Bladeless versus clear corneal incisions in cataract extraction: pros, cons and comparison

Session Details

Session Title: Presented Poster Session 04: Femto Laser 1

Session Date/Time: Saturday 13/09/2014 | 15:00-17:00

Paper Time: 15:15

Venue: Pod 1 (Poster Village)

First Author: : I.Vastardis SWITZERLAND

Co Author(s): :    B. Eggspuehler-Pajic   C. Nichorlis   B. Pajic        

Abstract Details

Purpose:

To asses if the reproducibility of Femto second (Fs.) assisted corneal incisions outmatch the standard clear corneal incisions (CCI) in terms of efficiency, safety, induced corneal higher order aberrations (HOA´s) and visual acuity rehabilitation.

Setting:

Eye Clinic ORASIS, Swiss eye research Foundation

Methods:

12 Patients (8 females) underwent age related cataract extraction in both eyes. In 12 eyes the main incision and the side ports were created with a standard one use knife (2,8 and 0,8 mm respectively), while in the partner eye Fs. assisted incisions were created using the LDV 6 Femto second platform. Intraoperative complications and the time regarding the creation of the incisions for both methods were documented and assessed. Postoperatively distance corrected visual acuity (DCVA) and scheimpflug corneal topography values were evaluated in a follow up period of 12 weeks (Baseline, 1st Day, 3rd Day, 1st Week, 1st Month, 3rd Month). Parametrical and non-parametrical tests according to distribution were used. Statistical importance was given at p≤0.05.

Results:

Intraoperative no major complications were noted in either group. All incisions in the Fs group were safe and highly reproducible. However, in 3 out of 12 eyes (25 %) one or both side ports were incomplete. The creation time for all incisions was 45 sec. All CCI were created approximately in 10-12 sec. Postoperative in both groups a slight epithelial corneal oedema and descemet folds accounted 58,3% for the CCI and 66,3% for the Fs. group respectively. No statistical difference was found between the groups (paired sample t-Test, p=0,67). After 1 week descemet corneal folds were evident only in one eye in the Fs group. The DCVA improved in both groups (ANOVA p≤0,001, respectively) but no statistical difference was found between the groups. Regarding the corneal induced astigmatism no statistical difference was found between the groups or in every follow up until the 3rd Month (paired sample t-Test, p=0,93, 1,1±1,0 D. and 1,08±0,9 D. respectively)for each group individually. Same wise no statistical difference was found regarding induced corneal HOA´s (Sph. Aberrations and Coma) between the groups or in every follow up until the 3rd Month (Wilcoxon, p=0,76, median 1,11 and 1,09 respectively) for each group individually.

Conclusions:

In overall both groups showed very good results regarding the DCVA as expected. We did not find any statistical difference regarding the corneal astigmatic values or the higher order aberrations when compared between the groups or during the follow up sessions for each group individually. Intra-operatively in the Fs group in 3 out of 12 eyes (25 %) some of the incisions were incomplete and the duration of the incision creation lasted significantly longer than those manually made. Taking into consideration that those eyes were applanated in order to create the incisions we found no statistical difference regarding the corneal epithelial oedema and descemet folds between the groups. All incisions in the Fs group were safe, highly reproducible and fine adjustments regarding the length, position, angle or the degree of steepness of the incision were able to be adjusted or modified in the laser panel thus allowing the surgeon to customise every single parameter to his or the patients benefit. However this benefit must be considered in relation to time efficiency and visual acuity rehabilitation.

Financial Interest:

NONE