The advantages of femtolaser technology for cataract surgeries in white intumescent cataracts vs standard phacoemulsification

Session Details

Session Title: FLACS II

Session Date/Time: Monday 07/09/2015 | 14:30-16:00

Paper Time: 15:18

Venue: Room 16

First Author: : O.Moraru ROMANIA

Co Author(s): :    I. Iliescu                    

Abstract Details

Purpose:

White, intumescent cataracts with shallow anterior chambers pose a challenge to all steps done in cataract surgery, but mainly for capsulorrhexis. Very small space for all manoeuvres and the great risk for the capsulorrhexis run out due to the white, under pression cortex, make the intumescent, white cataracts a surgeon's big concern. Our paper compares cataract surgeries in white, intumescent cataracts - some done by standard facoemulsification using CENTURION® Vision System and the others using LenSx® Femtolaser and CENTURION® Vision System, all surgeries done between march 2014 - march 2015 with a follow-up of minimum 4 months.

Setting:

Oculus Eye Clinic, Bucharest, Romania

Methods:

The higher risks of surgery associated with intumescent cataracts , especially the risks for capsulorrhexis, made us think of this comparison. We selected 47 similar cases, operated between march 2014- march 2015, all eyes with white, intumescent cataracts with shallow AC and we performed 34 of the surgeries in a standard manual manner and 13 using the femtolaser. All surgeries have been registered and compared. We then formed two groups of cases, the first group with standard phaco and the second with femto procedures and we evaluated total surgical time, the difficulty of each surgical step and the complications.

Results:

The standard phaco group (34 eyes) comprised two sets of cases: the majority with no complications and 4 surgeries (11,8%) with complications of the capsulorrhexis (two Argentinian Flag Sign, one with mild capsulorrhexis run out and another with solved capsulorrhexis run out tendency) which prolonged the surgery time, rendered all further steps more difficult and changed the predicted visual results. (risk for descentration/ tilt of the IOL) For the femto group (13 eyes), all procedures went smoothly, easier due to precut capsulotomy, but a little longer compared to standard, uneventful cases, due to longer docking time caused by difficult fixation of light.

Conclusions:

Despite the initial controversies related to the high costs , the femtosecond laser finds its place in difficult cataract cases such white, intumescent cataracts. The greatest advantage of the femtolaser in these cases is the possibility to have a perfect capsulotomy without the risk for capsulorrhexis run out or the Argentinian Flag Sign, despite a probably little more difficult docking phase. Standard procedures, where the capsulorrhexis runs to the periphery, can get even more complicated during phaco. These complications that might occur result in poorer long term stability and centration of the IOL, thus poorer long term predicted visual outcomes.

Financial Interest:

NONE