteanu
- Department of Ophthalmology, 'Victor Babes' University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Application of Femtosecond Laser in Anterior Segment Surgery. J Ophthalmol 2020; 2020:8263408. [PMID: 32351726 PMCID: PMC7171667 DOI: 10.1155/2020/8263408] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/12/2020] [Indexed: 11/24/2022] Open
Abstract
Femtosecond laser (FSL) is a near-infrared laser that can create reliable and reproducible tissue cutting with minimal damage to adjacent tissue. As the laser can also create incisions with various orientations, depths, and shapes, it is expected to be a useful tool for anterior segment surgery, such as cornea, refractive, and cataract surgery. In this review, the authors will introduce the application of FSL in various anterior segment surgeries and discuss the results of studies regarding the efficacy and safety of FSL in cornea, refractive, and cataract surgery. Experimental studies regarding the potential use of FSL will also be introduced. The studies discussed in this review suggest that FSL may be a useful tool for improving the prognosis and safety of surgeries of the anterior segment.
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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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Roberts HW, Wagh VB, Sung J, Ni MZ, O'Brart DPS. Risk-Adjusted CUSUM Analysis of the Learning Curve of Femtosecond Laser Assisted Cataract Surgery. Curr Eye Res 2019; 44:887-895. [PMID: 30929535 DOI: 10.1080/02713683.2019.1601742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To determine the length of the learning curve of femtosecond laser-assisted cataract surgery (FLACS) by a risk-adjusted cumulative sum method. Materials and Methods: This was a retrospective review of the first 288 FLACS performed by three surgeons over a 12-month period. The learning curves were analyzed separately for each surgeon and as pooled data via risk-adjusted cumulative sum methods. Change-point analysis was performed to estimate the length of the learning curve. Results: Rates of complications were as follows: anterior capsular tear (ACT) (3.4%), posterior capsular rupture (PCR) (0.7%), vitreous loss (0.3%), iris trauma (0.7%), Descemet's membrane tear (0.3%). There was a strong confidence level (96%) that there was a stable performance in terms of PCR after case 16 for the pooled data. Surgeon 1 did not have any cases of PCR, surgeons 2 and 3 exhibited change points at case 5 and 16, respectively (confidence levels = 99%, 98%). There was a strong confidence level (99.8%) that there was stable performance in terms of ACT after case 14 for the pooled data, however the individual surgeons demonstrated individual change points at case 1 (surgeon 1, confidence 99%), case 14 (surgeon 2, confidence 99%), and case 49 (surgeon 3, confidence 96%). Conclusions: The results suggest that there is an increased risk of ACT and PCR in FLACS within a surgeon's first 14 and 16 operations, respectively. Measures should be adopted to minimize harm to patients during this phase. However, overall rates of complications were safe.
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Affiliation(s)
- Harry W Roberts
- a Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust , London , UK.,b King's College London , London , UK
| | - Vijay B Wagh
- a Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | | | - Melody Z Ni
- d Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital , London , UK
| | - David P S O'Brart
- a Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust , London , UK.,b King's College London , London , UK
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Uy HS, Chan PS, Gil-Cazorla R, Shah S. Comparison of surgical parameters using different lens fragmentation patterns in eyes undergoing laser-assisted cataract surgery. Int Ophthalmol 2019; 39:2459-2465. [PMID: 30830545 DOI: 10.1007/s10792-019-01087-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 02/23/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare surgical parameters among eyes undergoing laser-assisted cataract surgery (LACS) using different lens fragmentation patterns (LFP). METHODS Prospective, randomized, unmasked clinical trial. One-hundred eyes underwent LACS and were randomly assigned to 1 of 3 LFP treatment groups: (1) laser capsulotomy only; no lens fragmentation (NLF) (n = 34); (2) three-plane chop (TPC) (n = 33); and, (3) pie-cut pattern (PCP) fragmentation (n = 33). Prechop phacoemulsification (PHACO) was performed on all eyes using the same femtosecond (FS) laser and active-fluidics PHACO machine. MAIN OUTCOME MEASURES FS laser dock time (s), PHACO time (s), PHACO power (%), cumulative dissipated energy (CDE) (%-s), irrigating fluid volume, and operative time. RESULTS The 3 treatment groups were comparable in terms of patient age (P = 0.164) and nuclear density (P = 0.669). FS dock time was higher in the PCP group (184.18 ± 25.86) compared to the TPC (145.09 ± 14.15) group (P < 0.001). PHACO time was significantly shorter in the PCP (23.19 ± 17.20 s) compared to TPC (35.27 ± 17.70) and NLF (46.15 ± 23.72) groups (P < 0.001). PHACO power was lower in the PCP (11.81 ± 3.71) compared to the NLF (14.41 ± 1.88) and TPC (14.04 ± 2.46) groups (P < 0.001). CDE was lower in the PCP (2.85 ± 2.32) compared to NLF (6.55 ± 3.32) and TPC (6.55 ± 5.45) groups (P < 0.001). Fluid volumes and operative times were similar. CONCLUSION LFP can influence PHACO surgical parameters. Extensive fragmentation patterns such as PCP appear to lower PHACO time, power, and CDE and may potentially reduce the risk of PHACO related complications.
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Affiliation(s)
- Harvey S Uy
- Peregrine Eye and Laser Institute, 50 Jupiter Street, 1209, Makati City, Philippines. .,Department of Ophthalmology and Visual Sciences, University of the Philippines, Manila, Philippines.
