2 years of femtosecond-assisted cataract surgery: what is the benefit for the patient?

Session Details

Session Title: Femtocataract I

Session Date/Time: Sunday 14/09/2014 | 08:00-10:00

Paper Time: 08:06

Venue: Boulevard A

First Author: : P.Hoffmann GERMANY

Co Author(s): :    C. Lindemann   M. Abraham           

Abstract Details

Purpose:

A lot of data on fs-laser assisted cataract surgery (FLACS) emerged during the last two years. Most of it is focussed on process quality, complications and innovative applications. We wanted to know if there is proof of comprehensible improvement for the patient and focussed on result quality.

Setting:

Private Eye Clinic in Germany

Methods:

Until 20th of February 2014, 679 FLACS procedures have been performed by two experienced surgeons using the B&L Technolas Victus fs-Laser platform. Pre- and intraoperative parameters were monitored in all cases. Postoperatively, 225 FLACS eyes (F) without antiastigmatic keratotomies could be examined 1 day, 211 1 month and 107 6 months after surgery. More data will be available at the time of presentation. Aspheric IOLs were implanted in all cases, 20.2% of them were also toric. A 5.0 to 5.2 mm capsulotomy was centred on the presumed line of sight. Nucleus fragmentation was either a 6- to 8-segment radial pattern or a combination of 4-segment radial with 4-8 circular cuts. Incision width was 2.2 mm in the majority of cases. A second group of n = 140 patients (M) was operated with manual phaco using the same diagnostics and implants. As a measure of result quality, visual acuity, corneal swelling, endothelial loss, axial IOL position, wavefront aberrations and refractive prediction error were examined. In two smaller subgroups (n = 30 (F), n = 28 (M)), IOL decentration and tilt was measured with Schaeffel’s purkinjemeter.

Results:

Mean central corneal thickness changed from preop 552 ± 38 µm to 1 day postop 574 ± 50 µm (F) and from 555 ± 30 µm to 585 ± 41 µm (M), P < 0.05. Mean endothelial loss was 4.3% (F) vs. 5.2% (M) P > 0.05. UCVA was 0.66 (F) vs 0.61 (M) geometric mean on day 1; no difference in DCVA could be observed after 1 and 6 months. Refractive prediction error was not different at 1 month, but at 6 months the FLACS eyes had a smaller standard deviation 0.34 vs 0.43 D (P < 0.05). The deviation of measured IOL position from the predicted position was also smaller in the FLACS eyes at 6 months (–0.15 ± 0.19 mm vs –0.22 ± 0.25 mm). Higher order aberrations were slightly lower in the FLACS group, especially coma (0.047 vs. 0.059 µm at 6 months). Geometrical decentration as measured with the purkinjemeter was more consistent at 0.27 ± 0.11 µm vs. 0.29 ± 0.23 mm and tilt was also somewhat smaller 3.7 ± 2.3° vs. 4.6 ± 2.6°. The vertical component of lens tilt was significantly smaller +0.13 ± 2.6° vs. –1.5 ± 3.0° P < 0.05.

Conclusions:

FLACS is an innovative surgical procedure coming at a very high expense. For the patient, it is important to know if any improvement in result quality over conventional phacoemulsification can be gained. This gain could be due to better positioning of the IOL and more gentle removal of the nucleus. We could prove slightly less endothelial trauma with FLACS and better lateral (less coma) as well as better axial IOL positioning (refractive predictability) ≥ 6 months after surgery. FLACS is a slight but comprehensible improvement on already very good quality manual phacoemulsification.

Financial Interest:

NONE