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Perone JM, Luc MS, Zevering Y, Vermion JC, Gan G, Goetz C. Narrative review after post-hoc trial analysis of factors that predict corneal endothelial cell loss after phacoemulsification: Tips for improving cataract surgery research. PLoS One 2024; 19:e0298795. [PMID: 38512953 PMCID: PMC10956851 DOI: 10.1371/journal.pone.0298795] [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: 08/09/2023] [Accepted: 01/21/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Identifying pre/perioperative factors that predict corneal endothelial-cell loss (ECL) after phacoemulsification may reveal ways to reduce ECL. Our literature analysis showed that 37 studies have investigated one or several such factors but all have significant limitations. Therefore, the data of a large randomized controlled trial (PERCEPOLIS) were subjected to post-hoc multivariate analysis determining the ability of nine pre/perioperative variables to predict ECL. METHODS PERCEPOLIS was conducted in 2015-2016 to compare two phacoemulsification techniques (subluxation and divide-and-conquer) in terms of 3-month ECL. Non-inferiority between the techniques was found. In the present study, post-hoc univariate and multivariate analyses were conducted to determine associations between ECL and age, sex, cataract density, preoperative endothelial-cell density, phacoemulsification technique, effective phaco time (EPT), and 2-hour central-corneal thickness. The data are presented in the context of a narrative review of the literature. RESULTS Three-month data were available for 275 patients (94% of the randomized cohort; mean age, 74 years; 58% women). Mean LOCSIII cataract grade was 3.2. Mean EPT was 6 seconds. Mean ECL was 13%. Only an older age (beta = 0.2%, p = 0.049) and higher EPT (beta = 1.2%, p = 0.0002) predicted 3-month ECL. Cataract density was significant on univariate (p = 0.04) but not multivariate analysis. The other variables did not associate with ECL. CONCLUSIONS Older age may amplify ECL due to increased endothelial cell fragility. EPT may promote ECL via cataract density-dependent and -independent mechanisms that should be considered in future phacoemulsification research aiming to reduce ECL. Our literature analysis showed that the average ECL for relatively unselected consecutively-sampled cohorts is 12%.
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Affiliation(s)
- Jean-Marc Perone
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Marie-Soline Luc
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Yinka Zevering
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Jean-Charles Vermion
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Grace Gan
- Ophthalmology Department, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
| | - Christophe Goetz
- Clinical Research Support Unit, Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, Grand Est, France
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Heit L, Datar M, Kyriakakos M, Orcutt C, Hsiao C, Pan SM, Shamie N. Comparing the time efficiency of two lasers used in FLACS: real-world observational study. J Cataract Refract Surg 2024; 50:116-121. [PMID: 37748033 PMCID: PMC10805351 DOI: 10.1097/j.jcrs.0000000000001321] [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: 05/25/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE To evaluate time efficiencies in the laser room for 2 different femtosecond laser systems. SETTING 1 private practice in Atlanta, Georgia, and 1 private practice in Los Angeles, California. DESIGN Prospective, observational, single-masked study. METHODS Patients scheduled to receive femtosecond laser-assisted cataract surgery (FLACS) included those who were not pregnant, had no previous eye surgeries, and were not scheduled to undergo additional surgical procedures at the time of treatment; patients who received a standard, monofocal lens without undergoing arcuate incisions were excluded. Patients taking Flomax or any tamsulosin were also excluded from the study. Each comparable step in the LenSx and CATALYS workflow was identified and clearly defined. Time for each step was evaluated and compared using t tests and regression analyses to control for patient and site-specific differences between the 2 groups. RESULTS Time data were collected for 89 patients (89 eyes). The overall procedure was 2.86 minutes shorter for the LenSx system when compared with the CATALYS system ( P < .05). Per patient, the LenSx system had significantly shorter time for patient positioning (57.26 vs 122.00 seconds; P < .05), imaging (33.23 vs 42.17 seconds; P < .05), laser treatment (21.57 vs 39.67 seconds; P < .05), and undocking/transition (67.13 vs 185.30 seconds; P < .05) compared with the CATALYS system. Regression analyses yielded similar results, with the LenSx system being over 35% (3.21 minutes; P < .05) shorter overall than the CATALYS system controlling for location, age, sex, lens thickness, cataract grade, fragmentation pattern, and arcuate incisions. CONCLUSIONS LenSx procedures were significantly shorter than the CATALYS procedures overall, which can enable ophthalmology practices to increase efficiency.