| | - Pik Sha Chan
- Peregrine Eye and Laser Institute, 50 Jupiter Street, 1209, Makati City, Philippines
| | | | - Sunil Shah
- Birmingham and Midland Eye Centre, Birmingham, UK
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Chaves MAPD, de Medeiros AL, Vilar CMC, Magalhães KRP, Gonçalves MR, Tzelikis PFDM, Hida WT, Carricondo PC, Alves MR. Architecture evaluation of the main clear corneal incisions in femtosecond laser-assisted cataract surgery by optical coherence tomography imaging. Clin Ophthalmol 2019; 13:365-372. [PMID: 30858686 PMCID: PMC6387592 DOI: 10.2147/opth.s184024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the stability and reliability of femtosecond laser-assisted cataract surgery (FLACS) incisions design and dimensions using anterior segment optical coherence tomography (AS-OCT) imaging. Setting Renato Ambrósio Ophthalmologic Study Center from Hospital Oftalmológico de Brasília, Brasília, Brazil. Design Prospective nonrandomized controlled case series. Methods Eyes undergoing FLACS with triplanar main temporal clear corneal incision (CCI) were evaluated at the end of the case. Eyes that required any incision hydration, surgical complications or lacked follow-up were excluded. The AS-OCT was performed after femtosecond delivery; at the end of the case; at 1 day and at 30 days after surgery. Data of pachymetry, endothelial and epithelial gaps, Descemet detachment and CCI architecture were compared. Results Eleven eyes from 11 patients completed follow-up. Corneal thickness was statistically different between after femtosecond delivery and the end of the case (P-value <0.05), but without difference compared to 30 days evaluation. There was an increase of Descemet detachments (P-value <0.05) and endothelial gaps (P-value =0.0133) at the end of the case compared to post-femtosecond delivery. As for the architecture of the CCI, significant difference was found between the parameters of entry angle and exit angle measured with AS-OCT and the programmed. Conclusion The AS-OCT was capable of visualizing changes in the cornea at the CCI. Despite the stress caused by manipulation, results indicated good stability of incision and reproducibility of tunnel length. Synopsis Difference of corneal thickness at the CCI between after femtosecond and after phacoemulsification measurements (P-value <0.05), with increase of endothelial gaps (P-value =0.0133) and Descemet detachments (P-value <0.05).
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Affiliation(s)
- Mario Augusto Pereira Dias Chaves
- Brasília Ophthalmologic Hospital (HOB), Department of Cataract, João Pessoa, Paraíba, Brazil, .,Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil, .,Provisão Paraíba Ophthalmologic Hospital, João Pessoa, Paraíba, Brazil,
| | - André Lins de Medeiros
- Brasília Ophthalmologic Hospital (HOB), Department of Cataract, João Pessoa, Paraíba, Brazil, .,Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil,
| | - César Martins Cortez Vilar
- Brasília Ophthalmologic Hospital (HOB), Department of Cataract, João Pessoa, Paraíba, Brazil, .,Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil, .,Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Patrick Frenzel de Moraes Tzelikis
- Brasília Ophthalmologic Hospital (HOB), Department of Cataract, João Pessoa, Paraíba, Brazil, .,Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil, .,São Paulo University School of Medicine (FM-USP), Department of Ophthalmology, São Paulo, Brazil
| | - Wilson Takashi Hida
- Brasília Ophthalmologic Hospital (HOB), Department of Cataract, João Pessoa, Paraíba, Brazil, .,Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil, .,São Paulo University School of Medicine (FM-USP), Department of Ophthalmology, São Paulo, Brazil.,São Paulo Federal University of School of Medicine (UNIFESP), Department of Ophthalmology, São Paulo, Brazil
| | - Pedro Carlos Carricondo
- Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil, .,São Paulo University School of Medicine (FM-USP), Department of Ophthalmology, São Paulo, Brazil
| | - Milton Ruiz Alves
- Renato Ambrosio Ophthalmologic Study Center (CEORA), Brasília, Federal District, Brazil, .,São Paulo University School of Medicine (FM-USP), Department of Ophthalmology, São Paulo, Brazil
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Ibrahim T, Goernert P, Rocha G. Intraoperative outcomes and safety of femtosecond laser-assisted cataract surgery: Canadian perspective. Can J Ophthalmol 2019; 54:130-135. [DOI: 10.1016/j.jcjo.2018.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/11/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
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Shajari M, Rusev V, Mayer W, Diakonis V, Petermann K, Kohnen T. Impact of lens density and lens thickness on cumulative dissipated energy in femtosecond laser-assisted cataract surgery. Lasers Med Sci 2019; 34:1229-1234. [PMID: 30661184 DOI: 10.1007/s10103-019-02715-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
To evaluate the required cumulative dissipated energy (CDE) to fragment the crystalline lens in femtosecond laser-assisted cataract surgery (FLACS) in relation to lens density and lens thickness. Consecutive eyes that underwent FLACS between September 2014 and March 2017 by a single surgeon using in all cases the same femtosecond laser and phacoemulsification platform were included in our retrospective study. Prior to surgery, corrected distance visual acuity (CDVA), optical biometry corneal, and crystalline lens tomographies were performed to assess anterior chamber depth (ACD), axial length (AL), and crystalline lens parameters (i.e., lens density, thickness, and nucleus staging (NS)). After surgery, CDE was calculated and analyzed in relation to lens density (LD) and lens thickness (LT). Zero ultrasound expenditure cases were recorded and their occurrence analyzed. The chart review identified 236 eyes of 200 patients, 98 males and 102 females aged 65± 15 years which were included in the study. Mean LD was 11.26 ± 2.05 pixel intensity units (range 7.30-18.80), and the mean LT was 3417 ± 405.17 μm (range 2545-4701). LD and LT correlated moderately (r = 0.50, p < 0.001) and weakly (r = 0.23, p < 0.001), with post-laser CDE. Higher LD and LT were also associated with lower rates of zero phaco (eyes in which no phacoemulsification energy was necessary). Furthermore, NS (r = 0.528, p < 0.001) and CDVA (r = - 0.3524, p < 0.001) also correlated with CDE. Higher LD, LT, NS values, and low CDVA are associated with higher ultrasound expenditure (CDE-cumulative dissipated energy) and with lower rates of zero ultrasound expenditure during FLACS.
