Outcome and complication rate of femtosecond laser-assisted cataract surgery performed by novice surgeons

Session Details

Session Title: Femtocataract I

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

Paper Time: 08:48

Venue: Boulevard A

First Author: : A.Intili USA

Co Author(s): :    M. Pyfer   M. Blecher   R. Bailey        

Abstract Details

Purpose:

Wills Eye Hospital is the first ophthalmology residency program in the U.S. to incorporate femtosecond laser-assisted cataract surgery (FLACS) during training. Previous reports indicate there may be an increased incidence of complications, such as anterior capsule tear, posterior capsule rupture, and dropped nucleus during initial use of the femtosecond laser, even for experienced surgeons. Novice surgeons are known to have a higher intraoperative complication rate than experienced surgeons when performing traditional manual cataract surgery with phacoemulsification. The complication rate of novice surgeons performing femtosecond laser-assisted cataract surgery is currently unknown. The purpose of this study is to report the outcomes and complications of the first 100 cataract procedures performed by novice surgeons using the Optimedica femtosecond laser at Wills Eye Hospital.

Setting:

This study was performed at Wills Eye Hospital in Philadelphia, PA, USA, a large metropolitan teaching specialty hospital. All surgical procedures were performed in the operating theater at the hospital. Preoperative examinations and postoperative visits took place either in the resident’s clinic at Wills Eye Hospital, or in the private attending offices nearby for non-teaching patients.

Methods:

Retrospective nonrandomized chart review was performed examining all femtosecond laser-assisted cataract surgeries performed by residents and attending surgeons at Wills Eye Hospital from January 2013 until March 2014. The occurrence of intraoperative complications including anterior capsule tears, posterior capsule ruptures, dropped nucleus, and retained lens material was recorded. The visual acuity one month postoperatively was examined as well as the incidence of intraocular pressure (IOP) above 24 mmHg in the early postoperative period, and any persistent postoperative inflammation requiring continued steroid or non-steroidal topical medication after the one-month postoperative visit. Age-matched controls were identified using the V43.1 ICD-9 code to search the Wills Eye Hospital electronic medical record database for patients who had undergone manual cataract surgery by residents during the same period of time. Patients with visually significant retinal disease, moderate to advanced glaucoma, chronic uveitis, or those requiring special surgical maneuvers qualifying as complex cataract extraction (such as pupil expansion devices) were excluded from the study.

Results:

All FLACS cases were analyzed and compared to appropriate age-matched controls. The FLACS outcomes showed a comparable or better safety profile compared to manual cataract surgery. Significantly, there were no posterior capsule ruptures or dropped nucleus events in the FLACS cases during the entire study period. The comparative rates of anterior capsule tears and retained cortex between the two techniques were not statistically significant. There was a trend toward fewer intraoperative complications in the FLACS cases, but this did not reach statistical significance. Similarly, the incidence of postoperative IOP elevation and final visual acuity were not significantly different. There was a higher incidence of persistent postoperative inflammation in the manual cataract surgery arm, and a trend towards greater incidence of retained cortex in the FLACS cases performed by residents.

Conclusions:

The rate of both intraoperative and postoperative complications of femtosecond laser assisted cataract surgery performed by novice surgeons was less than or equal to traditional manual cataract surgery. In the hands of novice surgeons, FLACS has a risk profile and visual outcome that is comparable to the current standard of care in the treatment of visually significant cataracts and can be safely incorporated into residency training programs in the appropriate patient population. This is the first study to evaluate the intraoperative and postoperative complication rate of resident surgeons in training performing femtosecond laser assisted cataract surgery.

Financial Interest:

One or more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented