Femtosecond laser-assisted cataract surgery combined with trifocal intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical efficacy of femtosecond laser-assisted cataract surgery combined with trifocal intraocular lens(IOL)implantation.<p>METHODS:From September 2016 to November 2017, 42 cases(59 eyes)of cataract patients receiving trifocal IOL implantation in Shanxi Eye Hospital were retrospectively enrolled in this study. Moreover, the visual and refractive outcomes, defocus curve, refractive stability, high order aberrations, patient satisfaction, and spectacle independence were evaluated at 1wk, 1mo, 3mo and 6mo after surgery, respectively.<p>RESULTS: All patients had attained good visual acuity of >0.1 LogMAR at different distances during the follow-up period; besides, the visual acuity at each distance was remarkably higher compared with that before surgery(<i>P</i><0.05). The defocus curve had displayed no significant decrease between 0D to -2.5D at 6mo postoperatively, with the visual acuity better than 0.8. At 6mo postoperatively, 63%(37 eyes)eyes had a spherical equivalent(SE)of ±0.25D, and 88%(52 eyes)eyes had a SE of ±0.50D. The incidences of high order aberrations, coma, spherical aberration and trefoil of all eyes were evidently lower than those before surgery, and the difference was statistically significant(<i>P</i><0.05). <p>CONCLUSION: Femtosecond laser-assisted cataract surgery combined with trifocal IOL implantation can provide patient with a comfortable and natural full-range vision, which can greatly improve the postoperative satisfaction of patients.

Possible Risk Factors Affecting Successful Femtosecond Laser-assisted Cataract Surgery

PURPOSE: To determine the risk factors of intraoperative complications in femtosecond laser-assisted cataract surgery. METHODS: This study included 598 eyes of 337 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) between July, 2012 and January, 2017. All eyes had corneal incisions, anterior capsulotomy, nuclear fragmentation, and limbal relaxing incisions (if required). Intraoperative complications were analyzed by watching videos, and the related factors of each complication were retrospectively reviewed alongside the medical records. RESULTS: The mean age of the patients was 62.1 ± 11.9 years. Among the study group, 18 eyes required manual creation of corneal incisions; because the corneal incisions could not be made due to corneal central opacity, corneal peripheral degeneration, ptreygium, conjunctival chalasis, or idiopathic. The anterior capsulotomy was incomplete in 43 cases and manual capsulorrhexis was required for completion. These cases were associated with various conditions, including hypermature cataract, anterior polar or subcapsular cataract, corneal central opacity, pupillary abnormality, lens subluxation, poor pupil dilation, and idiopathic. Overall, 22 eyes had difficulties with nuclear fragmentation, with either mature cataract, lens subluxation, corneal central opacity, anterior polar or subcapsular cataract, or pupillary abnormality. Using the Laser SoftFit™ patient interface decreased the incidences of incomplete corneal incision (from 3.56% to 2.24%, p = 0.367), anterior capsulotomy (from 9.31% to 4.03%, p < 0.05), and nuclear fragmentation (from 5.20% to 1.34%, p < 0.05). The incidences of complications in the experienced group was statistically lower compared with the novice group (p < 0.05 for all comparisons). CONCLUSIONS: The femtosecond laser platform was effective and safe for cataract surgery. However, in the presence of related factors, use of this platform might need to be re-assessed and should be considered for intraoperative complications. Additionally, with the Laser SoftFit™ patient interface and improved surgeon experience, better intraoperative results can be expected for FLACS surgery.