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Affiliation(s)
- Mehdi Shajari
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
- Department of Ophthalmology, Ludwig Maximillian University, Munich, Germany
| | - Vladimir Rusev
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Wolfgang Mayer
- Department of Ophthalmology, Ludwig Maximillian University, Munich, Germany
| | | | - Kerstin Petermann
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Horta GA, Horta RC, Steinfeld K, Koch CR, Mello GR, Kara-Junior N. Ultrasound power and irrigation volume in different lens opacity grades: comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification. Clinics (Sao Paulo) 2019; 74:e1294. [PMID: 31664421 PMCID: PMC6807685 DOI: 10.6061/clinics/2019/e1294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/24/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To compare the amount of ultrasound energy and irrigation volume in conventional phacoemulsification cataract surgery versus femtosecond laser-assisted phacoemulsification at different nuclear-cortical cataract grades. METHOD This was a prospective, consecutive, investigator-masked nonrandomized parallel cohort study. Patients were divided into 4 groups (Phaco1, Phaco2, Femto1 and Femto2) according to the surgical technique (conventional phacoemulsification [Group Phaco] or femtosecond laser-assisted cataract surgery [Group Femto]) and the Lens Opacity Classification System III (LOCS) grade (LOCS<11 [group 1] or LOCS≥11 [group 2]). The measured outcomes were effective phacoemulsification time (EPT), indicating the ultrasound energy, and balanced salt solution (BSS) use, indicating the irrigation volume, to indirectly estimate the damage to the corneal endothelium caused by the cataract surgery. RESULTS A total of 160 eyes from 109 patients were included: 87 eyes in Group Phaco, 73 eyes in Group Femto, 76 eyes in group 1 and 84 eyes in group 2. The EPT mean in Femto1 was 53% less (2.73±1.88, 0.1 to 8.65) than that in Phaco1 (5.80±2.86) (p=0.00) and in Femto2 (8.38±9.32) was 33% less than that in Phaco2 (12.55±8.38) (p=0.00). No significant differences in mean LOCS grades between the Phaco1 (8.21±1.44) and Femto1 (7.90±1.90) groups (p=0.73) or between the Phaco2 (13.15±2.55) and Femto2 (12.72±2.18) groups (p=0.95) were found. There were no significant differences in the mean BSS use between the Phaco1 (55.73±12.45) and Femto1 (59.37±10.93) groups (p=0.48) or between the Phaco2 (64.34±21.00) and Femto2 (65.71±17.60) groups (p=0.47). CONCLUSIONS Compared to conventional phacoemulsification at different nuclear-cortical cataract grades, femtosecond laser-assisted cataract surgery provides an EPT reduction but does not influence the BSS use.
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Affiliation(s)
- Guilherme A. Horta
- Centro de Estudos e Pesquisas Oculistas Associados, Rio de Janeiro, RJ, BR
| | | | | | - Camila R. Koch
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | | | - Newton Kara-Junior
- Departamento de Oftalmologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Yong WWD, Chai HCC, Shen L, Manotosh R, Anna Tan WT. Comparing Outcomes of Phacoemulsification With Femtosecond Laser-Assisted Cataract Surgery in Patients With Fuchs Endothelial Dystrophy. Am J Ophthalmol 2018; 196:173-180. [PMID: 30098347 DOI: 10.1016/j.ajo.2018.08.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the outcome in patients with Fuchs endothelial dystrophy (FED) who underwent standard phacoemulsification vs femtosecond laser-assisted cataract surgery (FLACS) in the treatment of visually significant cataracts. DESIGN Retrospective, comparative, interventional case series. METHODS Patient or Study Population: Between April 2013 and December 2016, 140 FED eyes with cataracts of all densities were included. Seventy-two eyes underwent phacoemulsification and 68 eyes underwent FLACS. Intervention or Observation Procedures: Automated noncontact specular microscopy was performed at baseline and postoperatively over a mean of 17.91 ± 10.47 months. Parameters collected include visual acuity, slit-lamp examination findings, and intraoperative findings. MAIN OUTCOME MEASURES Pachymetry, endothelial cell density (ECD), and coefficient of variance (COV) were compared. RESULTS Phacoemulsification had significantly greater postoperative median loss of ECD of 229.0 cells/mm2 (14.2%) compared to FLACS ECD of 133.0 cells/mm2 (6.5%) (U = 1343.0, Z = -2.241, P = .025). Mean loss of ECD was 346.524 ± 420.472 cells/mm2 and 119.964 ± 434.882 cells/mm2 for phacoemulsification and FLACS, respectively (P = .005). Mean percentage loss of ECD was 15.3% ± 17.5% for phacoemulsification and 4.4% ± 25.0% for FLACS (P = .006). Eyes that underwent phacoemulsification had 10.7% ± 15.4% mean ECD loss in the mild cataract group, and in the moderate/hard cataract group 19.5% ± 18.0%, P = .045. Eyes that underwent FLACS had 0.9% ± 22.5% mean ECD loss in the mild cataract group, and 8.2% ± 26.3% in the moderate/hard cataract group, P = .291. Comparison between procedures of mean ECD loss for moderate/hard cataracts was significant (P = .043). CONCLUSIONS FLACS is shown to be superior to phacoemulsification in reducing postoperative endothelial cell loss in FED patients, which translates to a lower risk of corneal decompensation, especially in patients with moderate/hard cataract densities.
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Affiliation(s)
- Wei Wei Dayna Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Hospital System, Singapore
| | - Ray Manotosh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Ophthalmology, National University Health System, Singapore
| | - Wee Tien Anna Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Ophthalmology, National University Health System, Singapore.
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Whang WJ, Yoo YS, Joo CK, Yoon G. Comparison of refractive outcomes between femtosecond laser-assisted cataract surgery and conventional cataract surgery. Medicine (Baltimore) 2018; 97:e13784. [PMID: 30593159 PMCID: PMC6314757 DOI: 10.1097/md.0000000000013784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of our study is to compare the predictive accuracy of femtosecond laser-assisted cataract surgery with the results of conventional cataract surgery. This prospective study included 83 eyes from 83 patients who underwent femtosecond laser-assisted cataract surgery and 83 eyes from 83 patients who underwent conventional cataract surgery. Preoperative IOL power calculations were performed with the partical coherence interferometry. Femtosecond laser-assisted capsulotomy was based on 5.2 mm scanned capsule center. Following phacoemulsification, 1-piece IOL was inserted into the capsular bag. Refractive outcome was measured 3 months postoperatively with manual refraction. Predicted refraction was assessed by the Barret-Universal II, Haigis, Hoffer Q, SRK/T, and T2 formulas. We applied optimized IOL constants and retrospectively personalized IOL constants. There was no difference in preoperative demographic data. When the optimized IOL constants were used, the femtosecond laser-assisted group produced significantly lower MAEs in the Barret-Universal II, Hoffer Q, SRK/T, and T2 formulas (P < .05). After the personalization of IOL constants, there were statistical differences in the Barret-Universal II, Hoffer Q (P < .05). The standard deviation of ME and MedAE were also relatively lower with femtosecond laser-assisted group. In conclusion, femtosecond laser-assisted cataract surgery with Catalys femtosecond laser system produced better refractive outcomes than conventional cataract surgery.
