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Cioana M, Patodia Y, Tong L, Chiu HH, Tam ES, Somani S. Anterior chamber cytokine production and postoperative macular edema in patients with diabetes undergoing FLACS. J Cataract Refract Surg 2024; 50:160-166. [PMID: 37847109 DOI: 10.1097/j.jcrs.0000000000001335] [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: 08/01/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery (MCS) on proinflammatory cytokine expression in patients with diabetes vs nondiabetic patients. SETTING Outpatient surgical center in Vaughan, Ontario, Canada. DESIGN Prospective cohort study. METHODS Patients with diabetes and nondiabetic patients undergoing noncomplicated MCS or FLACS were assigned into 4 cohorts: MCS nondiabetic (n = 30), FLACS nondiabetic (n = 42), MCS diabetic (n = 40), and FLACS diabetic (n = 40). Aqueous humor inflammatory mediator concentrations were evaluated at MCS onset and after femtosecond laser treatment. The presence of cystoid macular edema, anterior chamber (AC) inflammation, central retinal thickness, macular volume, and retinal microvascular changes (through optical coherence tomography angiography) were evaluated preoperatively and on postoperative day 1, week 1, month 1 (POM1), and month 3 (POM3). RESULTS Patients with diabetes receiving FLACS had a higher concentration of interleukin (IL)-7, IL-13, and interferon-induced protein-10 than MCS diabetic patients; they also demonstrated higher levels of vascular endothelial growth factor and lower levels of interferon (IFN)-γ, granulocyte colony-stimulating factor, and IFN-α2 compared with MCS nondiabetic patients. Macular volume appeared to be significantly higher in MCS diabetic vs MCS non-diabetic patients at POM1 and between FLACS diabetic vs FLACS nondiabetic patients at POM3. There were no other significant differences between the cohorts for any parameter. CONCLUSIONS FLACS use in patients with diabetes demonstrated some differences in AC cytokine expression compared with non-diabetic FLACS or diabetic patients undergoing MCS; however, there was no increase in clinical inflammatory biomarkers. FLACS seems to be a safe technique to use in patients with diabetes.
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Affiliation(s)
- Milena Cioana
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (Cioana); Uptown Eye Specialists, Vaughan, Ontario, Canada (Cioana, Tong, Chiu, Tam, Somani); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Patodia, Tong, Chiu, Tam, Somani); William Osler Health System, Brampton, Ontario, Canada (Tong, Chiu, Tam, Somani); Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada (Chiu)
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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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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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Kecik M, Schweitzer C. Femtosecond laser-assisted cataract surgery: Update and perspectives. Front Med (Lausanne) 2023; 10:1131314. [PMID: 36936227 PMCID: PMC10017866 DOI: 10.3389/fmed.2023.1131314] [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: 12/24/2022] [Accepted: 02/07/2023] [Indexed: 03/06/2023] Open
Abstract
Cataract surgery is among the most frequently performed surgical procedures worldwide and has a tremendous impact on patients' quality of life. Phacoemulsification (PCS) is accepted as a standard of care; its technique has continuously evolved and already achieved good anatomical, visual, and refractive outcomes. Lasers in ophthalmology are widely used in clinical practice, femtosecond lasers (FSLs) for corneal surgery in particular. It was natural to assess the usefulness of FSL in cataract surgery as this technology was within reach. Indeed, precise and reproducible cuttings provided by FSL platforms could improve standardization of care and limit the risk associated with the human element in surgery and provide a step toward robot-assisted surgery. After docking and planning the procedure, femtosecond lasers are used to perform corneal incisions, capsulorhexis, lens fragmentation, and arcuate incisions in an automated manner. A well-constructed corneal incision is primordial as it offers safety during the procedure, self-seals afterward, and influences the refractive outcome. Capsulorhexis size, centration, and resistance to shearing influence the surgery, intraocular lens (IOL) centration and stability, and posterior capsular opacification formation. Lens fragmentation is where most of the energy is delivered into the eye, and its amount influences endothelial cell damage and potential damage to other ocular structures. The arcuate incisions offer an additional opportunity to influence postoperative astigmatism. Femtosecond laser-assisted cataract surgery (FLACS) has been a topic of research in many studies and clinical trials that attempted to assess its potential benefits and cost-effectiveness over PCS and is the subject of this mini-review.
