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Clinical Outcomes in the First Two Years of Femtosecond Laser–Assisted Cataract Surgery

  • Soon-Phaik Chee
    Correspondence
    Inquiries to Soon-Phaik Chee, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751
    Affiliations
    Singapore National Eye Centre, Singapore

    Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

    Singapore Eye Research Institute, Singapore

    Duke-National University of Singapore Graduate Medical School, Singapore
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  • Younian Yang
    Affiliations
    Singapore National Eye Centre, Singapore
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  • Seng-Ei Ti
    Affiliations
    Singapore National Eye Centre, Singapore

    Singapore Eye Research Institute, Singapore

    Duke-National University of Singapore Graduate Medical School, Singapore
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Published:January 26, 2015DOI:https://doi.org/10.1016/j.ajo.2015.01.016

      Purpose

      To analyze outcomes of femtosecond laser cataract surgery cases in the first 2 years in an ophthalmic institution.

      Design

      Nonrandomized treatment comparison with matched, historical controls.

      Methods

      Outcomes and intraoperative events of all laser cataract surgeries (5.0- to 5.5-mm-diameter laser capsulotomies and nuclear fragmentation) at the Singapore National Eye Centre (May 2012–December 2013) were prospectively audited. The 6-weeks-postoperative unaided visual acuities (UAVA), mean absolute error (MAE), mean square error (MSE), and manifest refraction spherical equivalent (MRSE) results of surgeons with >50 laser cases were compared with controls, a random sample of manual cases with similar age, axial length, and preoperative cylinders. Statistical analysis was performed with SPSS (P < .05).

      Results

      A total of 1105 eyes (803 patients) underwent laser cataract surgery by 18 surgeons. The majority were female (56.9%) and Chinese (90.9%) with mean age 66.1 ± 11.0 years. Intraoperative complications were subconjunctival hemorrhage (290, 26.2%), anterior capsule tear (9 eyes, 0.81%), posterior capsule rupture (3 eyes, 0.27%), suction loss (5 eyes, 0.45%), iris hemorrhage (1 eye, 0.09%), and endothelial incision (1 eye, 0.09%). There was no dropped nucleus. Visual outcomes of 794 laser surgeries were compared to 420 controls. The %UAVA 20/25 or better was higher in laser cases (68.6% vs 56.3%; P < .0001) but MAE (0.30 ± 0.25 diopter [D] vs 0.33 ± 0.25; P = .062) and MSE (0.16 ± 0.27 D vs 0.17 ± 0.28 D; P = .065) were not significant. MRSE comparison was significant (target plano, preoperative cylinder <1.5 D −0.08 ± 0.36 D vs −0.13 ± 0.40 D; P = .034).

      Conclusions

      Femtosecond laser cataract surgery has a low complication rate. Cases compared to controls had statistically better %UAVA ≤20/25 and MRSE, although MAE was not significant.
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      References