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Affiliation(s)
- Woong-Joo Whang
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital
| | | | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Geunyoung Yoon
- Flaum Eye Institute, Center for Visual Science, The Institute of Optics, University of Rochester, Rochester, New York, USA
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Comparison of phacoemulsification parameters between manual and femtosecond laser-assisted cataract surgery. Can J Ophthalmol 2018; 53:542-547. [DOI: 10.1016/j.jcjo.2018.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 12/29/2017] [Accepted: 01/03/2018] [Indexed: 11/20/2022]
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Levitz L, Reich J, Hodge C. Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review. Clin Ophthalmol 2018; 12:1701-1706. [PMID: 30233133 PMCID: PMC6134952 DOI: 10.2147/opth.s173089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose The aim of the study was to determine whether femtosecond-assisted laser cataract surgery (FLACS) reduces the posterior capsular complication (PCC) rate compared to manual cataract surgery when performed by an experienced surgeon. Patients and methods We reviewed 2,021 consecutive FLACS procedures between 1 June 2012 and 30 August 2017. All cases of posterior capsular rupture (PCR) with or without vitreous prolapse or zonular dialysis (ZD) that prevented an in-the-bag placement of the intraocular lens were included. Risk factors were noted and outcomes documented. Results Six eyes of 2,021 (0.3%) who underwent FLACS had either a PCR or ZD. One eye (0.25%) of 403 eyes that had manual cataract surgery had a PCR. There was no significant difference in outcomes. Risk factors included advanced age, dense nuclei, pseudoexfoliation and small pupil. Only a single case in the FLACS series may have been directly attributed to the FLACS procedure. Conclusion This study provides evidence that there is no significant difference in the PCC rate between FLACS and manual cataract surgery in the hand of an experienced surgeon who performs >350 cases annually. This low rate of complications may be achieved by less experienced surgeons adopting FLACS.
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Affiliation(s)
- Lewis Levitz
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Joseph Reich
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia,
| | - Chris Hodge
- Vision Eye Institute Camberwell, Hawthorn East, VIC, Australia, .,Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
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Bascaran L, Alberdi T, Martinez-Soroa I, Sarasqueta C, Mendicute J. Differences in energy and corneal endothelium between femtosecond laser-assisted and conventional cataract surgeries: prospective, intraindividual, randomized controlled trial. Int J Ophthalmol 2018; 11:1308-1316. [PMID: 30140634 DOI: 10.18240/ijo.2018.08.10] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 05/17/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To compare intraoperative phacoemulsification parameters and its effect on the corneal endothelium of eyes undergoing femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification (CP) cataract surgery. METHODS Two hundred eyes from one hundred patients were included in a prospective, non-blinded, randomized, controlled, intraindividual clinical study. One hundred eyes underwent FLACS while their one hundred fellow eyes underwent CP. All surgeries were performed using the Victus® femtosecond laser platform and Infinity® Vision System phacoemulsification machine. Primary outcome measure was endothelial cell density 6mo after surgery. Secondary outcome measures included central corneal thickness (CCT), average cell area, standard deviation, coefficient of variation and hexagonality before surgery and 6mo after surgery and endothelial cell density loss during this period were also evaluated. Intraoperative efficiency parameters [cumulative dissipated energy (CDE), total intraocular surgery time, total ultrasound time, total phacoemulsification time, total torsional energy time, total aspiration time, ultrasound energy, torsional amplitude and fluid required during surgery] were also collated. RESULTS Data from these patients was not considered for analysis. Data from 92 patients were analysed. Postoperative endothelial cell density (cells/mm2) between groups (2211.88±392.49 CP; 2246.31±403.48 FLACS) was not statistically significant (P=0.869). Total ultrasound time, torsional energy time, CDE and fluid requirements were significantly lower the FLACS group (P<0.05). Other parameters did not show statistically significant difference between FLACS and CP. CONCLUSION FLACS displays significant improvements in phacoemulsification parameters in comparison to CP. There are no significant differences in corneal endothelium measures between FLACS and CP.
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Affiliation(s)
- Lucia Bascaran
- Ophthalmology Department, Donostia University Hospital, San Sebastián 20014, Spain
| | - Txomin Alberdi
- Ophthalmology Department, Donostia University Hospital, San Sebastián 20014, Spain
| | | | - Cristina Sarasqueta
- Biodonostia Institute, Donostia University Hospital, San Sebastián 20014, Spain
| | - Javier Mendicute
- Ophthalmology Department, Donostia University Hospital, San Sebastián 20014, Spain
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Jun JH, Bang SP, Yoo YS, Joo CK. Efficacy of 0.015% intracameral epinephrine for significant miosis induced by photodisruption during femtosecond laser-assisted cataract surgery. Medicine (Baltimore) 2018; 97:e11693. [PMID: 30075568 PMCID: PMC6081127 DOI: 10.1097/md.0000000000011693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite the various advantages of femtosecond laser-assisted cataract surgery (FLACS), pupillary constriction during laser photodisruption is considered one of the most unfavorable events. This study aimed to investigate the efficacy of intracameral 0.015% epinephrine injection for miosis after laser pretreatment during FLACS.A total of 82 patients who underwent FLACS for age-related cataracts were investigated in this retrospective study. The epinephrine group included patients who received intracameral epinephrine injection for miosis after femtosecond laser pretreatment, while the no-epinephrine group included the patients who underwent FLACS without intracameral epinephrine due to minimal miosis. Quantitative pupil area measurements were performed through the analysis of captured images extracted from surgical videos of both femtosecond laser pretreatment and phacoemulsification.Laser photodisruption induced miosis in both groups, although the degree of miosis was greater in the epinephrine group (4.65 ± 0.87 mm) than in the no-epinephrine group (6.30 ± 0.65 mm; P < .001). The intracameral epinephrine injection significantly increased the pupil diameter from 4.65 ± 0.87 to 5.49 ± 0.76 mm (21.61 ± 22.68%; P < .001) and the pupil area from 70.28 ± 24.46 to 96.49 ± 25.24 mm (52.89 ± 63.54%; P < .001). After additional viscomydriasis, there was no difference between groups in pupil diameter (epinephrine vs no-epinephrine group; 6.10 ± 0.77 vs 6.39 ± 0.65 mm; P = .073).A single intracameral injection of 0.015% epinephrine provided immediate and appropriate redilation of pupil in patients with significant miosis after femtosecond laser photodisruption. Intracameral epinephrine is a simple and practical option for pupil redilation in case of miosis during FLACS.