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Affiliation(s)
- Mateusz Kecik
- Department of Ophthalmology, Hopitaux Universitaires de Genève (HUG), Genève, Switzerland
| | - Cedric Schweitzer
- Department of Ophthalmology, CHU Bordeaux, Bordeaux, France
- INSERM, Bordeaux Population Health Research Center, Team LEHA, UMR 1219, Univ. Bordeaux, Bordeaux, France
- *Correspondence: Cedric Schweitzer
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Stewart S, Liu YC, Setiawan M, Lin MTY, Lee IXY, Sim N, Htoon HM, Ong HS, Mehta JS. The Effects of High Energy Capsulotomy on Aqueous Cytokine Profiles and Pupil Size During Femtosecond Laser-Assisted Cataract Surgery. J Refract Surg 2022; 38:587-594. [PMID: 36098390 DOI: 10.3928/1081597x-20220808-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess whether aqueous cytokine profiles and pupil size are altered when high capsulotomy energy is used in eyes undergoing femtosecond laser-assisted cataract surgery (FLACS), and if preoperative use of a topical non-steroidal anti-inflammatory drug (NSAID) has an effect on this. METHODS This prospective study recruited 83 eyes (63 patients) that were allocated to four treatment groups: conventional phacoemulsification (n = 20 eyes); FLACS with 90% capsulotomy energy without NSAID pretreatment (n = 20 eyes); FLACS with 90% capsulotomy energy with NSAID pre-treatment (n = 21 eyes); and FLACS with 150% capsulotomy energy with NSAID pretreatment (n = 22 eyes). Aqueous humor was collected before and after phacoemulsification to assess cytokine profiles. Pupil size was measured before and after laser capsulotomy. RESULTS FLACS increased aqueous concentrations of pros-taglandin E2 (PGE2), interferon γ (IFN-γ), and interleukin 6 (IL-6) compared to conventional phacoemulsification. However, when increasing capsulotomy energy from 90% to 150% (with topical NSAID pretreatment), there was no significant increase in aqueous concentrations of PGE2 (37.7 ± 21.7 vs 33.6 ± 27.6 pg/mL, P = .99), IFN-γ (3.6 ± 1.1 vs 3.6 ± 0.8 pg/mL, P = .99), or IL-6 (7.1 ± 2.9 vs 6.3 ± 2.4 pg/mL, P = .99). For 90% and 150% capsulotomy energy, there was significant miosis following laser capsulotomy. Increased PGE2 concentration was significantly correlated with a reduction in pupil area (r = -0.58, P < .001) and pupil diameter (r = -0.57, P < .001). However, when a topical NSAID was given preoperatively, there was no difference in the degree of miosis between the 90% and 150% capsulotomy energy groups. CONCLUSIONS Pretreatment with a topical NSAID prevented a rise in PGE2, IFN-γ, and IL-6 levels and excessive miosis when a higher capsulotomy energy was used. When a topical NSAID is used preoperatively, it is safe to use higher capsulotomy energy settings (with a low pulse energy femtosecond laser system) to achieve a satisfactory capsulotomy. [J Refract Surg. 2022;38(9):587-594.].
