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AIM: To explore the effects of femtosecond laser-assisted cataract surgery combined with intraocular lens implantation(FLACS-IOL)on postoperative deviation rate of multifocal intraocular lens(MIOL)and visual quality in cataract patients.METHODS: In the prospective study, 95 patients with cataract(108 eyes)who underwent MIOL implantation in the hospital between January 2021 and December 2022 were enrolled. According to different surgical methods, they were divided into FLACS group(51 cases, 56 eyes)and Phaco group(44 cases, 52 eyes). The operation time, incision diameter of anterior capsule, effective phaco time(EPT), cumulative dissipated energy(CDE), uncorrected distance visual acuity(UCDVA), best corrected distance visual acuity(BCDVA), eccentricity distance of IOL and deviation rate at 3 mo after surgery, total high order aberration(HOA), Trefoil and coma under 3 mm pupil were compared between the two groups.RESULTS: The operation time in the FLACS group was significantly shorter than that in the Phaco group, EPT and CDE were significantly lower than those in the Phaco group(all P<0.05). There was no significant difference in incision diameter of anterior capsule between the two groups(P>0.05). At 1 wk, 3 mo after surgery, UCDVA in the FLACS group was better than that in the Phaco group(all P<0.05). There were significant difference in UCDVA at 1 wk, 3 mo after surgery or BCDVA at 3 mo after surgery between the two groups(P<0.05). At 3 mo after surgery, eccentricity distance of IOL in the FLACS group was shorter than that in the Phaco group, and deviation rate was significantly lower than that in the Phaco group(all P<0.05). Under pupil diameter of 3 mm, HOA, trefoil and coma of whole eyes were decreased in both groups at 3 mo after surgery(P<0.05). At 3 mo after surgery, there were significant differences in HOA and trefoil of whole eyes between the FLACS group and Phaco group(P<0.05), but there was no significant difference in coma at 3 mo after surgery(P>0.05).CONCLUSION: FLACS-IOL can effectively reduce deviation rate of IOL and obtain better visual quality in cataract patients.
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AIM: To measure the indexes including postoperative distance, middle, near visual acuity and near stereopsis vision of patients with high myopia cataract and corneal astigmatism by femtosecond laser, which can quantify the diameter of capsulorhexis opening, and to evaluate the availability and necessity of Toric intraocular lenses(IOL)in high myopia.METHODS: Prospective case-control study. Patients with binocular high myopia cataract and corneal astigmatism who undergone femtosecond laser-assisted cataract surgery in our hospital were selected, and they were divided into two groups, with 20 cases(40 eyes)in group A(Toric IOL)and 20 cases(40 eyes)in group B(IQ IOL). Indexes, including preoperative corneal astigmatism and spherical equivalent and best-corrected distance visual acuity, uncorrected middle visual acuity, uncorrected near visual acuity, residual refractive astigmatism, near stereopsis acuity, total high-order aberration and total spherical aberration, were measured postoperatively at 7d, 1 and 3mo.RESULTS: The uncorrected middle and near visual acuity, Titmus near stereopsis acuity and residual astigmatism at 7d, 1 and 3mo after surgery were significantly improved in the Toric IOL group than the non-Toric group(all P&#x003C;0.05). The dependence on glasses was reduced. The postoperative best-corrected distance visual acuity, total high-order aberration and total spherical aberration of the two groups showed no statistically significant differences(all P&#x003E;0.05).CONCLUSIONS: The implantation of Toric IOL in patients with high myopia cataract and corneal astigmatism can effectively correct corneal astigmatism, improve postoperative uncorrected middle and near visual acuity and near stereopsis visual function, reduce postoperative dependence on glasses and enhance binocular stereopsis visual function.
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AIM: To evaluate the clinical efficacy of femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation.METHODS:The retrospective study enrolled 22 cases(26 eyes)of cataract patients who underwent femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation from August 2020 to August 2021. Follow-up to 3mo after surgery, the changes of far, intermediate and near visual acuity, aberration, Strehl ratio(SR)and modulation transfer function cutoff(MTF-cutoff)frequency were compared. Defocus curve at 1mo postoperatively was made, and the visual quality and satisfaction were evaluated after 3mo of surgery.RESULTS: The visual acuity of all patients was better than 0.1(LogMAR)at the far, intermediate and near distance at 1d, 1wk, 1 and 3mo postoperatively, and it was significantly improved compared with those before surgery(all P&#x003C;0.01). The defocus curve transitioned smoothly between +0.5 and -3.0D at 1mo after surgery, and visual acuity was better than 0.63. The total aberration and spherical aberration in the whole eye were significantly lower after surgery than before, and the SR and MTF-cutoff were significantly improved at 1d and 1wk after surgery(all P&#x003C;0.05). With high satisfaction and good visual quality, patients could watch at far, intermediate and near distance without wearing glasses at 3mo after surgery.CONCLUSION: Femtosecond laser-assisted cataract surgery combined with PanOptix trifocal intraocular lens implantation gave patients a comfortable and satisfactory full-course vision.
