1
|
Zhong Y, Zhu Y, Wang W, Wang K, Liu X, Yao K. Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: comparison of internal aberrations and visual quality. Graefes Arch Clin Exp Ophthalmol 2021; 260:901-911. [PMID: 34636992 DOI: 10.1007/s00417-021-05441-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To compare the internal aberrations and optical quality after femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). METHODS This study included patients who received FLACS or CPCS from January 2016 to July 2019. Postoperative examinations included wavefront measurements under pupil diameters of 3.0 mm and 5.0 mm, intraocular lens (IOL) decentration, visual acuity (VA), and refractive outcomes. Visual quality was measured with Strehl ratio and modulation transfer function (MTF). Subgroup analyses were conducted based on monofocal or multifocal-extended depth of focus (EDOF) IOL. RESULTS The study consisted of 221 eyes (105 eyes in FLACS and 116 eyes in CPCS). With a pupil diameter of 5.0 mm, FLACS demonstrated a significantly lower root mean square of total internal aberration (P = 0.004), higher order aberrations (HOAs) (P = 0.034), tilt (P = 0.049), coma (P = 0.004), and spherical aberration (P = 0.014). IOL tilt was found to be positively correlated with total internal aberration (P < 0.001), HOAs (P < 0.001), and coma (P < 0.001). The FLACS group presented significantly smaller IOL decentration than the CPCS group (P < 0.001), but there were no significant differences in terms of VA and refractive outcomes between groups. In the multifocal-EDOF subgroup, Strehl ratio and MTF values were significantly higher in the femtosecond group with a 3.0-mm pupil. CONCLUSION FLACS induced significantly lower values of IOL tilt, decentration, and internal aberrations compared with the CPCS group with a pupil diameter of 5.0 mm, while no significant differences were found in the VA or optical quality over long-term observation. TRIAL REGISTRATION This trial was registered at www.chictr.org.cn (registration number ChiCTR2000038965).
Collapse
Affiliation(s)
- Yueyang Zhong
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Yanan Zhu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Wei Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Kai Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Xin Liu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou, 310009, Zhejiang Province, China.
| |
Collapse
|
2
|
Abstract
PURPOSE Review scientific literature concerning femtosecond laser-assisted cataract surgery. METHODS Following databases were searched: CENTRAL (Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 2 of 12, June 2019), Ovid MEDLINE® without Revisions (1996 to June 2019), Ovid MEDLINE® (1946 to June 2019), Ovid MEDLINE® Daily Update June 2019, MEDLINE and MEDLINE Non-Indexed Items, Embase (1980-2019), Embase (1974 to June 2019), Ovid MEDLINE® and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1946 to June 2019), Web of Science (all years), the metaRegister of Controlled Trials ( www.controlled-trials.com ), ClinicalTrials.gov ( www.clinicaltrial.gov ) and World Health Organization International Clinical Trials Registry Platform ( www.who.int/ictrp/search/en ). Search terms/keywords included 'Femtosecond laser' combined with 'cataract', 'cataract surgery'. RESULTS Based on quality of their methodology and their originality, 121 articles were reviewed, including randomised controlled trials, cohort studies, case-controlled studies, case series, case reports and laboratory studies. Each step of the femtosecond laser-assisted cataract surgery procedure (corneal incisions, arcuate keratotomies, capsulotomy and lens fragmentation) has been discussed with relevance to published outcomes, as well as complication rates of femtosecond laser-assisted cataract surgery, and what we can learn from the larger studies/meta-analyses and the economics of femtosecond laser-assisted cataract surgery within different healthcare settings. CONCLUSION Studies suggest that the current clinical outcomes of femtosecond laser-assisted cataract surgery are not different to conventional phacoemulsification surgery and it is not cost effective when compared with conventional phacoemulsification surgery. In its current technological form, it is a useful surgical tool in specific complex cataract scenarios, but its usage has not been shown to translate into better clinical outcomes.