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Liu YC, Setiawan M, Chin JY, Wu B, Ong HS, Lamoureux E, Mehta JS. Randomized Controlled Trial Comparing 1-Year Outcomes of Low-Energy Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification. Front Med (Lausanne) 2022; 8:811093. [PMID: 34977102 PMCID: PMC8718704 DOI: 10.3389/fmed.2021.811093] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/30/2021] [Indexed: 01/11/2023] Open
Abstract
Purpose: To compare 1-year clinical outcomes, phacoemulsification energy, aqueous profiles, and patient-reported outcomes of low-energy femtosecond laser-assisted cataract surgery (FLACS) vs. conventional phacoemulsification. Methods: The study is a randomized controlled trial (RCT) with paired-eye design. Eighty-five patients were randomized to receive FLACS (Ziemer LDV Z8) in one eye and conventional phacoemulsification in the fellow eye. Clinical data including phacoemulsification energy parameters (cumulative dissipated energy, phacoemulsification power, and phacoemulsification time), uncorrected and corrected distance visual acuities (UCDVA and BCDVA), manifest refraction spherical equivalent (MRSE), central corneal thickness (CCT), endothelial cell count (ECC), anterior chamber flare, and post-operative complications were obtained for 1 year. Aqueous humor was collected for the analysis of prostaglandin (PGE)2, cytokines and chemokines concentrations. Patients' reported-outcomes on surgical experiences were evaluated using an in-house questionnaire. Results: Compared to conventional phacoemulsification, the low-energy assisted FLACS group had significantly less ECC reduction at 3 months (1.5 ± 0.3% vs. 7.0 ± 2.4%; P < 0.01) and 1 year (8.2 ± 2.8% vs. 11.2 ± 3.6%; P = 0.03). There were no significant differences in the phacoemulsification energy parameters, UCDVA, BCDVA, MRSE, CCT, occurrence of post-operative complications between the 2 groups throughout post-operative 1 year. Patients' subjective surgical experiences, including the surgical duration and perceived inconvenience, were comparable between the 2 groups. FLACS resulted in significantly higher aqueous PGE2 (P < 0.01), interleukin (IL)-6 (P = 0.03), IL-8 (P = 0.03), and interferon (IFN)-γ (P = 0.04) concentrations and greater anterior chamber flare at 1 day (P = 0.02). Conclusions: Our RCT presented 1-year longitudinal clinical and laboratory data. The long-term ECC result was more favorable in low-energy FLACS. The rest of the intraoperative and post-operative outcomes, as well as patient-reported outcomes, were comparable between these two procedures.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Melina Setiawan
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Jia Ying Chin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Benjamin Wu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Hon Shing Ong
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Population Health Group, Singapore Eye Research Institute, Singapore, Singapore.,Health Services and System Research Department, Population Health Research, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore, Singapore.,Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke- National University of Singapore (NUS) Medical School, Singapore, Singapore
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Taubenslag KJ, Kim SJ, Grzybowski A. Anti-inflammatory Pharmacotherapy for the Prevention of Cystoid Macular Edema After Cataract Surgery. Am J Ophthalmol 2021; 232:1-8. [PMID: 34157275 DOI: 10.1016/j.ajo.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE To elucidate strategies for and controversies surrounding the use of anti-inflammatory medications after uneventful cataract surgery, with a focus on the prevention of irreversible vision loss due to cystoid macular edema (CME). DESIGN Perspective. METHODS Expert commentary on the management of inflammation after cataract surgery. Discussion includes combination therapy with corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), dosing strategies, and emerging therapies. RESULTS While prescribing both NSAIDs and corticosteroids for cataract surgery is common, these classes have overlapping mechanisms. Combination therapy may speed visual recovery, but there remains little evidence for improved long-term visual outcomes from NSAIDs. The last 2 decades have seen increasing data on potential benefits of pretreatment with NSAIDs 1-3 days prior to cataract surgery. Simultaneously, newly approved "dropless" delivery systems hold promise, and clinical trials are ongoing to assess outcomes of such formulations. CONCLUSIONS Optimal pharmacologic treatment for inflammation after cataract surgery remains controversial. A consensus definition for clinically significant CME may facilitate the comparison of anti-inflammatory drugs. And there remains a need for well-designed trials examining both topical and extended-release drug-delivery systems to refine the treatment paradigm.