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Affiliation(s)
- Larry Heit
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Manasi Datar
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Maria Kyriakakos
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Cecelia Orcutt
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Carine Hsiao
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Sun-Ming Pan
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
| | - Neda Shamie
- From the Thomas Eye Group, Atlanta, Georgia (Heit); Boston Healthcare Associates (a Veranex company), Boston, Massachusetts (Datar, Kyriakakos, Orcutt); Alcon Laboratories, Inc., Fort Worth, Texas (Hsiao, Pan); Maloney-Shamie Vision Institute, Los Angeles, California (Shamie)
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Pichardo-Loera NS, Corredor-Ortega C, Castro-Monreal MA, Massaro-Corredor MG, Pérez-Vázquez JF, Gonzalez-Salinas R. Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: A meta-analysis of randomized controlled trials. Eur J Ophthalmol 2024:11206721241229129. [PMID: 38291620 DOI: 10.1177/11206721241229129] [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: 02/01/2024]
Abstract
PURPOSE The main purpose of our study is to compare the adverse events occurrence, complications, and postoperative outcomes of Femtosecond Laser-Assisted Cataract Surgery (FLACS) versus conventional phacoemulsification surgery (CPS) in adult patients undergoing cataract surgery. METHODS We conducted our research using PubMed, Scopus, and MEDLINE through EBSCOhost from 2012 to July 2022 with English and Spanish language restriction, including only Randomized Controlled Trials (RCTs). The PRISMA guidelines were observed for data abstraction, including a random-effects model for each outcome. RESULTS We analyzed 4844 eyes from 23 RCTs with some low risk of bias according to RoB 2 tool. We found statistically significant differences between the FLACS and CPS groups for the mean absolute error (MD = -0.12, 95% CI:-0.22-[-0.02], p = 0.01), the circularity of capsulorhexis (MD = 0.04, 95% CI: 0.04-0.05, p ≤ 0.00001), IOL centration (D = -0.07, 95% CI:-0.09-[-0.05], p ≤ 0.00001), CDE count (MD = -1.75, 95% CI: -2.75-[-0.74], p = 0.0006), mean phacoemulsification time (MD = -12.90, 95% CI:-20.89-[-4.92], p = 0.002), EPT (MD = -0.93, 95% CI: -1.68-[-0.019], p = 0.01) and endothelial cell density loss ((MD = -0.6, 95% CI: -1-[-0.19], p = 0.004). Also, the safety analysis showed a lower incidence of posterior capsule tear (PCT) in the FLACS group (OR =0.29, 95% CI: 0.09-1, p = 0.05). CONCLUSIONS Our results suggest that FLACS might be helpful for patients with relatively dense cataracts and low preoperative endothelial cell values.
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Affiliation(s)
| | - Claudia Corredor-Ortega
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
| | | | | | | | - Roberto Gonzalez-Salinas
- Anterior Segment Department, Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico
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Cruz JCG, Moreno CB, Soares PVBDS, Moscovici BK, Colombo-Barboza GN, Colombo-Barboza LR, Colombo-Barboza MN. Comparison of endothelial cell loss in diabetic patients after conventional phacoemulsification and femtosecond laser-assisted cataract surgery. BMC Ophthalmol 2023; 23:181. [PMID: 37101284 PMCID: PMC10131353 DOI: 10.1186/s12886-023-02923-3] [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: 11/04/2022] [Accepted: 04/14/2023] [Indexed: 04/28/2023] Open
Abstract
PURPOSE This study aims to comparatively evaluate the morphological changes of the cornea after phacoemulsification (PHACO) and femtosecond laser-assisted cataract surgery (FLACS) without intercurrences in patients with type 2 diabetes mellitus. METHODS A total of 95 diabetic patients with moderate cataracts (N2 + and N3+), 47 undergoing PHACO and 48 undergoing FLACS, were selected randomly for the study. Surgeries were performed by a single surgeon between July 2021 and December 2021. Cumulative dissipated energy (CDE) and total balanced saline solution (BSS) data were obtained at the end of each surgery. Changes in corneal endothelial cell density (ECD) and central corneal thickness (CCT) at three months postoperatively were investigated. RESULTS After three months, evidence is lacking between groups in the CCT measures; the difference was neither statistically nor clinically relevant. However, for ECD, a significant and clinically significant difference was found; if all patients were treated with laser, the mean ECD would be 423.55 greater (RSE: 86.09; p-value < 0.001; 95% CI: 254.81-592.29) than the ECD potential means of 1656.423 among the conventional group (RSE: 74.90; p-value < 0.001; 95% CI: 1509.62-1803.23). CONCLUSIONS Diabetic patients under treatment with moderate cataracts may predispose themselves to a more significant loss of endothelial cells after conventional phacoemulsification than femtosecond laser-assisted cataract surgery. TRIAL REGISTRATION It was registered at The Brazilian Registry of Clinical Trials (ReBEC) with the code RBR-6d8whb5 (UTN code: U1111-1277-6020) on 17/05/2022.
