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Intraoperative complications of cataract surgery using a low-energy femtosecond laser: Results from a real-world high-volume setting.

ABSTRACT: In this study, we report data on intraoperative complications occurring after cataract surgery in a high-volume single-center setting using a low-energy, mobile femtosecond laser. We retrospectively reviewed the medical records of patients who underwent femtosecond laser-assisted cataract surgery (FLACS) in our hospital between August 2015 and December 2019. Among the sample of 1,806 eyes of 1,131 patients (903 left and 903 right eyes), the mean age was 75.8 years (range, 21-99 years). The overall intraoperative complication rate was 0.28% (n = 5), with three cases of anterior capsule tear (0.17%) and two cases of posterior capsule tear (0.11%). No further complications occurred. This study underlines the safety of low-energy femtosecond-assisted cataract surgery in a real-world setting with a very low rate of intraoperative complications.

SUBMITTER: Riemey J

PROVIDER: S-EPMC9754167 | biostudies-literature | 2022

REPOSITORIES: biostudies-literature

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Intraoperative complications of cataract surgery using a low-energy femtosecond laser: Results from a real-world high-volume setting.

Riemey Julia J Latz Catharina C Mirshahi Alireza A

PloS one 20221215 12

In this study, we report data on intraoperative complications occurring after cataract surgery in a high-volume single-center setting using a low-energy, mobile femtosecond laser. We retrospectively reviewed the medical records of patients who underwent femtosecond laser-assisted cataract surgery (FLACS) in our hospital between August 2015 and December 2019. Among the sample of 1,806 eyes of 1,131 patients (903 left and 903 right eyes), the mean age was 75.8 years (range, 21-99 years). The overa ...[more]

PMID: 36520860

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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: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.

Project description:Purpose To evaluate capsulotomy shape and posterior capsule opacification (PCO) during an 18-month follow-up for bimanual femtosecond laser-assisted cataract surgery (FLACS). Methods 74 eyes operated by a well-trained surgeon with bimanual FLACS technique using low-energy LDV Z8 (Ziemer Ophthalmic Systems AG, Port, Switzerland) were included in the study. The follow-up period was 18?±?2 months. Another 91 eyes, which underwent standard bimanual microincision cataract surgery (B-MICS), served as a control group. In all cases, a BunnyLens AF (Hanita Lenses, Israel) intraocular lens was implanted in the bag. A digital image of the capsule with slit-lamp retroillumination was performed in all patients at 18 months of follow-up. Image analysis software (ImageJ) was used to evaluate the shape of the capsulotomy in terms of diameter, area, and circularity. PCO score was evaluated using EPCO 2000 software. Best corrected visual acuity (BCVA) and endothelial cell count (ECC) were evaluated before and after surgery at 1 and 18?±?2 months. Results At 18 months, mean capsulotomy diameter was 5.34?±?0.21?mm while capsulorhexis was 5.87?±?0.37?mm (p < 0.001) and the deviation area from baseline was 1.13?±?1.76?mm2 in FLACS and 2.67?±?1.69?mm2 in B-MICS (p < 0.001). Capsulotomy circularity was 0.94?±?0.04 while capsulorhexis was 0.83?±?0.07 (p < 0.001). EPCO score was 0.050?±?0.081 in the FLACS group and 0.122?±?0.239 in the B-MICS group (p=0.03). The mean BCVA improvement was significant in both groups, without a significant difference at 18 months. We noticed a statistically significant difference in endothelial cell loss at 18 months (FLACS 12.4% and B-MICS 18.1%; p=0.017). Conclusions Bimanual FLACS is a safe and effective technique, as determined in a long-term follow-up. Capsulotomy shape presented higher stability and circularity in the FLACS group over the 18-month observation period. FLACS resulted in lower PCO scores and endothelial cell loss at 18 months in comparison to B-MICS standard technique.

Dataset Information

Intraoperative complications of cataract surgery using a low-energy femtosecond laser: Results from a real-world high-volume setting.

Publications

Intraoperative complications of cataract surgery using a low-energy femtosecond laser: Results from a real-world high-volume setting.

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