        • Abell R.G.
        • Kerr N.M.
        • Vote B.J.
        Femtosecond laser-assisted cataract surgery compared with conventional cataract surgery.
        Clin Experiment Ophthalmol. 2013; 41: 455-462
        • Bali S.J.
        • Hodge C.
        • Lawless M.
        • Roberts T.V.
        • Sutton G.
        Early experience with the femtosecond laser for cataract surgery.
        Ophthalmology. 2012; 119: 891-899
        • Nagy Z.Z.
        • Takacs A.
        • Filkorn T.
        • Sarayba M.
        Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery.
        J Refract Surg. 2009; 25: 1053-1060
        • Reddy K.P.
        • Kandulla J.
        • Auffarth G.U.
        Effectiveness and safety of femtosecond laser-assisted lens fragmentation and anterior capsulotomy versus the manual technique in cataract surgery.
        J Cataract Refract Surg. 2013; 39: 1297-1306
        • Friedman N.J.
        • Palanker D.V.
        • Schuele G.
        • et al.
        Femtosecond laser capsulotomy.
        J Cataract Refract Surg. 2011; 37: 1189-1198
        • Kránitz K.
        • Takacs A.
        • Miháltz K.
        • Kovács I.
        • Knorz M.C.
        • Nagy Z.Z.
        Femtosecond laser capsulotomy and manual continuous curvilinear capsulorrhexis parameters and their effects on intraocular lens centration.
        J Refract Surg. 2011; 27: 558-563
        • Nagy Z.Z.
        • Kránitz K.
        • Takacs A.
        • Miháltz K.
        • Kovács I.
        • Knorz M.C.
        Comparison of intraocular lens decentration parameters after femtosecond and manual capsulotomies.
        J Refract Surg. 2011; 27: 564-569
        • Kránitz K.
        • Miháltz K.
        • Sándor G.L.
        • Takacs A.
        • Knorz M.C.
        • Nagy Z.Z.
        Intraocular lens tilt and decentration measured by Scheimpflug camera following manual or femtosecond laser-created continuous circular capsulotomy.
        J Refract Surg. 2012; 28: 259-263
        • Filkorn T.
        • Kovács I.
        • Takács A.
        • Horváth E.
        • Knorz M.C.
        • Nagy Z.Z.
        Comparison of IOL power calculation and refractive outcome after laser refractive cataract surgery with a femtosecond laser versus conventional phacoemulsification.
        J Refract Surg. 2012; 28: 540-544
        • Abell R.G.
        • Kerr N.M.
        • Vote B.J.
        Toward zero effective phacoemulsification time using femtosecond laser pretreatment.
        Ophthalmology. 2013; 120: 942-948
        • Conrad-Hengerer I.
        • Hengerer F.H.
        • Schultz T.
        • Dick H.B.
        Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery.
        J Refract Surg. 2012; 28: 879-883
        • Conrad-Hengerer I.
        • Hengerer F.H.
        • Schultz T.
        • Dick H.B.
        Effect of femtosecond laser fragmentation of the nucleus with different softening grid sizes on effective phaco time in cataract surgery.
        J Cataract Refract Surg. 2012; 38: 1888-1894
        • Masket S.
        • Sarayba M.
        • Ignacio T.
        • Fram N.
        Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility.
        J Cataract Refract Surg. 2010; 36: 1048-1049
        • Miháltz K.
        • Knorz M.C.
        • Alió J.L.
        • et al.
        Internal aberrations and optical quality after femtosecond laser anterior capsulotomy in cataract surgery.
        J Refract Surg. 2011; 27: 711-716
        • Chylack Jr., L.T.
        • Wolfe J.K.
        • Singer D.M.
        • et al.
        The Lens Opacities Classification System III. The Longitudinal Study of Cataract Study Group.
        Arch Ophthalmol. 1993; 111: 831-836
        • Ti S.E.
        • Yang Y.N.
        • Lang S.S.
        • Chee S.P.
        A 5-year audit of cataract surgery outcomes after posterior capsule rupture and risk factors affecting visual acuity.
        Am J Ophthalmol. 2014; 157: 180-185
        • Day A.C.
        • Gartry D.S.
        • Maurino V.
        • Allan B.D.
        • Stevens J.D.
        Efficacy of anterior capsulotomy creation in femtosecond laser-assisted cataract surgery.
        J Cataract Refract Surg. 2014; 40: 2031-2034
        • Roberts T.V.
        • Lawless M.
        • Bali S.J.
        • Hodge C.
        • Sutton G.
        Surgical outcomes and safety of femtosecond laser cataract surgery.
        Ophthalmology. 2013; 120: 227-233
        • Abell R.G.
        • Davies P.E.
        • Phelan D.
        • Goemann K.
        • McPherson Z.E.
        • Vote B.J.
        Anterior capsulotomy integrity after femtosecond laser-assisted cataract surgery.
        Ophthalmology. 2014; 121: 17-24
        • Chang J.S.
        • Chen I.N.
        • Chan W.M.
        • Ng J.C.
        • Chan V.K.
        • Law A.K.
        Initial evaluation of femtosecond laser system in cataract surgery.
        J Cataract Refract Surg. 2014; 40: 29-36
        • Lawless M.
        • Bali S.J.
        • Hodge C.
        • Roberts T.V.
        • Chan C.
        • Sutton G.
        Outcomes of femtosecond laser cataract surgery with a diffractive multifocal intraocular lens.
        J Refract Surg. 2012; 28: 859-864
        • Takács A.I.
        • Kovács I.
        • Miháltz K.
        • Filkorn T.
        • Knorz M.C.
        • Nagy Z.Z.
        Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification.
        J Refract Surg. 2012; 28: 387-391
        • Conrad-Hengerer I.
        • Al Juburi M.
        • Schultz T.
        • Hengerer F.H.
        • Dick H.B.
        Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up.
        J Cataract Refract Surg. 2013; 39: 1307-1313
        • Abell R.G.
        • Allen P.L.
        • Vote B.J.
        Anterior chamber flare after femtosecond laser-assisted cataract surgery.
        J Cataract Refract Surg. 2013; 39: 1321-1326

      Biography

      Soon-Phaik Chee is currently Head, Cataract at the Singapore National Eye Centre (SNEC) and Singapore Eye Research Institute and Head, Ocular Inflammation and Immunology at the SNEC. In addition, she is Professor, Duke-National University of Singapore Graduate Medical School and at the Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore. Her research interests lie in femtosecond laser cataract surgery, cataract techniques and complex cataract.

      Biography

      Seng-Ei Ti is currently Senior Consultant, Cornea Service at the Singapore National Eye Centre (SNEC). Her current speciality practice revolves around cataract, cornea and refractive surgeries. She holds a special interest in ocular surface reconstructive surgery using amniotic membrane transplantation. Her research interests include translational research involving laboratory cultivation of limbal stem cells for clinical transplantation and cataract intraocular lens implant clinical trials.

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