1
|
Combined Femtosecond Laser-Assisted Cataract Surgery and 27-Gauge Transconjunctival Sutureless Vitrectomy. J Ophthalmol 2020; 2020:7651941. [PMID: 32280534 PMCID: PMC7125466 DOI: 10.1155/2020/7651941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To report the outcomes of combined surgery using femtosecond laser-assisted cataract surgery (FLACS) and sutureless 27-gauge pars plana vitrectomy with intravitreal tamponade. Methods This retrospective clinical study involved 23 eyes of 23 patients on whom combined vitreoretinal surgery was performed. Patients were initially given the femtosecond laser treatment that was performed after selection of capsulotomy and lens fragmentation patterns. The capsulotomy diameter was chosen as 4.9 mm in all patients. After the femtosecond laser, the sutureless phacovitrectomy procedure was performed. At the end of surgery, perfluoropropane or sterile air tamponade was applied. Results The mean age of patients was 66.43 ± 7.61 (range, 54–83) years. Fifteen patients were females (65.2%). The mean follow-up was 16.09 ± 4.71 (range, 9–25) months. The most common surgical indication was epiretinal membrane (65.3%). The mean preoperative best-corrected visual acuity (BCVA) was 0.71 ± 0.44 (range, 1.7–0.3) logMAR, and the mean postoperative BCVA at 6 months was 0.16 ± 0.14 (range, 0.4–0) logMAR (p < 0.001). The mean target sphere refractive error was −0.24 ± 0.16 (range, −0.50–0.11) D, and the mean postoperative spherical equivalent refractive error was −0.14 ± 0.39 (range, −1.00–0.50) D at 6 months (p=0.196). All intraocular lenses (IOLs) remained well centered in the capsular bag during surgery and follow-up. There was no iris capture, posterior synechiae, capsular opacification, or pseudophakic cystoid macular edema. The only complication related to femtosecond laser was two cases of subconjunctival haemorrhage related with suction. Conclusions FLACS is a safe and effective technique providing the advantage of repeatable, precise capsulorhexis shape and size to achieve a well-centered and stable IOL postoperatively. These advantages can certainly improve the results of vitrectomy, especially in gas-filled eyes. FLACS and 27-gauge sutureless combined surgery may be a future trend in appropriate cases.
Collapse
|
2
|
Kubota M, Watanabe A, Watanabe T, Kono H, Hayashi T, Nakano T. Complications of femtosecond laser-assisted cataract surgery combined with vitrectomy. Int Ophthalmol 2020; 40:943-949. [DOI: 10.1007/s10792-019-01266-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
|
3
|
Malyugin BE, Anisimova NS. [Mechanical dilation of the pupil and its possible applications in femtosecond laser-assisted cataract surgery]. Vestn Oftalmol 2018. [PMID: 29543206 DOI: 10.17116/oftalma2018134197-103] [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: 11/17/2022]
Abstract
In certain cases intraoperative pupil dilation during cataract surgery may be necessary to improve the visualization of intraocular structures and assure the atraumatic nature of surgical manipulations. The article reviews a wide range of pupil expanders, their historical aspects and possibilities of their application in modern cataract surgery.
Collapse
Affiliation(s)
- B E Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky Blvd., 59А, Moscow, Russian Federation, 127486
| | - N S Anisimova
- S. Fyodorov Eye Microsurgery Federal State Institution, Beskudnikovsky Blvd., 59А, Moscow, Russian Federation, 127486
| |
Collapse
|
4
|
Femtosecond laser-assisted cataract in vitreoretinal surgery. Eur J Ophthalmol 2017; 27:565-568. [PMID: 28604979 DOI: 10.5301/ejo.5000986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the safety and surgical results of femtosecond laser-assisted phacovitrectomy. METHODS Fifteen patients over 50 years of age with coexisting vitreoretinal pathologies and cataract underwent combined femtosecond laser-assisted cataract extraction and sutureless 25-G and 27-G vitreoretinal surgery. RESULTS The indication for surgery was macular hole in 6 patients, epiretinal membrane in 6, vitreous hemorrhage in 2, and retinal detachment in 1. The mean preoperative best-corrected visual acuity (BCVA) was 0.64 ± 0.23 logMAR and the mean postoperative BCVA was 0.19 ± 0.11 logMAR. In 4 patients with epiretinal membrane with corneal astigmatism of 3.35 ± 0.32 D as mean value, a toric intraocular lens (IOL) was implanted: mean residual refractive cylinder was 0.47 ± 0.23 D. Three months postoperatively, mean IOL rotation was 1.64 ± 0.28°. All patients improved their visual acuity. The intraoperative complications of femtosecond laser were 1 subconjunctival hemorrhage, 1 case of miosis, and 1 suction loss. The surgeon was able to maintain a clear view of the retina at all times. After surgery, a better fundus examination was possible with no capsular opacification. Mean follow-up was 6 months. CONCLUSIONS Femtosecond laser cataract in vitreoretinal surgery appears a safe and effective technique with potential benefits: the precision and centration of the capsulorhexis may potentially reduce the risk of IOL prolapse into the anterior chamber in gas-filled eyes. Implantation of the toric IOL was effective in reducing preexisting corneal astigmatism and provided good rotational stability and refractive outcome.