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Affiliation(s)
- João Carlos Gonçalves Cruz
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil.
| | - Celso Busnelo Moreno
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
| | | | - Bernardo Kaplan Moscovici
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Guilherme Novoa Colombo-Barboza
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
- Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Luiz Roberto Colombo-Barboza
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
- Faculdade de Ciências Médicas de Santos (UNILUS), Santos, Brazil
| | - Marcello Novoa Colombo-Barboza
- Hospital Oftalmológico Visão Laser, Avenida Conselheiro Nébias, 355, Santos, São Paulo, 11015-003, Brazil
- Department of Ophthalmology and Visual Sciences, Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, Brazil
- Faculdade de Ciências Médicas de Santos (UNILUS), Santos, Brazil
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Wang H, Chen X, Xu J, Yao K. Comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification on corneal impact: A meta-analysis and systematic review. PLoS One 2023; 18:e0284181. [PMID: 37058458 PMCID: PMC10104330 DOI: 10.1371/journal.pone.0284181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/26/2023] [Indexed: 04/15/2023] Open
Abstract
This meta-analysis aims to compare corneal injuries and function after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS). A comprehensive literature search of PubMed, EMBASE, and the Cochrane Controlled Trials Register was conducted to identify randomized controlled trials (RCT) and high-quality prospective comparative cohort studies comparing FLACS with CPS. Endothelial cell loss percentage (ECL%), central corneal thickness (CCT), endothelial cell density (ECD), endothelial cell loss (ECL), percentage of the hexagonal cell (6A), and coefficient of variance (CoV) were used as an indicator of corneal injury and function. Totally 42 trials (23 RCTs and 19 prospective cohort studies), including 3916 eyes, underwent FLACS, and a total of 3736 eyes underwent CPS. ECL% is significantly lower in the FLACS group at 1-3 days (P = 0.005), 1 week (P = 0.004), 1 month (P<0.0001), 3 months (P = 0.001), and 6 months (P = 0.004) after surgery compared to CPS. ECD and ECL appeared no statistically significant difference between the two groups, except for the significant reduction of ECD at 3 months in the CPS group (P = 0.002). CCT was significantly lower in the FLACS group at 1 week (P = 0.05) and 1 month (P = 0.002) early postoperatively. While at 1-3 days (P = 0.50), 3 months (P = 0.18), and 6 months (P = 0.11), there was no difference between the FLACS group and the CPS group. No significant difference was found in the percentage of hexagonal cells and the coefficient of variance. FLACS, compared with CPS, reduces corneal injury in the early postoperative period. Corneal edema recovered faster in the FLACS group in the early postoperative period. In addition, FLACS may be a better option for patients with corneal dysfunction.