Comparison of Effective Phacoemulsification Time between Femtosecond Laser-Assisted Cataract Surgery and Conventional Cataract Surgery

PURPOSE: To compare the effect of femtosecond laser-assisted cataract surgery with conventional cataract surgery on effective phacoemulsification time (EPT). METHODS: This study included 66 patients 100 eyes who underwent femtosecond laser-assisted cataract surgery and 68 patients 100 eyes who underwent conventional cataract surgery. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated. The groups were further analyzed according to preoperative Lens opacities classification system (LOCS) III grading. Patients who had femtosecond laser-assisted cataract surgery underwent lens fragmentation with quadrant, hybrid, or grid pattern and the EPT was respectively evaluated. RESULTS: The mean EPT was 5.85 +/- 4.31 seconds in the femtosecond laser-assisted cataract surgery group and 10.34 +/- 6.61 seconds in the conventional group. Overall, EPT was statistically significantly lower in the femtosecond laser-assisted cataract surgery group compared to the conventional group. When the groups were analyzed according to LOCS III grading, this result was consistent for all cataract grades and the reduction in EPT was increased with the higher LOCS III grade. When the groups were analyzed according to lens fragmentation patterns, the mean EPT was lower with 350 microm grid pattern than the quadrant or hybrid pattern. CONCLUSIONS: The femtosecond laser-assisted system in cataract surgery can be an efficient cataract surgery using lower EPT compared to the conventional procedure. Additionally, significant differences were observed in the mean EPT of cataract surgery using the femtosecond laser-assisted system among the 3 lens fragmentation pattern groups.

Comparison of Continuous Curvilinear Capsulorhexis Parameters between Femtosecond Laser and Conventional Cataract Surgery

PURPOSE: To compare parameters of femtosecond laser and manual continuous curvilinear capsulorhexis (CCC) using anterior segment optical coherence tomography (AS-OCT). METHODS: Femtosecond laser cataract surgery was performed in 30 eyes of 30 patients, and conventional cataract surgery with a manual CCC in 30 eyes of 30 patients. One month after surgery, CCC diameters, circularity of capsulotomy, and distance between the CCC and pupil center were analyzed using the AS-OCT. RESULTS: Mean maximal CCC diameter was 4.96 +/- 0.23 mm in the femtosecond laser group, and 4.70 +/- 0.82 mm in the manual CCC group. Mean minimal CCC diameter was 4.91 +/- 0.23 mm in the femtosecond group, and 4.48 +/- 0.64 mm in the manual CCC group showing significant difference between the two groups (p = 0.000). Circularity of capsulotomy was 0.99 +/- 0.01 in the femtosecond group and 0.91 +/- 0.13 in the manual CCC group and was statistically different between the 2 groups (p = 0.000). The distance from the CCC center to the pupil center was 0.18 +/- 0.09 mm in the femtosecond group and 0.26 +/- 0.17 mm in the manual CCC group. The CCC center was closer to the pupil center in the femtosecond than in the manual CCC group (p = 0.038). CONCLUSIONS: Properly sized and shaped capsulotomy can be expected in femtosecond laser CCC compared with manual CCC.

Comparison of Continuous Curvilinear Capsulorhexis Parameters between Femtosecond Laser and Conventional Cataract Surgery

PURPOSE: To compare parameters of femtosecond laser and manual continuous curvilinear capsulorhexis (CCC) using anterior segment optical coherence tomography (AS-OCT). METHODS: Femtosecond laser cataract surgery was performed in 30 eyes of 30 patients, and conventional cataract surgery with a manual CCC in 30 eyes of 30 patients. One month after surgery, CCC diameters, circularity of capsulotomy, and distance between the CCC and pupil center were analyzed using the AS-OCT. RESULTS: Mean maximal CCC diameter was 4.96 +/- 0.23 mm in the femtosecond laser group, and 4.70 +/- 0.82 mm in the manual CCC group. Mean minimal CCC diameter was 4.91 +/- 0.23 mm in the femtosecond group, and 4.48 +/- 0.64 mm in the manual CCC group showing significant difference between the two groups (p = 0.000). Circularity of capsulotomy was 0.99 +/- 0.01 in the femtosecond group and 0.91 +/- 0.13 in the manual CCC group and was statistically different between the 2 groups (p = 0.000). The distance from the CCC center to the pupil center was 0.18 +/- 0.09 mm in the femtosecond group and 0.26 +/- 0.17 mm in the manual CCC group. The CCC center was closer to the pupil center in the femtosecond than in the manual CCC group (p = 0.038). CONCLUSIONS: Properly sized and shaped capsulotomy can be expected in femtosecond laser CCC compared with manual CCC.