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Affiliation(s)
- Jong Hwa Jun
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu
| | - Seung Pil Bang
- Department of Ophthalmology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu
| | | | - Choun-Ki Joo
- Catholic Institute for Visual Science
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhu DC, Shah P, Feuer WJ, Shi W, Koo EH. Outcomes of conventional phacoemulsification versus femtosecond laser-assisted cataract surgery in eyes with Fuchs endothelial corneal dystrophy. J Cataract Refract Surg 2018; 44:534-540. [PMID: 29773458 PMCID: PMC5997572 DOI: 10.1016/j.jcrs.2018.03.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the outcomes in eyes with Fuchs endothelial corneal dystrophy after standard phacoemulsification with those of femtosecond laser-assisted cataract surgery. SETTING Bascom Palmer Eye Institute, Miami, Florida, USA. DESIGN Retrospective case series. METHODS Charts from patients diagnosed with Fuchs endothelial corneal dystrophy who had phacoemulsification cataract surgery at Bascom Palmer Eye Institute between January 1, 2014, and January 1, 2017, were reviewed. The Institutional Review Board, University of Miami Human Subjects Research Office, approved the study protocol. Complicated surgeries and cases with concurrent keratoplasty, previous keratoplasty or glaucoma surgery, or a follow-up shorter than 3 months were excluded. The corrected distance visual acuity (CDVA), central corneal thickness (CCT), and corneal edema at each visit were analyzed. Clinically significant corneal decompensation was defined by corneal edema with CDVA worse than 20/50 lasting more than 3 months, any case resulting in keratoplasty, or both. RESULTS The study comprised 207 eyes of 207 patients (64 femtosecond laser-assisted cataract surgery, 143 conventional phacoemulsification). Demographics, baseline guttata and cataract grades, and follow-up time (mean 30 months) were similar between groups (P > .05). The proportion of cases progressing to clinically significant decompensation (13%) was similar between groups (P > .05). Univariate Cox survival analysis also found no difference (hazard ratio, 1.0; 95% confidence interval, 0.4-2.7; P = .96). CONCLUSIONS Compared with conventional phacoemulsification, femtosecond laser-assisted cataract surgery did not lower the rate of corneal decompensation in eyes with mild to moderate Fuchs endothelial corneal dystrophy.
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Affiliation(s)
- Dagny C Zhu
- From the Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Parth Shah
- From the Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - William J Feuer
- From the Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Wei Shi
- From the Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, Florida, USA
| | - Ellen H Koo
- From the Bascom Palmer Eye Institute, Department of Ophthalmology, Miller School of Medicine at the University of Miami, Miami, Florida, USA.
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Sun W, Liu J, Li J, Wu D, Wang J, Wang MW, Zhang JS, Zhao JY. Human lens epithelial cell apoptosis and epithelial to mesenchymal transition in femtosecond laser-assisted cataract surgery. Int J Ophthalmol 2018; 11:401-407. [PMID: 29600173 PMCID: PMC5861229 DOI: 10.18240/ijo.2018.03.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/15/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate human lens epithelium cell apoptosis and epithelial to mesenchymal transition (EMT) induced by femtosecond laser in femtosecond laser assisted cataract surgery (FLACS). METHODS Sixty cataract patients with N2 to N3 stage according to the LOCS III were enrolled in this study and divided into three groups randomly: FLACS1 group (cataract surgery by FLACS with LenSx), FLACS2 group (cataract surgery by FLACS with LensAR) and manual group (cataract surgery by phacoemulsification). Patients in two FLACS groups performed anterior capsulotomy by LenSx or LensAR laser system. Patients in the manual group were performed continuous curvilinear capsulorrhexis (CCC) manually. The anterior capsules were fixed right after moved out of eye. Hematoxylin-eosine staining, immunofluorescence staining and real-time PCR were performed in order to observe human lens epithelium cells changes after cataract surgery. RESULTS The capsule cutting edge was shown irregularity and roughness in two FLACS groups and smooth edge in manual capsulotomy by pathologic staining. Irregularities of the cell configuration with partly swollen and destroyed nuclei were observed in two FLACS groups. Femtosecond laser could induce a significantly higher cell apoptosis in human lens epithelium cell than manually performed CCC (P<0.05). Lens epithelium cells apoptosis were correlated with femtosecond laser duration according to Pearson correlation analysis. Decreased N-cadherin expression, alpha-SMA and FSP-1 level in two FLACS groups showed the inhibition of cell EMT. CONCLUSION Femtosecond laser may affect the apoptosis and EMT of lens epithelium cells which are under the peeled central lens capsule.