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Affiliation(s)
- Hanle Wang
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Xinyi Chen
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Jingjie Xu
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
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Tao J, Wan Y, Song X. Comparison of the reverse chopper-assisted prechop and phaco-chop nucleotomy techniques during phacoemulsification for cataracts with grade III nuclei: a randomized controlled trial. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:105. [PMID: 36819536 PMCID: PMC9929748 DOI: 10.21037/atm-22-6163] [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: 10/21/2022] [Accepted: 01/10/2023] [Indexed: 01/31/2023]
Abstract
Background Phacoemulsification surgery is the standard treatment for cataract. However, excessive ultrasound (US) energy may cause injury to the corneal endothelium and other ocular tissues. Recently, a new prechop technique assisted with the reverse chopper is showed to be more efficient and safe, by splitting the nuclei in situ without using any US energy. However, it is verified only in treating some kinds of complex cataracts such as grade IV hard nuclei cataract, small-pupil cataract, and ultra-high myopia cataract. Since grade III nuclei cataract is the most common type of cataract, it is necessary to evaluate the efficacy and safety of prechop technique with reverse chopper in routine cataract surgery. Methods This prospective, two-parallel, randomized controlled trial was conducted in Beijing Tongren Hospital from January 2022 to September 2022. A total of 89 cataract patients (89 eyes) were enrolled and then randomly assigned to either the reverse chopper-assisted prechop group (n=45) or the phaco-chop group (n=44). The patients were followed for 3 months postoperatively. The best-corrected visual acuity (BCVA), cumulative dissipated energy (CDE), corneal endothelial cell loss (ECL), and degree of corneal edema were evaluated and compared between these 2 groups. Data were analyzed using SPSS 23.0 and GraphPad Prism 8.0. Results The CDE of the reverse chopper-assisted prechop group was significantly less than that of the phaco-chop group (P=0.011). Compared with the phaco-chop group, the corneal edema in the reverse chopper-assisted prechop group was milder (P=0.026) and the BCVA was better (P=0.0012) at 1 day after surgery. No significant difference was found in the count or rate of corneal ECL between the 2 groups at 1 month after surgery (corneal ECL count: P=0.090; corneal ECL rate: P=0.053). The BCVA of the 2 groups at 1 week, 1 month, and 3 months after surgery was equivalent (P=0.052, 0.26, and 0.41, respectively). Conclusions The prechop technique assisted with the reverse chopper in treating cataract with grade III nuclei enables less phaco energy consumption, milder ocular structural damage, and faster recovery of vision, compared with traditional phaco-chop technique.
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Affiliation(s)
- Jing Tao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Yu Wan
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Xudong Song
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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Jin EY, Chen DZ. Comparison of complication rates between femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery. Int J Ophthalmol 2023; 16:156-158. [PMID: 36659940 PMCID: PMC9815983 DOI: 10.18240/ijo.2023.01.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/26/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Eric Y Jin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - David Z Chen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore,Department of Ophthalmology, National University Hospital, Singapore 119074, Singapore
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Management of inflammation after the cataract surgery. Curr Opin Ophthalmol 2023; 34:9-20. [PMID: 36305352 DOI: 10.1097/icu.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To review most recent studies and clinical trials regarding pathogenesis, treatment, and prevention of inflammation after the cataract surgery. RECENT FINDINGS FLACS gave opportunity to evaluate inflammatory cytokines in the aqueous humour right after the laser procedure, which led to acknowledging the inflammation pathogenesis during the phacoemulsification. Although there is still a lack of evidence, which would prove the long-term benefit of NSAIDs, they are indicated and effective when risk factors for PCME are present. PREMED studies showed that combination of NSAID and steroids after the surgery for healthy subjects is cost-effective. The triamcinolone injection together with topical steroids and NSAIDs for diabetic patients after the cataract surgery was the most cost-effective in preventing PCME according to the PREMED. Dropless cataract surgery is another emerging topic: dexamethasone implants and suspensions look promising as we await more clinical trials with drug-loaded IOLs. SUMMARY Inflammation after the cataract surgery can be prevented, and these methods are one of the most essential topics with growing phacoemulsification rate. Topical NSAIDs are cost-effective not only for patients with risk factors for PCME but also for healthy subjects. New dropless techniques are being successfully introduced in the clinical practice.
