Dataset Information

Femtosecond laser-assisted cataract surgery in patients with zonular weakness.

ABSTRACT:

Purpose

To present the clinical value of femtosecond laser assisted cataract surgery (FLACS) in eyes with compromised zonules.

Observations

We present two cases of femtosecond laser assisted cataract surgery (FLACS) in eyes with compromised zonules. Three eyes from two patients with zonular weakness and cataract underwent FLACS (Alcon LenSx Lasers Inc., Aliso Viejo, CA). One patient underwent bilateral FLACS in the setting of spherophakia with zonular weakness. The other patient had Marfan's syndrome with associated ectopia lentis. Laser assisted capsulotomy was achieved in all eyes. One eye had vitreous prolapse during surgery and required an iris-sutured lens. All eyes had a postoperative corrected distance visual acuity of 20/25 or better.

Conclusions and importance

FLACS is a safe and effective alternative to conventional phacoemulsification cataract surgery in patients with zonular weakness.

SUBMITTER: Dryjski O

PROVIDER: S-EPMC6582391 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Publications

Femtosecond laser-assisted cataract surgery in patients with zonular weakness.

Dryjski Olivia O Awidi Abdelhalim A Daoud Yassine J YJ

American journal of ophthalmology case reports 20190606

<h4>Purpose</h4>To present the clinical value of femtosecond laser assisted cataract surgery (FLACS) in eyes with compromised zonules.<h4>Observations</h4>We present two cases of femtosecond laser assisted cataract surgery (FLACS) in eyes with compromised zonules. Three eyes from two patients with zonular weakness and cataract underwent FLACS (Alcon LenSx Lasers Inc., Aliso Viejo, CA). One patient underwent bilateral FLACS in the setting of spherophakia with zonular weakness. The other patient h ...[more]

PMID: 31245652

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Project description:PurposeTo report the 3-month results of a randomized trial (Femtosecond Laser-Assisted Cataract Trial [FACT]) comparing femtosecond laser-assisted cataract surgery (FLACS) with standard phacoemulsification cataract surgery (PCS).DesignMulticenter, randomized controlled trial funded by the UK National Institute of Health Research (HTA 13/04/46/).ParticipantsSeven hundred eighty-five patients with age-related cataract.MethodsThis trial took place in 3 hospitals in the UK National Health Service (NHS). Randomization (1:1) was stratified by site, surgeon, and 1 or both eyes eligible using a secure web-based system. Postoperative assessments were masked to the allocated intervention. The primary outcome was unaided distance visual acuity (UDVA) in the study eye at 3 months. Secondary outcomes included corrected distance visual acuity, complications, and patient-reported outcomes measures. The noninferiority margin was 0.1 logarithm of the minimum angle of resolution (logMAR). ISRCTN.com registry, number ISRCTN77602616.Main outcome measuresWe enrolled 785 participants between May 2015 and September 2017 and randomly assigned 392 to FLACS and 393 to PCS. At 3 months postoperatively, mean UDVA difference between treatment arms was -0.01 logMAR (-0.05 to 0.03), and mean corrected distance visual acuity difference was -0.01 logMAR (95% confidence interval [CI], -0.05 to 0.02). Seventy-one percent of both FLACS and PCS cases were within ±0.5 diopters (D) of the refractive target, and 93% of FLACS and 92% of PCS cases were within ±1.0 D. There were 2 posterior capsule tears in the PCS arm and none in the FLACS arm. There were no significant differences between arms for any secondary outcome.ConclusionsFemtosecond laser-assisted cataract surgery is not inferior to conventional PCS surgery 3 months after surgery. Both methods are as good in terms of vision, patient-reported health, and safety outcomes at 3 months. Longer-term outcomes of the clinical effectiveness and cost-effectiveness are awaited.

Project description:Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant ( p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications ( p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

Dataset Information

Femtosecond laser-assisted cataract surgery in patients with zonular weakness.

Purpose

Observations

Conclusions and importance

Publications

Femtosecond laser-assisted cataract surgery in patients with zonular weakness.

Similar Datasets

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