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Lee JH, Chung HS, Moon SY, Yoon J, Lee K, Lee H, Kim JY, Lim HT, Tchah H. Effect of preoperative eyedrops on cytokine concentrations in aqueous humor of patients undergoing femtosecond laser-assisted cataract surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:885-891. [PMID: 34625847 DOI: 10.1007/s00417-021-05428-1] [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: 02/04/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare the anti-inflammatory activity of preoperatively applied eyedrops, as determined by cytokine concentrations in aqueous humor collected during surgery in patients undergoing femtosecond laser-assisted cataract surgery. METHODS A total of 120 patients undergoing femtosecond laser-assisted cataract surgery were randomly assigned to four groups of 30 patients each. Groups were administered 0.1% fluorometholone eyedrops, 0.45% ketorolac tromethamine eyedrops, both 0.1% fluorometholone and 0.45% ketorolac tromethamine eyedrops, or no eyedrops. Eyedrops were instilled 1 h, 20 min, and just before surgery. After anterior capsulotomy and nuclear fragmentation using a femtosecond laser, 0.1 cc aqueous humor was obtained using a needle and syringe. Cytokine and prostaglandin E2 (PGE2) concentrations were quantitatively determined. RESULTS The 120 patients included 59 men and 61 women, of mean age 65.02 years. The mean interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) concentrations after treatment did not differ significantly in the four groups. The average interleukin-8 (IL-8) concentrations were significantly lower in the fluorometholone (4.80 pg/mL), ketorolac tromethamine (4.84 pg/mL), and fluorometholone + ketorolac tromethamine (4.68 pg/mL) groups than in the control group (6.83 pg/mL). Furthermore, the average PGE2 concentrations were significantly lower in the ketorolac tromethamine (270.04 pg/mL) and fluorometholone + ketorolac tromethamine (239.00 pg/mL) groups, but not in the fluorometholone (393.16 pg/mL) group, than in the control group (472.36 pg/mL). CONCLUSION Preoperative fluorometholone instillation reduced IL-8, and ketorolac tromethamine instillation reduced IL-8 and PGE2, in aqueous humor of patients undergoing femtosecond laser surgery, with the combination of both eyedrops being more effective than either alone. TRIAL REGISTRATION KCT0005717.
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Affiliation(s)
- Jae Hyuck Lee
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Republic of Korea.,Department of Ophthalmology, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea
| | - Ho Seok Chung
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Su Young Moon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jooyoung Yoon
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Koeun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hun Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Jae Yong Kim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea
| | - Hungwon Tchah
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Krarup T, Rose K, Mensah AMLA, la Cour M, Holm LM. Comparing corneal outcome between femtosecond laser-assisted cataract surgery and conventional phaco surgery in Fuchs' endothelial dystrophy patients: a randomized pilot study with 6mo follow up. Int J Ophthalmol 2021; 14:684-692. [PMID: 34012882 DOI: 10.18240/ijo.2021.05.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the corneal outcome in Fuchs' endothelial dystrophy (FED) patients between femtosecond laser-assisted cataract surgery (FLACS) and conventional phaco surgery (CPS). METHODS This was a randomized controlled study comparing one eye surgery by FLACS and the contralateral eye operated by CPS (stop and chop technique) in FED patients. Central corneal thickness, corneal light backscatter, corneal densitometry, and central corneal endothelial cell count and hexagonality (noncontact endothelial cell microscope), and corrected distance visual acuity (CDVA) were assessed preoperatively and at day 1, 40, and 180 postoperatively. RESULTS Totally 31 patients (16 women) were included. At day 40 postoperatively, the mean endothelial cell loss (ECL) was 23.67% by FLACS and 17.30% by CPS (P=0.53). At day 180 postoperatively, ECL was 25.58% in FLACS and 21.32% in CPS (P=0.69). Densitometry data in all layers and all annuli from anterior layer to posterior layer in annuli 0-2, 2-6, 6-10 and 10-12, total densitometry with all layers and all annuli was performed. A significant difference was found in 6-10 (posterior layer) at day 1 with -1.42 grayscale units (GSU; 95%CI: -2.66 to -0.19, P=0.02). In 10-12 (anterior layer, central layer and all layers) at day 40 were significant different with 7.7 (95%CI: 1.89 to 13.50, P=0.009), 3.97 (95%CI: 0.23 to 7.71, P=0.03), 4.73 GSU (95%CI: 0.71 to 8.75, P=0.02), respectively. In the remaining parameters we found no difference between the two groups (P>0.05). Three CPS eyes suffered from corneal decompensation. CONCLUSION There is no significant difference in corneal outcome between FLACS and CPS. Endothelial cell density and pentacam corneal outcome may be inadequate as outcome parameters in FED patients.