Collapse
|
5
|
Israni NA, Kanhere M, Kathiriya V, Ramchandani S. Comment on: To assess survival outcomes of combined femtosecond laser-assisted cataract surgery with 25-gauge vitrectomy surgery at a tertiary eye care center. Indian J Ophthalmol 2017; 65:327. [PMID: 28513502 PMCID: PMC5452590 DOI: 10.4103/ijo.ijo_961_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Neeraj Ashok Israni
- Department of Ophthalmology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Minal Kanhere
- Department of Ophthalmology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Vidhi Kathiriya
- Department of Ophthalmology, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Suresh Ramchandani
- Department of Ophthalmology, Shivam Eye Clinic, Navi Mumbai, Maharashtra, India
| |
Collapse
|
6
|
Roberts TV, Lawless M, Sutton G, Hodge C. Update and clinical utility of the LenSx femtosecond laser in cataract surgery. Clin Ophthalmol 2016; 10:2021-2029. [PMID: 27799728 PMCID: PMC5074708 DOI: 10.2147/opth.s94306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The introduction of femtosecond lasers to cataract surgery has been the major disruptive technology introduced into ophthalmic surgery in the last decade. Femtosecond laser cataract surgery (FLACS) integrates high-resolution anterior segment imaging with a femtosecond laser allowing key steps of cataract surgery to be performed with computer-guided laser accuracy, precision, and reproducibility. Since the introduction of FLACS, there have been significant advances in laser software and hardware as well as surgeon experience, with over 250 articles published in the peer-reviewed literature. This review examines the published evidence relating to the LenSx platform and discusses surgical techniques, indications, safety, and clinical results.
Collapse
Affiliation(s)
- Timothy V Roberts
- Vision Eye Institute, Chatswood
- Sydney Medical School, University of Sydney
| | - Michael Lawless
- Vision Eye Institute, Chatswood
- Sydney Medical School, University of Sydney
| | - Gerard Sutton
- Vision Eye Institute, Chatswood
- Sydney Medical School, University of Sydney
| | - Chris Hodge
- Vision Eye Institute, Chatswood
- Graduate School of Health Sciences, University of Technology, Sydney, NSW, Australia
| |
Collapse
|
7
|
Moya Romero JO, Ochoa Máynez GA, Cantero Vergara MA, Gómez Cortes CA. Femtophacovitrectomy. Case series and description of the technique. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:461-468. [PMID: 27230592 DOI: 10.1016/j.oftal.2016.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/12/2016] [Accepted: 03/14/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The aim of this study was to assess the safety and surgical results of combined pars plana vitrectomy and femtosecond laser-assisted cataract surgery (femtophacovitrectomy). MATERIAL AND METHODS A prospective, non-comparative case series was conducted by selecting patients with cataract and vitreoretinal pathology who underwent femtophacovitrectomy by a single surgeon at the Hospital Central Militar between June 2013 and February 2014. An evaluation was made of the preoperative characteristics, surgical indications, results, and postoperative complications, with a minimum follow-up of 3 months. RESULTS The study included 35 eyes of 35 patients, of whom 20 (57.1%) were male. The mean age was 60.76±4.2 years. Diagnoses included vitreous haemorrhage (19 cases), macular hole (6 cases), epiretinal membrane (7), and tractional detachment (5 cases). The mean best corrected visual acuity was 1.3 LogMAR before surgery, and 0.5 LogMAR at 3-months follow-up (P<.05). No patient had visual loss. The intra-operative complication was miosis in 14.28%. In the early postoperative period (<1 month), all had subconjunctival haemorrhage, with moderate corneal oedema in 20% of cases, and only 2.85% (one case) ocular hypertension associated with use of intraocular gas. There were no cases of endophthalmitis. The mean follow-up was 13.3 months (10-16 months). CONCLUSIONS The use of femtosecond laser in phacovitrectomy is a safe and effective alternative, with similar risk of complications in cases of macular pathology, tractional retinal detachment, and/or vitreous haemorrhage.