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Affiliation(s)
- Wei Sun
- Department of Ophthalmology, the 4 Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Provincial Key Laboratory of Lens Research, Shenyang 110005, Liaoning Province, China
| | - Jia Liu
- Department of Ophthalmology, the 4 Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Provincial Key Laboratory of Lens Research, Shenyang 110005, Liaoning Province, China
| | - Jing Li
- Department of Ophthalmology, the 4 Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Provincial Key Laboratory of Lens Research, Shenyang 110005, Liaoning Province, China
| | - Di Wu
- Department of Ophthalmology, the 4 Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Provincial Key Laboratory of Lens Research, Shenyang 110005, Liaoning Province, China
| | - Jing Wang
- Department of Ophthalmology, the 4 Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Provincial Key Laboratory of Lens Research, Shenyang 110005, Liaoning Province, China
| | - Ming-Wu Wang
- Department of Ophthalmology and Vision Science, the University of Arizona College of Medicine, Tucson, AZ 85711-1824, USA
| | - Jin-Song Zhang
- Department of Ophthalmology, the 4 Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Provincial Key Laboratory of Lens Research, Shenyang 110005, Liaoning Province, China
| | - Jiang-Yue Zhao
- Department of Ophthalmology, the 4 Affiliated Hospital of China Medical University; Eye Hospital of China Medical University; Provincial Key Laboratory of Lens Research, Shenyang 110005, Liaoning Province, China
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Roberts HW, Wagh VK, Mullens IJM, Borsci S, Ni MZ, O’Brart DPS. Evaluation of a hub-and-spoke model for the delivery of femtosecond laser-assisted cataract surgery within the context of a large randomised controlled trial. Br J Ophthalmol 2018; 102:1556-1563. [DOI: 10.1136/bjophthalmol-2017-311319] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 12/08/2017] [Accepted: 01/20/2018] [Indexed: 11/04/2022]
Abstract
AimsTo test a hypothesis that cataract operating room (OR) productivity can be improved with a femtosecond laser (FL) using a hub-and-spoke model and whether any increase in productivity can offset additional costs relating to the FL.Methods400 eyes of 400 patients were enrolled in a randomised-controlled trial comparing FL-assisted cataract surgery (FLACS) with conventional phacoemulsification surgery (CPS). 299 of 400 operations were performed on designated high-volume theatre lists (FLACS=134, CPS=165), where a hub-and-spoke FLACS model (1×FL, 2×ORs=2:1) was compared with independent CPS theatre lists. Details of operative timings and OR utilisation were recorded. Differences in productivity between hub-and-spoke FLACS and CPS sessions were compared using an economic model including testing hypothetical 3:1 and 4:1 models.ResultsThe duration of the operation itself was 12.04±4.89 min for FLACS compared with CPS of 14.54±6.1 min (P<0.001). Total patient time in the OR was reduced from 23.39±6.89 min with CPS to 20.34±5.82 min with FLACS (P<0.001)(reduction of 3.05 min per case). There was no difference in OR turnaround time between the models. Average number of patients treated per theatre list was 9 for FLACS and 8 for CPS. OR utilisation was 92.08% for FLACS and 95.83% for CPS (P<0.001). Using a previously established economic model, the FLACS service cost £144.60 more than CPS per case. This difference would be £131 and £125 for 3:1 and 4:1 models, respectively.ConclusionThe FLACS hub-and-spoke model was significantly faster than CPS, with patients spending less time in the OR. This enabled an improvement in productivity, but insufficient to meaningfully offset the additional costs relating to FLACS.
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Wang EF, Worsley A, Polkinghorne PJ. Comparative study of femtosecond laser-assisted cataract surgery and conventional phacoemulsification in vitrectomized eyes. Clin Exp Ophthalmol 2018; 46:624-629. [PMID: 29240287 DOI: 10.1111/ceo.13133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/28/2022]
Abstract
IMPORTANCE To compare the safety and outcomes of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification in post-vitrectomy eyes. BACKGROUND To compare visual outcomes and adverse outcomes of FLACS and conventional phacoemulsification in vitrectomized eyes. DESIGN Single surgeon, retrospective study set in a private clinic in Auckland, New Zealand. Patients selected in a chronological manner, without masking or randomization. PARTICIPANTS Only patients undergoing cataract extraction following vitrectomy were included. METHODS The last 25 surgeries performed prior to acquisition of the femtosecond laser and the first 25 surgeries performed following acquisition of the femtosecond laser were included. Patient demographic data, preoperative and postoperative visual acuities were collected. Intraoperative and postoperative complications were compared. Follow-up ranged from 1 to 74 months. MAIN OUTCOME MEASURES The main outcome measures are postoperative visual outcomes and intra- and postoperative complications for both groups. RESULTS Results of FLACS compared to conventional phacoemulsification are as follows: preoperative logMAR best corrected visual acuity (BCVA) (0.63 vs. 0.69), postoperative logMAR BCVA (0.17 vs. 0.19), posterior capsule complications (0% vs. 12%, P = 0.235), cystoid macular oedema (CMO) (12% vs. 20%, P = 0.705) and postoperative neodymium-doped yttrium aluminium garnet (Nd:YAG) capsulotomy (16% vs. 48%, P = 0.032). CONCLUSIONS AND RELEVANCE FLACS demonstrates comparable visual outcomes to conventional phacoemulsification. Whilst outcomes measured were not statistically significant, except postoperative YAG capsulotomy, FLACS showed a trend towards a better intraoperative and postoperative safety profile. Femtosecond laser offers a theoretical advantage in reducing complication rates in post-vitrectomy eyes, further larger studies are needed.
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Affiliation(s)
- Ellen F Wang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Andrew Worsley
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Philip J Polkinghorne
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Pham R, Worrell B, Nguyen P, Narain K. Femtosecond laser-assisted cataract surgery and implantable miniature telescope. Am J Ophthalmol Case Rep 2017; 7:40-49. [PMID: 29260077 PMCID: PMC5722141 DOI: 10.1016/j.ajoc.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/06/2017] [Accepted: 05/19/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose This paper is a case report of the use of femtosecond laser for cataract surgery to implant an implantable miniature telescope for a patient with large central areas of geographic atrophy. Observations On postoperative day 1 the patient's uncorrected visual acuity at near was 20/50. The cornea was clear and the patient reported no problem with navigation without occupational therapy training. Conclusions and importance To our knowledge and confirmed by the manufacturer of the implantable miniature telescope this is the first case ever reported of a patient who has undergone femtosecond laser cataract surgery with corneal astigmatism correction and implantation of the implantable miniature telescope. This is also the first case report of the preoperative use of microperimetry and visual electrophysiology to evaluate a patient's postoperative potential visual acuity. The success of the procedure illustrated the importance of meticulous preoperative planning, the combined use of state-of-the-art technologies and the seamless teamwork in order to achieve the best clinical outcome for patients who undergo implantation of the implantable miniature telescope.