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Affiliation(s)
- Therese Krarup
- Department of Ophthalmology, Rigshospitalet-Glostrup Valdemar Hansens Vej 1-23, Glostrup 2600, Denmark
| | - Kathrine Rose
- Department of Ophthalmology, Rigshospitalet-Glostrup Valdemar Hansens Vej 1-23, Glostrup 2600, Denmark
| | | | - Morten la Cour
- Department of Ophthalmology, Rigshospitalet-Glostrup Valdemar Hansens Vej 1-23, Glostrup 2600, Denmark
| | - Lars Morten Holm
- Department of Ophthalmology, Rigshospitalet-Glostrup Valdemar Hansens Vej 1-23, Glostrup 2600, Denmark
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Mirshahi A, Schneider A, Latz C, Ponto KA. Perioperative pupil size in low-energy femtosecond laser-assisted cataract surgery. PLoS One 2021; 16:e0251549. [PMID: 33999970 PMCID: PMC8128224 DOI: 10.1371/journal.pone.0251549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/28/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess potential changes in pupil size during femtosecond laser-assisted cataract surgery (FLACS) using a low-energy laser system. METHODS The pupil sizes of eyes undergoing FLACS were measured using the Ziemer LDV Z8 by extracting images from the laser software after each of the following steps: application of suction, lens fragmentation, and capsulotomy. Furthermore, the pupil diameters were measured based on preoperative surgical microscope images and after releasing the suction. Paired t-test and the two one-sided tests (TOST) procedure were used for statistical analyses. The horizontal and vertical pupil diameters were compared in each of the steps with preoperative values. RESULTS Data were available for 52 eyes (52 patients, mean age 73.4 years, range 51-87 years). The equivalence between mean preoperative pupil size and status immediately after femtosecond laser treatment was confirmed (p<0.001; 95% confidence interval [-0.0637, 0.0287] for horizontal and p<0.001; 95% CI [-0.0158, 0.0859] for vertical diameter). There was statistically significant horizontal and vertical enlargement of pupil diameters between 0.15 and 0.24 mm during the laser treatment steps as compared with preoperative values (all p values <0.001). CONCLUSIONS No progressive pupil narrowing was observed using low-energy FLACS. Although a suction-induced, slight increase in pupil area became apparent, this effect was completely reversible after removing the laser interface.
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Affiliation(s)
| | - Astrid Schneider
- Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | | | - Katharina A. Ponto
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
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Surgical outcomes with high and low pulse energy femtosecond laser systems for cataract surgery. Sci Rep 2021; 11:9525. [PMID: 33947910 PMCID: PMC8096967 DOI: 10.1038/s41598-021-89046-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/20/2021] [Indexed: 02/02/2023] Open
Abstract
Currently, there is no clear consensus in cataract surgery if low compared to high energy femto-lasers may enable better capsulotomy quality and induce lower inflammatory response. Therefore, the aim of this study was to compare the intra-operative outcomes achieved with high and low pulse energy femtosecond laser systems for cataract surgery. The charts of 200 eyes of 200 patients aged 68.3 ± 10.3 years who had undergone femtosecond laser-assisted cataract surgery using either group 1 high pulse energy: LenSx (Alcon Laboratories) (N = 100) or group 2 low pulse energy: FEMTO LDV Z8 (Ziemer) (N = 100) laser were reviewed retrospectively. Integrity of anterior capsulotomy, classified as (1) complete (free-floating or with minor microadhesions), (2) incomplete and (3) with capsular tears, intraoperative completeness of the clear corneal incisions (CCI, main incision and side port), incidences of intraoperative miosis and incidence of subconjunctival hemorrhage were evaluated and compared between the two groups. The proportion of complete capsulotomies was significantly higher in the group 2 than the group 1 (100% vs 94%; p = 0.03). The incidences of intraoperative miosis (0% vs 19%) and subconjunctival hemorrhage (1% vs 63%) were significantly lower in the group 2 than the group 1 (p < 0.001). Completeness of the main incision was comparable (97% vs 95%; p = 0.721) between the two groups. Although not statistically significant, the completeness of side-port incision was slightly better in the group 2 than the group 1 (91% vs 86%). Low energy laser system performed significantly better in terms of completeness of capsulotomy, intraoperative miosis and sub-conjunctival hemorrhage, compared with high energy laser; the CCI outcomes were comparable.
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12
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Piñero A, Kanclerz P, Barraquer RI, Maldonado MJ, Alió JL. Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application. ACTA ACUST UNITED AC 2020; 95:528-537. [PMID: 32694026 DOI: 10.1016/j.oftal.2020.05.038] [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: 02/12/2020] [Revised: 05/20/2020] [Accepted: 05/25/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.
