Impact of capsulorhexis architecture on IOL position: does femtosecond laser-assisted cataract surgery (FLACS) have an edge?

Session Details

Session Title: Evolution in FLACS & Phaco Technology

Session Date/Time: Sunday 23/09/2018 | 08:00-09:45

Paper Time: 08:33

Venue: Room A3, Podium 2

First Author: : A.Koul INDIA

Co Author(s): :    N. Shroff   R. Dutta   G. Singh   K. Priya           

Abstract Details

Purpose:

To analyze and compare the impact of capsulorhexis (CCC) architecture in terms of size, circularity, and optic cover on the final IOL position in terms of decentration, tilt, effective lens position (ELP) and visual outcomes in Femtosecond Laser Assisted Cataract Surgery (FLACS) and conventional Micro Incision Cataract Surgery (MICS).

Setting:

Cataract & Intraocular Lens Implantation Services, Shroff Eye Centre, A-9 Kailash Colony, New Delhi, India 110048.

Methods:

50 eyes each in FLACS and MICS groups underwent cataract extraction. All eyes underwent phacoemulsification by the Centurion Vision System by the same surgeon. Parameters evaluated at 1 month were UCVA, refractive spherical equivalent (SEQ), residual astigmatism and IOL prediction error. The achieved ELP (IOLMaster700) was compared with the predicted ELP (Holladay1 Formula). IOL tilt was assessed by measuring coma (iTrace Ray Tracing Aberrometry) and IOLMaster700. Dilated slit-lamp photographs were analyzed for IOL and CCC centration and size, as well as CCC overlap using Meazure 2.0 software. Circularity of CCC was assessed by Photoshop CS5 Extended.

Results:

CCC size was 4.99±0.21mm in FLACS versus 4.93±0.44mm in MICS (p=.890). Coefficient-of-variation was 4.2% in FLACS versus 8.9% in MICS (Homogeneity-of-Variances p<.001). Circularity was 0.885 in FLACS versus 0.877 in MICS (p=.004). CCC centration w.r.t. limbus was comparable (FLACS 0.19±0.10mm, MICS 0.22±0.11mm). CCC-IOL overlap ratio was comparable in both groups. IOL centration w.r.t. limbus was comparable (FLACS 0.20±0.12mm, MICS 0.24±0.12mm). ELP prediction error was comparable (FLACS 0.59±0.27mm, MICS 0.54±0.30mm). Mean IOL tilt was comparable (FLACS 2.11±1.21°, MICS 1.81±0.84°). Total-Coma values showed no significant differences. Mean LogMAR UCVA was comparable.

Conclusions:

The femtosecond laser technology definitely helps create a more circular capsulorhexis with a consistent diameter. However, this level of perfection neither translates into better IOL positioning in terms of a more predictable ELP, better IOL centration, or lesser tilt, nor does it provide improved visual outcomes in terms of final post-operative refraction and unaided visual acuity. In the hands of an experienced surgeon, the results of both techniques are comparable.

Financial Disclosure:

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