[Results of femtosecond laser-assisted cataract surgery using the new 2.16 software and the SoftFit® Patient Interface]

Lens capsule-related complications in femtosecond laser-assisted cataract surgery: a study based on video analysis

PURPOSE

To analyse the occurrence and potential causes of lens capsule-related complications during femtosecond laser-assisted cataract surgery (FLACS).

METHODS

This prospective consecutive cohort study included the first 1600 eyes (from 1140 consecutive patients) who received FLACS performed by the same surgeon from May 2015 to December 2018. The potential causes and characteristic signs of capsulotomy-related complications, including incomplete capsulotomies and radial anterior capsule (AC) tears, were summarised based on the agreement of two ophthalmologists after they analysed the surgical videos. Subgroup analysis was conducted to characterise the capsulotomy learning curve.

RESULTS

Of the 1600 eyes, 52 (3.25%) had incomplete capsulotomies and 22 (1.38%) had radial AC tears. The most common causes of incomplete capsulotomies were eye tilt (16 eyes, 30.77%), air bubbles or ocular secretions at the interface (14 eyes, 26.92%) and white cataracts (7 eyes, 13.46%). Additionally, 54.55% (12/22) of AC tears were due to incomplete capsulotomy and secondary capsulorhexis. A significant difference was noted between the first 200 eyes and subsequent groups in terms of the incidence of incomplete capsulotomies. No difference was observed in the incidence of AC tears after the initial 100 procedures.

CONCLUSION

The most common causes of incomplete capsulotomies were eye tilt and air bubbles or ocular secretions at the interface. Secondary capsulorhexis after incomplete capsulotomy is the main risk factor for AC tears. There was a steep learning curve for laser capsulotomy in the first 100 operated eyes, as evidenced by the higher complication rate, but this stabilised after 200 procedures.

Femtosecond laser cataract surgery

Femtosecond laser (FSL) cataract surgery is in its infancy but is rapidly gaining popularity due to the improved consistency and predictability for corneal incisions and anterior capsulorhexis. It enables subsequently less phacoemulsification energy and time to be employed, which has gains in terms of reduced corneal oedema. In addition, the FSL allows better circularity of the anterior capsulotomy, capsule overlap, intraocular lens (IOL) placement and centration of the IOL. These advantages have resulted in improved visual and refractive outcomes in the short term. Complication rates are low which reduce with surgeon experience. This review article focuses on the Alcon LenSx system.

Laser-Assisted Cataract Surgery: Soft Lens Assisted Interface (SoftFit) versus Direct Contact Interface

Purpose

To determine the safety of the Laser SoftFit™ patient interface by comparing intraoperative results with the contact interface of the LenSx® femtosecond laser platform (FSL).

Methods

In this nonrandomized, consecutive case series, 50 eyes underwent femtosecond laser-assisted cataract surgery (FLACS) using the LenSx® laser platform (group 1); FLACS was performed in another 50 eyes, using the Laser SoftFit™ patient interface (group 2). Intraoperative complications (corneal folds) and surgical results (incomplete and free capsulotomies, incomplete phacofragmentation, and unopened incisions) were compared.

Results

Corneal folds and incomplete capsulotomies were less common (p = 0.0001 for both) and free-floating capsulotomies were more frequent (p = 0.0001) with the Laser SoftFit™ patient interface. Incomplete phacofragmentation and unopened incision exhibited similar rates in both groups (p = 0.436 and 0.204, respectively).

Conclusions

Using the Laser SoftFit™ patient interface decreased the incidence of corneal folds, resulting in better capsulotomy outcomes during FLACS.