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Affiliation(s)
- A Piñero
- Fellow Curso online Experto Universitario en Cirugía Refractiva, Córnea y Catarata, Clínica Piñero, Sevilla, España
| | | | - R I Barraquer
- Centro de Oftalmología Barraquer, Barcelona, España; Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, España; Universitat Internacional de Catalunya, Barcelona, España
| | - M J Maldonado
- Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, España
| | - J L Alió
- División de Oftalmología, Universidad Miguel Hernández, Alicante, España; Vissum Instituto Oftalmológico de Alicante, Alicante, España.
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Kanclerz P, Alio JL. The benefits and drawbacks of femtosecond laser-assisted cataract surgery. Eur J Ophthalmol 2020; 31:1021-1030. [PMID: 32508179 DOI: 10.1177/1120672120922448] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Since the introduction, femtosecond laser-assisted cataract surgery was believed to revolutionize cataract surgery. However, the judgment of clinical benefit was found to be far more complex than initially might have been thought. The aim of this review was to analyze the benefits and drawbacks of femtosecond laser-assisted cataract surgery compared with traditional phacoemulsification cataract surgery. METHODS PubMed and the Web of Science were used to search the medical literature. The following keywords were searched in various combinations: femtosecond laser, femtosecond laser-assisted cataract surgery, phacoemulsification cataract surgery, FLACS. RESULTS The benefits of femtosecond laser-assisted cataract surgery include lower cumulated phacoemulsification time and endothelial cell loss, perfect centration of the capsulotomy, and opportunity to perform precise femtosecond-assisted arcuate keratotomy incisions. The major disadvantages of femtosecond laser-assisted cataract surgery are high cost of the laser and the disposables for surgery, femtosecond laser-assisted cataract surgery-specific intraoperative capsular complications, as well as the risk of intraoperative miosis and the learning curve. CONCLUSION Femtosecond laser-assisted cataract surgery seems to be beneficial in some groups of patients, that is, with low baseline endothelial cell count, or those planning to receive multifocal intraocular lens. Nevertheless, having considered that the advantages of femtosecond laser-assisted cataract surgery might not be clear in every routine case, it cannot be considered as cost-effective.
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Affiliation(s)
| | - Jorge L Alio
- Vissum Instituto Oftalmologico de Alicante, Alicante, Spain.,Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Wang Y, Zhang J, Qin M, Miao J, Chen W, Huang Y, Wu J, Guan Y, Guan H. Comparison of optical quality and distinct macular thickness in femtosecond laser-assisted versus phacoemulsification cataract surgery. BMC Ophthalmol 2020; 20:42. [PMID: 32007086 PMCID: PMC6995244 DOI: 10.1186/s12886-020-1319-3] [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: 09/03/2019] [Accepted: 01/17/2020] [Indexed: 11/12/2022] Open
Abstract
Background Optical quality and macular thickness changing optical quality is rarely reported after femtosecond laser-assisted cataract surgery (FLACS). In current research, we evaluated optical quality recovery and distinct macular thickness changes after FLACS and phacoemulsification cataract surgery (PCS). Methods A total of 100 cataract patients (100 eyes) were included (50 eyes for the FLACS group and 50 eyes for the PCS group). Modulation transfer function (MTF), point spread function (PSF) and dysfunctional lens index (DLI) were measured by a ray-tracing aberrometer (iTrace). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were also assessed pre-operation,1 week and 1 month after surgery. The MTF values at spatial frequencies of 5, 10, 15, 20, 25 and 30 cycles/degree (c/d) were selected. We used optical coherence tomography (OCT) to assess the macular thickness of different regions pre-operatively and1month after the surgery. Results In PCS group, we found the statistically significant differences between pre-operation and post-operation in DLI (p < 0.0001), PSF (strehl ratio, SR) (p = 0.027) and MTF (p = 0.028), but not intraocular pressure (IOP) (p = 0.857). The differences between pre-operation and post-operation for DLI (p = 0.031), SR (p = 0.01) and IOP (p = 0.03), but not MTF (p = 0.128) were also found in FLACS group. The differences were statistically significant when the spatial frequencies were at 5, 10 and 25 (p = 0.013, 0.031 and 0.048) between pre-operation and post-operation in PCS group but not FLACS group at 1 month. In PCS group, we found the differences between pre-operation and post-operation in nasal inter macular ring thickness (NIMRT) (p = 0.03), foveal volume (FV) (p = 0.034) and average retinal thickness (ART) (p = 0.025) but not FLACS group at 1 month. Conclusion FLACS is safe that did not cause significant increase of macular thickness in current study. However, it also cannot produce better optical quality. In contrast, PCS can produce macular thickness changes, but better optical quality recovery. The slightly retinal change may not affect optical quality.