Collapse
Affiliation(s)
- J O Moya Romero
- Alta Especialidad en Retina y Vítreo, Subsección de Retina, Sección de Oftalmología, Hospital Central Militar, Ciudad de México, México; Alta Especialidad en Córnea y Segmento Anterior, Subsección de Córnea y Segmento Anterior, Sección de Oftalmología, Hospital Central Militar, Ciudad de México, México.
| | - G A Ochoa Máynez
- Subsección de Retina, Sección de Oftalmología, Hospital Central Militar, Ciudad de México, México
| | - M A Cantero Vergara
- Subsección de Córnea y Segmento Anterior, Sección de Oftalmología, Hospital Central Militar, Ciudad de México, México
| | - C A Gómez Cortes
- Alta Especialidad en Retina y Vítreo, Subsección de Retina, Sección de Oftalmología, Hospital Central Militar, Ciudad de México, México; Alta Especialidad en Córnea y Segmento Anterior, Subsección de Córnea y Segmento Anterior, Sección de Oftalmología, Hospital Central Militar, Ciudad de México, México
| |
Collapse
|
8
|
Kelkar A, Kelkar J, Chitale S, Shah R, Jain A, Kelkar S. To assess surgical outcomes of combined femtosecond laser-assisted cataract surgery with 25-gauge vitrectomy surgery at a tertiary eye care center. Indian J Ophthalmol 2016; 64:584-8. [PMID: 27688280 PMCID: PMC5056546 DOI: 10.4103/0301-4738.191501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study was to assess the surgical outcomes of combined femtosecond laser-assisted cataract surgery (FLACS) with 25-gauge vitrectomy surgery. Materials and Methods: A retrospective analysis of 45 patients who underwent combined FLACS with 25-gauge vitrectomy surgery. Results: A total number of 45 eyes of 45 patients were treated with a mean age of 63.27 years (range 45–75). The mean follow-up was 3 months (range 3–12 months). The mean preoperative best-corrected visual acuity was 1.47 ± 0.86. The mean postoperative vision was 0.36 ± 0.36 and 0.275 ± 0.184 at a paired t-test revealed a statistically significant improvement in visual acuity at 1 month (P < 0.001) and 3 months (P < 0.001). The most common indication for surgery was full-thickness macular hole (51.1%), vitreous hemorrhage (24.4%), followed by epiretinal membrane (17.7%) and rhegmatogenous retinal detachment (4.4%). Conclusion: Combining FLACS with vitrectomy may be a step toward achieving better outcomes when combined CS and vitrectomy is performed.
Collapse
Affiliation(s)
- Aditya Kelkar
- Department of Retina, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Jai Kelkar
- Department of Retina, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Sampada Chitale
- Department of Retina, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Rachana Shah
- Department of Retina, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Ashish Jain
- Department of Retina, National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Shreekant Kelkar
- Department of Retina, National Institute of Ophthalmology, Pune, Maharashtra, India
| |
Collapse
|
9
|
Uchida A, Inoue M, Bissen-Miyajima H, Hirakata A. Dynamic changes of optical aberrations during restoration of optical properties of hydrophobic acrylic intraocular lens ejected through cartridge. Br J Ophthalmol 2015; 99:1143-8. [PMID: 25868789 DOI: 10.1136/bjophthalmol-2014-306592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/19/2015] [Indexed: 11/03/2022]
Abstract
AIM To evaluate the effect of temperature on the restoration of the optical properties of hydrophobic acrylic intraocular lenses (IOLs) after ejection through a cartridge into a temperature-controlled water chamber. METHODS Acrylic IOLs (SA60AT; iSert 251; W-60; X-70; and VA-70AD) were loaded into a cartridge with viscoelastic material and ejected into a water chamber at 24°C or 34°C. A wavefront analyser was used to measure the spherical and cylindrical powers, and the higher-order aberrations of the optics of the IOLs. The time to restore the cylindrical power to within 0.1 dioptres of the baseline power was determined. RESULTS Surface irregularities of the IOLs after ejection were detected in the dioptric power maps but not in the higher-order aberration maps. The cylindrical power and the astigmatic and coma aberrations recovered immediately at 34°C but were delayed at 24°C. The restoration time of all IOLs at 24°C was significantly longer than that at 34°C (p<0.05). CONCLUSIONS The dioptric power maps determined by the wavefront analyser can detect and follow the restoration of the optical properties of hydrophobic acrylic IOLs immediately after ejection. The restoration time was dependent on the temperature of the water chamber.
Collapse
Affiliation(s)
- Atsuro Uchida
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Makoto Inoue
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan Department of Ophthalmology, Tokyo Dental College Suidobashi Hospital, Tokyo, Japan
| | | | - Akito Hirakata
- Kyorin Eye Center, Kyorin University School of Medicine, Tokyo, Japan
| |
Collapse
|