Collapse
Affiliation(s)
- Harry W Roberts
- King's College London, London, UK.,Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | | | - David Ps O'Brart
- King's College London, London, UK.,Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Zhu S, Qu N, Wang W, Zhu Y, Shentu X, Chen P, Xu W, Yao K. Morphologic features and surgically induced astigmatism of femtosecond laser versus manual clear corneal incisions. J Cataract Refract Surg 2019; 43:1430-1435. [PMID: 29223232 DOI: 10.1016/j.jcrs.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the morphologic features and surgically induced astigmatism (SIA) between laser and manual clear corneal incisions (CCIs) after femtosecond laser-assisted cataract surgery. SETTING Eye Center, 2nd Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China. DESIGN Prospective case series. METHODS Patients had femtosecond laser-assisted cataract surgery with a CCI created with the laser or manually after random allocation. The corrected distance visual acuity, corneal topography, and anterior segment optical coherence tomography were assessed at the 1-day, 1-week, 1-month, and 3-month follow-ups. RESULTS The laser CCI group comprised 45 eyes and the manual CCI group, 48 eyes. The SIA was significantly lower in the manual CCI group than the laser CCI group at all visits (P < .05). At the 1-day and 1-week follow-ups, the mean CCI thickness was significantly smaller in the manual CCI group (P < .05). In the laser CCI group, the perpendicular linear distance between the external wound opening and the corneal vertex central line was statistically shorter than in the manual CCI group (P < .05). At 3 months, the SIA was correlated with the perpendicular linear distance with a Pearson correlation coefficient of -0.341 (P = .001). CONCLUSIONS Femtosecond laser-created CCIs for cataract surgery caused more SIA than manually created CCIs, which could have resulted from inaccurate or uncertain corneal incision positioning of the femtosecond machine. Manual creation of CCIs is recommended in femtosecond laser-assisted cataract surgery until the locating system for the femtosecond laser incision is updated.
Collapse
Affiliation(s)
- Sha Zhu
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Naibin Qu
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Wang
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanan Zhu
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xingchao Shentu
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peiqing Chen
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wen Xu
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ke Yao
- From the Eye Center, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| |
Collapse
|
4
|
Pereira A, Somani S, Tam ES, Chiu H, Maini R. Comparison of Surgically Induced Astigmatism and Corneal Morphological Features Between Femtosecond Laser and Manual Clear Corneal Incisions. J Refract Surg 2019; 35:796-802. [PMID: 31830296 DOI: 10.3928/1081597x-20191024-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/23/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess corneal morphologic changes and surgically induced astigmatism (SIA) following clear corneal incisions (CCIs) created manually or with the Catalys femtosecond laser (Johnson & Johnson Vision, Santa Ana, CA). METHODS In this retrospective cohort analysis, patients undergoing femtosecond laser-assisted cataract surgery (FLACS) or manual cataract surgery between June and September 2018 from a single surgical center in Toronto, Canada, were considered for inclusion. Postoperative corneal astigmatism values were compared to preoperative astigmatism indices to determine the SIA at the postoperative 3-month (POM3) mark using the Alpins vector method. Secondary outcomes included postoperative corrected distance visual acuity (CDVA), central corneal thickness (CCT), and CCI morphology parameters. RESULTS Refractive outcomes from 104 eyes of 61 patients (54 eyes in the manual group and 50 eyes in the FLACS group) were included. There was no significant difference in POM3 SIA (manual: 0.45 ± 0.28 diopters [D], FLACS: 0.57 ± 0.46 D, P = .11); however, a significantly larger SIA was noted in the FLACS cohort at postoperative 1 week (P = .02) and 1 month (P = .04). FLACS led to a significantly smaller POM3 CCI thickness (P = .006), and CCI position was comparable between the two techniques (P = .44). There were no significant differences between groups in CDVA (P = .19), CCT thickness (P = .20), or phacoemulsification time (P = .59). CONCLUSIONS There was no significant difference in SIA between FLACS and manual cataract surgery at POM3. With a significantly smaller CCI thickness seen in FLACS cases, and a comparable CCI position, the reason for the increased SIA following laser CCIs in the early postoperative period was unclear. [J Refract Surg. 2019;35(12):796-802.].
Collapse
|
5
|
Roberts HW, Wagh VB, Sung J, Ni MZ, O'Brart DPS. Risk-Adjusted CUSUM Analysis of the Learning Curve of Femtosecond Laser Assisted Cataract Surgery. Curr Eye Res 2019; 44:887-895. [PMID: 30929535 DOI: 10.1080/02713683.2019.1601742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: To determine the length of the learning curve of femtosecond laser-assisted cataract surgery (FLACS) by a risk-adjusted cumulative sum method. Materials and Methods: This was a retrospective review of the first 288 FLACS performed by three surgeons over a 12-month period. The learning curves were analyzed separately for each surgeon and as pooled data via risk-adjusted cumulative sum methods. Change-point analysis was performed to estimate the length of the learning curve. Results: Rates of complications were as follows: anterior capsular tear (ACT) (3.4%), posterior capsular rupture (PCR) (0.7%), vitreous loss (0.3%), iris trauma (0.7%), Descemet's membrane tear (0.3%). There was a strong confidence level (96%) that there was a stable performance in terms of PCR after case 16 for the pooled data. Surgeon 1 did not have any cases of PCR, surgeons 2 and 3 exhibited change points at case 5 and 16, respectively (confidence levels = 99%, 98%). There was a strong confidence level (99.8%) that there was stable performance in terms of ACT after case 14 for the pooled data, however the individual surgeons demonstrated individual change points at case 1 (surgeon 1, confidence 99%), case 14 (surgeon 2, confidence 99%), and case 49 (surgeon 3, confidence 96%). Conclusions: The results suggest that there is an increased risk of ACT and PCR in FLACS within a surgeon's first 14 and 16 operations, respectively. Measures should be adopted to minimize harm to patients during this phase. However, overall rates of complications were safe.