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Affiliation(s)
- Yong Wang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China.,Nantong University, Nantong, Jiangsu, China
| | - Jinling Zhang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Miaomiao Qin
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Jianguo Miao
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Wei Chen
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Yemeng Huang
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Jian Wu
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Yu Guan
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China
| | - Huaijin Guan
- Department of Ophthalmology, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong, Jiangsu, China.
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Aguilar Sierra MC, Alvarado-Villacorta R, Pastrana CP. Topical Bromfenac Sodium in Femtosecond Laser-Assisted Cataract Surgery. J Curr Ophthalmol 2020; 32:32-37. [PMID: 32510011 PMCID: PMC7265276 DOI: 10.1016/j.joco.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/14/2019] [Accepted: 07/31/2019] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To evaluate the effect of preoperative 0.09% bromfenac ophthalmic solution for the reduction of intraoperative miosis and pain in patients who have undergone femtosecond laser-assisted cataract surgery. METHODS This prospective randomized clinical study included 65 patients with senile cataracts in the absence of significant ocular comorbidity. The patients received 0.09% bromfenac ophthalmic solution or control placebo twice a day for 3 days before surgery. Pupil diameter was measured at the initiation and finalization of femtosecond laser-assisted cataract surgery, and pain quantification was assessed by an analogous pain scale after one day of follow-up. RESULTS A total of 65 patients were randomly divided into two groups. Five patients were excluded due to defective coupling with the laser interface. Each of the 60 patients was randomized to receive preoperative topical treatment with either 0.09% bromfenac or 0.1% sodium hyaluronate. Baseline characteristics were similar between groups for age and gender. The mean change in horizontal and vertical pupil diameter from the preoperative to post-femtosecond laser measurements were significantly less in the bromfenac group than in the placebo group (0.43 ± 0.6 vs. 1.71 ± 0.9, P < 0.001 and 0.40 ± 0.6 vs. 1.78 ± 0.9, P < 0.001, respectively). Compared with untreated patients, the quantification of pain one day after the procedure was significantly lower in the 0.09% bromfenac group (46.7% with a score of 3 vs. 50% with a score of 1, P < 0.001, respectively). CONCLUSIONS The maintenance of pupil dilation and the prevention of miosis were more effective in the 0.09% bromfenac group than in the control group. Likewise, the greater control of postoperative pain represented an additional significant benefit.
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Popiela MZ, Young-Zvandasara T, Nidamanuri P, Moore T, Leccisotti A, Kumar V. Factors influencing pupil behaviour during femtosecond laser assisted cataract surgery. Cont Lens Anterior Eye 2019; 42:295-298. [DOI: 10.1016/j.clae.2018.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/29/2022]
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Endothelial cell density and corneal graft thickness following excimer laser vs. femtosecond laser-assisted penetrating keratoplasty—a prospective randomized study. Graefes Arch Clin Exp Ophthalmol 2019; 257:975-981. [DOI: 10.1007/s00417-019-04263-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 10/27/2022] Open
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Liu YC, Setiawan M, Ang M, Yam GHF, Mehta JS. Changes in aqueous oxidative stress, prostaglandins, and cytokines: Comparisons of low-energy femtosecond laser–assisted cataract surgery versus conventional phacoemulsification. J Cataract Refract Surg 2019; 45:196-203. [DOI: 10.1016/j.jcrs.2018.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/27/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
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Anisimova NS, Arbisser LB, Petrovski G, Petrichuk SV, Sobolev NP, Petrovski B, Borsenok SA, Komah YA, Malyugin BE. Effect of NSAIDs on Pupil Diameter and Expression of Aqueous Humor Cytokines in FLACS Versus Conventional Phacoemulsification. J Refract Surg 2018; 34:646-652. [DOI: 10.3928/1081597x-20180814-02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/13/2018] [Indexed: 12/11/2022]