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Affiliation(s)
- Randal Pham
- Aesthetic and Refractive Surgery Medical Center, 455 O'Connor Drive, Ste 180, San Jose, CA 95128, USA
| | - Burton Worrell
- Advance Vision Center of Optometry, 545 Meridian Avenue, San Jose, CA 95126, USA
| | - Phuc Nguyen
- Advanced Surgery Medical Center, 989 Story Road, Suite 8066, San Jose, CA 95122, USA
| | - Keshav Narain
- South Bay Retina Inc., 333 El Camino Real, Suite 340, Sunnyvale, CA 94087, USA
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Ranjini H, Murthy PR, Murthy GJ, Murthy VR. Femtosecond laser-assisted cataract surgery versus 2.2 mm clear corneal phacoemulsification. Indian J Ophthalmol 2017; 65:942-948. [PMID: 29044058 PMCID: PMC5678329 DOI: 10.4103/ijo.ijo_152_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: Phacoemulsification is the surgical procedure of choice for cataract, providing excellent visual and safety outcomes. Femtosecond laser-assisted cataract surgery (FLACS) is an addition to the surgical armamentarium. The study aims to compare the outcomes of FLACS using LenSx™ (Alcon Inc., USA) to standard 2.2 mm clear corneal phacoemulsification. Prospective case–control, comparative, interventional study was conducted in a tertiary care center. Methods: In each group, 55 eyes of 55 patients underwent cataract surgery using either FLACS or conventional phacoemulsification (control group). The primary outcome variables, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), specular microscopy, pachymetry, mean absolute error (MAE), and anterior chamber depth (ACD) were compared between two groups at 4 weeks postoperatively. Intraoperative effective phaco time (EPT), postoperative circularity of the rhexis, capsular overlap over the edge of the intraocular lens (IOL), and decentration of the IOL were the secondary variables which were compared. Results: No significant difference was found between the groups for UCVA, pachymetry, MAE, and ACD at 4 weeks postoperatively. The FLACS group had better BCVA (P = 0.0294). Circularity of capsulorrhexis (P = 0), circular overlap over the edge of IOL (P = 0), and centration of IOL (P = 0.002) at 4 weeks postoperatively were better in the FLACS group. EPT was lower in FLACS for similar grade of cataract (P = 0). Endothelial cell loss in FLACS group was 4.2% more (P = 0.032). Conclusions: FLACS is superior to conventional phaco in the circularity of rhexis, capsular overlap, and centration of the IOL and uses less EPT. However, conventional phacoemulsification is equivalent to FLACS in most other parameters.
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Affiliation(s)
- H Ranjini
- Department of Ophthalmology, Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India
| | - Praveen R Murthy
- Department of Vitreo-Retina, Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India
| | - Gowri J Murthy
- Department of Glaucoma, Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India
| | - Vinay R Murthy
- Department of Cornea and Refractive Surgery, Prabha Eye Clinic and Research Center, Bengaluru, Karnataka, India
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Shajari M, Khalil S, Mayer WJ, Al-Khateeb G, Böhm M, Petermann K, Hemkeppler E, Kohnen T. Comparison of 2 laser fragmentation patterns used in femtosecond laser–assisted cataract surgery. J Cataract Refract Surg 2017; 43:1571-1574. [DOI: 10.1016/j.jcrs.2017.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/01/2017] [Accepted: 09/13/2017] [Indexed: 10/18/2022]
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Asena BS, Kaskaloglu M. Comparison of hybrid and cross fragmentation patterns in terms of phaco time and corneal effects. Lasers Surg Med 2017; 50:319-323. [DOI: 10.1002/lsm.22764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 11/09/2022]
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Ibrahim T, Goernert P, Rocha G. Effect of femtosecond laser on efficiency of cataract surgery in public setting. Can J Ophthalmol 2017; 53:56-59. [PMID: 29426442 DOI: 10.1016/j.jcjo.2017.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 06/01/2017] [Accepted: 07/04/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the time needed to perform a femtosecond laser-assisted cataract surgery (FLACS) and its effect on the efficiency of cataract surgery flow in a Canadian public health centre. DESIGN Retrospective chart review. PARTICIPANTS Patients who had cataract surgery performed in the first 3 months of femtosecond laser (FSL) technology use were compared with patients who had conventional phacoemulsification in the 3 months before FSL installation at Brandon Regional Health Centre (Brandon, Man.). METHODS The primary outcome measure was the time needed to complete FLACS versus the time needed to complete conventional phacoemulsification. Secondary outcome measures were the time the patient spent in the operating room (time in and time out) and the number of cataract surgeries done per surgical day before and after FSL was implemented systemwide. RESULTS There were 235 FSL cases and 199 conventional cases. Operating room time, total surgery time, and manual time were significantly longer in patients who underwent FLACS compared with patients who underwent conventional phacoemulsification (p < 0.001). Manual times and FSL suction times on the first day of implementing FLACS surgery were significantly longer than those on day 23 (p < 0.03), which suggests a learning curve effect. The number of cases per surgical day dropped by 28.6% in the first operative day and by 7.1% in the second and third operative days of FSL use, then reverted to pre-FSL levels. CONCLUSION The addition of FLACS results in longer time per case than traditional cataract surgery. Although statistically significant, the results may not be indicative of practical differences.
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Affiliation(s)
- Tarek Ibrahim
- Ocular Microsurgery & Laser Centre, Brandon, Man; Eye Consultant Centre, Dubai, UAE.
| | | | - Guillermo Rocha
- Ocular Microsurgery & Laser Centre, Brandon, Man; Department of Ophthalmology, University of Manitoba, Winnipeg, Man; Brandon Regional Health Centre, Prairie Mountain Health, Brandon, Man
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Hooshmand J, Vote BJ. Femtosecond laser-assisted cataract surgery, technology, outcome, future directions and modern applications. Asia Pac J Ophthalmol (Phila) 2017; 6:393-400. [PMID: 28780777 DOI: 10.22608/apo.2017159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/26/2017] [Indexed: 11/08/2022] Open
Abstract
Since its introduction in 2009 femtosecond laser-assisted cataract surgery (FLACS) has promised to revolutionize cataract surgery. Despite its promise, the assessment of FLACS's perceived benefits has proven to be far more complicated than initially might have been thought. Most studies to date have not provided validation of FLACS technology as a clinically significant advancement on our current techniques. We review FLACS technology and outcomes including detailed analysis of safety, efficacy, cost effectiveness and future prospects using data from the literature and our own published clinical experience.