Collapse
Affiliation(s)
- Harry W Roberts
- a Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust , London , UK.,b King's College London , London , UK
| | - Vijay B Wagh
- a Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust , London , UK
| | | | - Melody Z Ni
- d Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital , London , UK
| | - David P S O'Brart
- a Department of Ophthalmology, Guy's and St. Thomas' NHS Foundation Trust , London , UK.,b King's College London , London , UK
| |
Collapse
|
6
|
Serrao S, Giannini D, Schiano-Lomoriello D, Lombardo G, Lombardo M. New technique for femtosecond laser creation of clear corneal incisions for cataract surgery. J Cataract Refract Surg 2017; 43:80-86. [DOI: 10.1016/j.jcrs.2016.08.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/13/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
|
7
|
Park YM, Choi BJ, Lee JS. Effect of incision types for Artisan phakic intraocular lens implantation on ocular higher order aberrations. Int J Ophthalmol 2016; 9:1785-1789. [PMID: 28003980 DOI: 10.18240/ijo.2016.12.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/12/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effect of incision types for Artisan phakic intraocular lens (PIOL) implantation on ocular higher-order aberrations (HOAs). METHODS A retrospective review was conducted of the patients who had undergone Artisan PIOL implantation for the correction of myopia and followed up for at least 6mo. Patients are classified into 2 groups considering the incision type: cornea group with patients undergone clear corneal incision; sclera group with patients undergone sclera tunnel incision. All patients with postoperative astigmatism of under 1 diopter (D) were included to minimize the effect of residual astigmatism on postoperative HOAs. Visual acuity, special equivalents, astigmatism, predictability (±1 D from target refraction), HOAs (coma, trefoil, spherical aberration), and corneal endothelial counts were analyzed preoperatively and 6mo postoperatively. RESULTS At the postoperative 6mo, all patients of both groups achieved uncorrected visual acuity of 16/20 or better, and significantly decreased the spherical equivalents compared with preoperative values. The predictability of refractive correction was 96% in the former, and 94% in the latter. Unlike the sclera group, preoperative astigmatism decreased significantly in cornea group at postoperative 6mo. The HOAs increased significantly at postoperative 6mo compared to the preoperative values in both groups, and the root mean square (RMS) total and trefoil wavefront aberration of cornea group were significantly higher than those of sclera group. CONCLUSION Although corneal incision significantly reduces preexisting astigmatism, the postoperative 6mo of total RMS and trefoil aberration change may deteriorate the visual quality after Artisan PIOL implantation.
Collapse
Affiliation(s)
- Young Min Park
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon-si, Gyeongsangnam-do 51472, Korea
| | | | - Jong Soo Lee
- Department of Ophthalmology, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Pusan 602-739, Korea
| |
Collapse
|
8
|
Analysis of femtosecond laser assisted capsulotomy cutting edges and manual capsulorhexis using environmental scanning electron microscopy. J Ophthalmol 2014; 2014:520713. [PMID: 25505977 PMCID: PMC4258322 DOI: 10.1155/2014/520713] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/02/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate the structure and irregularity of the capsulotomy cutting edges created by two femtosecond (FS) laser platforms in comparison with manual continuous circular capsulorhexis (CCC) using environmental scanning electron microscopy (eSEM). Methods. Ten anterior capsulotomies were obtained using two different FS laser cataract platforms (LenSx, n = 5, and Victus, n = 5). In addition, five manual CCC (n = 5) were obtained using a rhexis forceps. The specimens were imaged by eSEM (FEI Quanta 400, OR, USA). Objective metrics, which included the arithmetic mean deviation of the surface (Sa) and the root-mean-square deviation of the surface (Sq), were used to evaluate the irregularity of both the FS laser capsulotomies and the manual CCC cutting edges. Results. Several microirregularities were shown across the FS laser capsulotomy cutting edges. The edges of manually torn capsules were shown, by comparison of Sa and Sq values, to be smoother (P < 0.05) than the FS laser capsulotomy edges. Conclusions. Work is needed to understand whether the FS laser capsulotomy edge microirregularities, not seen in manual CCC, may act as focal points for the concentration of stress that would increase the risk of capsular tear during phacoemulsification as recently reported in the literature.
Collapse
|