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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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Diakonis VF, Anagnostopoulos AG, Moutsiopoulou A, Yesilirmak N, Cabot F, Waren DP, O'Brien TP, Yoo SH, Weinstock RJ, Donaldson KE. The Effect of NSAID Pretreatment on Aqueous Humor Prostaglandin E 2 Concentration in Eyes Undergoing Femtosecond Laser-Assisted Capsulotomy. J Ophthalmol 2018; 2018:1891249. [PMID: 30116626 PMCID: PMC6079456 DOI: 10.1155/2018/1891249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 06/24/2018] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To assess aqueous humor concentration of prostaglandin E2 (PGE2) after capsulotomy creation using a femtosecond laser (FLAC) in patients pretreated with short-term topical ketorolac versus patients without pretreatment. METHODS This prospective study comprised consecutive patients scheduled to undergo cataract surgery using a femtosecond laser platform to perform only capsulotomies. An identical protocol for preoperative mydriasis was used for all the eyes included in the study, while aqueous humor was extracted from the anterior chamber of all patients immediately after the initial side port incision. ELISA was performed to quantify aqueous humor PGE2. The patients were divided into 2 groups; in group 1, the patients received short-term topical ketorolac preoperatively, while the patients in group 2 did not receive NSAID pretreatment. RESULTS Twenty eyes of 20 patients were included in the study (10 eyes in each group). Mean concentration of aqueous humor PGE2 after FLAC was 392.16 ± 162.00 pg/ml and 622.63 ± 331.84 pg/ml for groups 1 and 2, respectively. A statistically significant difference in aqueous humor PGE2 concentration between the two groups (p < 0.05) was demonstrated, with the eyes that received ketorolac pretreatment demonstrating a lower concentration of PGE2. CONCLUSION Short-term topical use of ketorolac prior to FLAC seems to prevent excessive release of PGE2 in the anterior chamber of the eyes that received NSAID pretreatment when compared to the eyes that did not receive NSAIDs preoperatively.
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Affiliation(s)
- Vasilios F. Diakonis
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Eye Institute of West Florida, Largo, FL, USA
| | | | | | - Nilufer Yesilirmak
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Florence Cabot
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Daniel P. Waren
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Terrence P. O'Brien
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonia H. Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Kendall E. Donaldson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Assam JH, Bernhisel A, Lin A. Intraoperative and postoperative pain in cataract surgery. Surv Ophthalmol 2018; 63:75-85. [DOI: 10.1016/j.survophthal.2017.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 07/04/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
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Femtosecond laser-assisted versus phacoemulsification for cataract extraction and intraocular lens implantation: clinical outcomes review. Curr Opin Ophthalmol 2017; 29:54-60. [PMID: 28914688 DOI: 10.1097/icu.0000000000000433] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Femtosecond laser-assisted cataract surgery (FLACS) has gained popularity in recent years with the new technology suggesting potential improvements in clinical and safety outcomes over conventional phacoemulsification cataract surgery (PCS). A decade since the advent of FLACS has given time and experience for laser technology to develop in maturity, and better quality evidence to become available. This review evaluates current evidence on the clinical and safety outcomes for FLACS in comparison to PCS. RECENT FINDINGS FLACS technology continues to improve and with it our confidence in tackling more complex patient indications. Concurrently other new technologies such as precision pulse capsulotomy also look to deliver the biomechanically ideal 5.2 mm capsulotomy, particularly as there remain suggestions from large studies and meta-analyses of raised capsular complications with FLACS compared with PCS and IOL technology responding to advantages of a consistent capsulotomy. Visual benefits of FLACS over and above PCS also remain to be conclusively demonstrated, with equivalence but not superiority. Economic modelling continues to indicate that FLACS remains 'not' cost-effective. SUMMARY FLACS can be considered non-inferior to conventional PCS in term of safety and clinical outcomes. However, FLACS has yet to demonstrate an overall cost-benefit to the patient.
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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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Effects of topical ketorolac tromethamine 0.45% on intraoperative miosis and prostaglandin E2 release during femtosecond laser–assisted cataract surgery. J Cataract Refract Surg 2017; 43:492-497. [DOI: 10.1016/j.jcrs.2017.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 11/18/2022]
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