ABSTRACT
We propose a technique for combined femto laser?assisted cataract surgery (FLACS) and limited vitrectomy from the pars?plana site for optimization of surgical results in subluxated cataracts. FLACS creates a free?floating, customised capsulotomy, minimizes stress on compromised zonules, and prechops the nucleus, effectively reducing the ultrasonic power as well as the forces required to chop the nucleus. The area of zonular dehiscence creates a direct communication between the irrigation fluid and the anterior vitreous, leading to its hydration. Trans?limbal vitrectomy creates a continuum between the liquefied vitreous and the main wound, leading to further vitreous loss, and exaggeration of the zonular weakness, while pars?plana vitrectomy avoids this by cutting the liquefied vitreous, near its attachment, thereby preventing further hydration and causing lesser stress to the zonules. A combination of these procedures, along with a capsule support device, gives favorable surgical outcomes in moderate to severe subluxations.
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Purpose: To determine the rate of posterior capsular rupture (PCR) and assess the postoperative outcomes in patients of posterior polar cataract (PPC) undergoing phacoemulsification using a combination of 揤� or �� nucleofractis and viscodissection. Methods: It was a retrospective study of 80 eyes of 64 patients undergoing surgery for PPC. All surgeries were performed by a single surgeon. After completion of the continuous curvilinear capsulorrhexis (CCC), controlled hydrodelineation was used to separate the endonucleus from the epinuclear shell with limited viscodissection. Phacoemulsification was then carried out by making a 揤� or lambda-shaped nucleofractis with the phaco tip followed by multiple chopping of the nucleus, ensuring the integrity of the epinuclear part of the lens. The epinuclear plate was removed after viscodissection. Results: The overall rate of PCR was 7.5% (6 out of 80 eyes). Of the 6 eyes, 4 eyes had been documented to have a pre-existing posterior capsular defect on slit-lamp examination. The rate of 搊n table� PCR, that is, PCR occurring intraoperatively was only 2.6% (2 of 76 eyes). Nucleus drop was not encountered in any case. Overall 87.5% eyes achieved a final visual acuity of 20/40 or better with 68.75% being 20/20 or better. Of the eyes developing PCR, two-third achieved a visual acuity of 20/30 or better. Conclusion: Using a combination of surgical techniques of V groove or lambda technique for nucleofractis and removal of epinucleus by viscodissection can result in a low rate of PCR and extremely good postoperative outcomes in cases of PPC.
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Femtosecond laser-assisted cataract surgery was performed in a case of posttraumatic cataract with six clock hours subluxation and vitreous in the anterior chamber (AC). Femtosecond laser pretreatment allowed a closed-chamber creation of corneal incisions, capsulotomy, and lens fragmentation with minimal sudden lens-diaphragm movements and zonular stress. Integrated imaging systems allowed customization of the size and position of capsulotomy and nuclear fragmentation, based on the extent and site of subluxation. Presence of vitreous in AC did not hamper femtosecond laser application. Triamcinolone-assisted vitrectomy was performed before phacoemulsification and after implanting the intraocular lens (IOL). Postoperative uncorrected visual acuity was 20/20 with a stable IOL.
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@#AIM: To investigate the related factors of pupil diameter changes in femtosecond laser-assisted cataract surgery in patients of different ages and their effects on the operation time and surgical efficacy of patient interface.<p>METHODS: One hundred and one patients(101 eyes)with femtosecond laser assisted cataract surgery were enrolled in this study from March 2017 to June 2018, the age group was divided into middle-aged group(46 cases)and old age group(55 cases). Routine mydriasis was carried out in every patient. The operation time of patient interface, docking time, nucleus radius and pupil diameter before, during and after interface operation, best corrected visual acuity before and after surgery were recorded. The state anxiety questionnaire was used to assess the state anxiety symptoms during interfacing operation and evaluate the clinical efficacy.<p>RESULTS: The age of patients with femtosecond laser assisted cataract surgery was significantly negatively correlated with the diameter of the pupil before, during and after the interface operation, the radius of the nucleus, and the state anxiety score. The interface operation time and the state anxiety score were significantly negative correlation. The pupil diameters of the middle-aged patients(8.89±0.57, 7.52±0.52, 8.96±0.54mm)were significantly greater than those of the elderly group(8.43±0.73, 7.14±0.55, 8.44±0.75mm)before, during and after the interface operation,and the state anxiety score(42.19±9.27)was significantly greater than that of the elderly group(39.80±9.15 points)(<i>P</i><0.01), however there was no difference in interface operation time, docking time and total effective rate of treatment between the two groups(<i>P</i>>0.05).<p>CONCLUSION: The pupillary changes in middle-aged femtosecond laser-assisted cataract patients are more sensitive and these patients are prone to anxiety, which has certain influence on the progress of the surgery.