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Affiliation(s)
| | - Brendan J Vote
- Tasmanian Eye Institute, South Launceston, Tasmania, Australia
- University of Tasmania, Hobart, Tasmania, Australia
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Pajic B, Cvejic Z, Pajic-Eggspuehler B. Cataract Surgery Performed by High Frequency LDV Z8 Femtosecond Laser: Safety, Efficacy, and Its Physical Properties. SENSORS 2017. [PMID: 28629164 PMCID: PMC5492121 DOI: 10.3390/s17061429] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of our study was to investigate the safety and efficacy of the LDV Z8 femtosecond laser in cataract surgery compared to the conventional procedure. Methods: This prospective study was performed at the Swiss Eye Research Foundation, Eye Clinic ORASIS, Reinach, Switzerland. The study included 130 eyes from 130 patients: 68 treated with femtosecond laser-assisted cataract surgery (FLACS) using the FEMTO LDV Z8 and 62 treated with conventional phacoemulsification. Capsulotomy and lens fragmentation in the laser group were performed with the FEMTO LDV Z8 femtosecond laser system, which employs a new, low-energy, high repetition rate laser process for cataract surgery. In the conventional group, the capsulotomy was performed by a cystotome, and lens fragmentation was achieved by the stop-and-chop. Results: Ease of phacoemulsification (on a 4-point scale), the completeness of capsulotomy (on a 10-point scale), effective phacoemulsification time (seconds), uncorrected distance visual acuity (UCVA), best spectacle-corrected distance visual acuity (BSCVA), spherical equivalent (SE), and safety of the procedure were evaluated. The total follow-up time was three months. Conclusions: FLACS with the FEMTO LDV Z8 system was characterized by complete and reproducible capsulotomy and highly effective lens fragmentation. Postoperative visual outcomes were excellent, and the safety of the procedure was optimal.
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Affiliation(s)
- Bojan Pajic
- Eye Clinic Orasis, Swiss Eye Research Foundation, 5734 Reinach AG, Switzerland.
- Department of Physics, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia.
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland.
- Faculty of Medicine of the Military Medical academy, University of Defense, 11000 Belgrade, Serbia.
| | - Zeljka Cvejic
- Department of Physics, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia.
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Roberts HW, Ni MZ, O'Brart DPS. Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a 'hub and spoke' model for the delivery of high-volume cataract surgery. BMJ Open 2017; 7:e013616. [PMID: 28302635 PMCID: PMC5372035 DOI: 10.1136/bmjopen-2016-013616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS To develop financial models which offset additional costs associated with femtosecond laser (FL)-assisted cataract surgery (FLACS) against improvements in productivity and to determine important factors relating to its implementation into the National Health Service (NHS). METHODS FL platforms are expensive, in initial purchase and running costs. The additional costs associated with FL technology might be offset by an increase in surgical efficiency. Using a 'hub and spoke' model to provide high-volume cataract surgery, we designed a financial model, comparing FLACS against conventional phacoemulsification surgery (CPS). The model was populated with averaged financial data from 4 NHS foundation trusts and 4 commercial organisations manufacturing FL platforms. We tested our model with sensitivity and threshold analyses to allow for variations or uncertainties. RESULTS The averaged weekly workload for cataract surgery using our hub and spoke model required either 8 or 5.4 theatre sessions with CPS or FLACS, respectively. Despite reduced theatre utilisation, CPS (average £433/case) was still found to be 8.7% cheaper than FLACS (average £502/case). The greatest associated cost of FLACS was the patient interface (PI) (average £135/case). Sensitivity analyses demonstrated that FLACS could be less expensive than CPS, but only if increased efficiency, in terms of cataract procedures per theatre list, increased by over 100%, or if the cost of the PI was reduced by almost 70%. CONCLUSIONS The financial viability of FLACS within the NHS is currently precluded by the cost of the PI and the lack of knowledge regarding any gains in operational efficiency.
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Affiliation(s)
- H W Roberts
- Department of Ophthalmology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - M Z Ni
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
| | - D P S O'Brart
- Department of Ophthalmology, Guy's and St Thomas’ NHS Foundation Trust, London, UK
- King's College London, London, UK
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Garcia GA, Tian JJ, Falavarjani KG, Karanjia R, Lu KL. Corneal etching in femtosecond laser-assisted cataract surgery. Can J Ophthalmol 2017; 52:e15-e18. [PMID: 28237162 DOI: 10.1016/j.jcjo.2016.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/05/2016] [Accepted: 07/18/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Giancarlo A Garcia
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, Calif; University of California, Irvine, School of Medicine, Irvine, Calif.
| | - Jack J Tian
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, Calif
| | | | - Rustum Karanjia
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, Calif; Ottawa Eye Institute, University of Ottawa, Ottawa, Ont
| | - Kenneth L Lu
- Doheny Eye Institute, University of California, Los Angeles, Los Angeles, Calif
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Pittner AC, Sullivan BR. Resident surgeon efficiency in femtosecond laser-assisted cataract surgery. Clin Ophthalmol 2017; 11:291-297. [PMID: 28203055 PMCID: PMC5298295 DOI: 10.2147/opth.s128626] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Comparison of resident surgeon performance efficiencies in femtosecond laser-assisted cataract surgery (FLACS) versus conventional phacoemulsification. Patients and methods A retrospective cohort study was conducted on consecutive patients undergoing phacoemulsification cataract surgery performed by senior ophthalmology residents under the supervision of 1 attending physician during a 9-month period in a large Veterans Affairs medical center. Medical records were reviewed for demographic information, preoperative nucleus grade, femtosecond laser pretreatment, operative procedure times, total operating room times, and surgical complications. Review of digital video records provided quantitative interval measurements of core steps of the procedures, including completion of incisions, anterior capsulotomy, nucleus removal, cortical removal, and intraocular lens implantation. Results Total room time, operation time, and corneal incision completion time were found to be significantly longer in the femtosecond laser group versus the traditional phacoemulsification group (each P<0.05). Mean duration for manual completion of anterior capsulotomy was shorter in the laser group (P<0.001). There were no statistically significant differences in the individual steps of nucleus removal, cortical removal, or intraocular lens placement. Surgical complication rates were not significantly different between the groups. Conclusion In early cases, resident completion of femtosecond cataract surgery is generally less efficient when trainees have more experience with traditional phacoemulsification. FLACS was found to have a significant advantage in completion of capsulotomy, but subsequent surgical steps were not shorter or longer. Resident learning curve for the FLACS technology may partially explain the disparities of performance. Educators should be cognizant of a potential for lower procedural efficiency when introducing FLACS into resident training.
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Affiliation(s)
- Andrew C Pittner
- Department of Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Maywood
| | - Brian R Sullivan
- Edward Hines Jr VA Hospital, Ophthalmology Section, Hines, IL, USA
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Outcomes of femtosecond laser-assisted cataract surgery performed by surgeons-in-training. Graefes Arch Clin Exp Ophthalmol 2017; 255:805-809. [DOI: 10.1007/s00417-016-3581-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 12/18/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022] Open
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