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Chen W, Chen H, Mi L, Li J, Lin H, Chen W. Subfoveal Choroidal Thickness After Femtosecond Laser-Assisted Cataract Surgery for Age-Related Cataracts. Front Med (Lausanne) 2022; 9:826042. [PMID: 35860729 PMCID: PMC9289166 DOI: 10.3389/fmed.2022.826042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/15/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare the effects of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS) on subfoveal choroidal thickness (SFCT) in patients with age-related cataracts. Methods In this prospective consecutive study, 26 patients (26 eyes) with age-related cataracts without previous ocular surgery or other ocular diseases who had FLACS were included as the study group. Twenty-six age-matched patients (26 eyes) who underwent CPS in the same period were also included as the control group. The SFCT and the foveal retinal thickness (FRT) were measured at baseline and at 1 day (D1), 7 days (D7), 1 month (M1), and 3 months (M3) postoperatively by spectral-domain optical coherence tomography. Aqueous flare was also measured with a laser flare meter. Results The mean SFCTs of the FLACS group at baseline and at D1, D7, M1, and M3 were 185.2, 174.3, 184.2, 180.8, and 184.1 μm, respectively. A Bonferroni posttest showed that the choroid became thinner on postoperative D1 (P = 0.006). The measurements at 1 week, 1 month, and 3 months postoperatively showed no significant differences in the SFCTs compared with that at baseline (P = 0.66, P = 0.22, and P = 0.53, respectively). A different trend was observed in the CPS group. The choroid became thicker by the 3-month postoperative measurement, as follows: 1 day (P = 0.28), 1 week (P = 0.016), 1 month (P = 0.020), and 3 months (P < 0.001). Conclusion The mean SFCT significantly and temporarily decreased following FLACS. In contrast, an increased SFCT was observed following CPS.
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Affiliation(s)
- Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Hui Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Lan Mi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
- Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Haotian Lin,
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, China
- Weirong Chen,
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Abstract
PURPOSE OF REVIEW Modern phacoemulsification machines apply ultrasound through a variety of settings and parameters to remove a cataract. Using these new technologies efficiently is critical for both reducing surgical times and improving postoperative outcomes. The present article reviews recent findings in phacodynamics to explore the optimum use of ultrasound in cataract surgery. RECENT FINDINGS In studies seeking to determine the optimum parameters in both fluidics and power, increased power and aspiration does not necessarily equate to more efficiency. New developments, such as torsional ultrasound, micropulse, and burst mode have shown increased efficiency in randomized control trials and in-vitro compared with conventional ultrasound. Regarding vacuums, the venturi pump has demonstrated greater efficiency compared with the peristaltic pump. We also explore other parameters, such as chamber pressure and tip selection. Meta-analyses on femtosecond-laser assisted cataract surgery (FLACS) have shown similar long-term visual outcomes compared to conventional cataract surgery. SUMMARY Though conventional cataract surgery remains highly effective, surgeons have increasing options for customizing their ultrasound settings and phacoemulsification techniques.
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Abbas AA, Bu JJ, Chung J, Afshari NA. Recent developments in anterior capsulotomy for cataract surgery. Curr Opin Ophthalmol 2022; 33:47-52. [PMID: 34854828 DOI: 10.1097/icu.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Successful anterior capsulotomy is an important step in cataract surgery. This article reviews the various anterior capsulotomy techniques available to surgeons to optimize the step, including those that have become available since the introduction of femtosecond-laser-assisted cataract surgery (FLACS). Studies comparing the relative advantages of each technique will be emphasized. RECENT FINDINGS Manual continuous curvilinear capsulorhexis (CCC) and FLACS remain the two most widely studied techniques for achieving anterior capsulotomy. Each technique has been shown to be effective for a wide range of patients and cataract surgery complications. Meta-analyses have shown that FLACS provides similar results to manual CCC for long-term cataract surgery outcomes. Several alternative methods for anterior capsulotomy have been described, which aim to provide some of the advantages of laser capsulotomy at a lower cost; among these, precision pulse capsulotomy (PPC) and selective laser capsulotomy (SLC) have been investigated the most in the literature so far. SUMMARY Cataract surgeons have an increasing number of techniques for anterior capsulotomy available. Manual CCC and FLACS remain the most widely used, and most well studied. The latest techniques, PPC and SLC, have shown promise in the few studies performed since they were introduced.
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Affiliation(s)
- Anser A Abbas
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jennifer J Bu
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
| | - Jinkwon Chung
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
- Department of Ophthalmology, Soonchunhyang University College of Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Natalie A Afshari
- Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, California, USA
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