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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<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>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<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<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.
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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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@#In recent years, with the extensive development of phacoemulsification and the gradual application of femtosecond laser technology in the field of cataract surgery, femtosecond laser-assisted cataract surgery(FLACS)has become popular year by year, and has been recognized and promoted by more and more doctors. Femtosecond laser technology has high accuracy, automation and repeatability, so it is quite suitable for cataract surgery characterized by precision operation, it can be used in cataract surgery for corneal incision and limbal incision, anterior capsule incision, lens fragmentation and other key operations. FLACS has broad application prospects and can greatly improve the predictability and safety of surgery. The emergence of FLACS is one of the most important developments in modern cataract surgery. With the continuous development of FLACS, cataract surgery will usher in new technological innovations. However, FLACS are relatively new, and longer term, more comprehensive data are still needed to better demonstrate their effectiveness in the future. We review the current research progress of FLACS.
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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.
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·AIM: To investigate the effect of femtosecond laser assistedcataractsurgeryconventional phacoemulsification surgery on corneal endothelial cell morphology and function. ·METHODS: This study included 80 cases of cataract patients (88 sicked eyes) treated in our hospital from January 2016 to January 2017. All patients underwent phacoemulsification combining with intraocular lens implantation for treatment. Based on the review of treatment, 40 cases ( 43 sicked eyes ) receiving femtosecond laser assisted cataract surgery were included into the observation group, 40 cases (45 sicked eyes) receiving conventional phacoemulsification only were divided into the control group. The proportion of patients whose postoperative uncorrected visual acuity >0.5 of the two groups were compared, and sac diameter, capsule size, intraoperative cumulative energy release (CDE) were recorded, the corneal endothelial cell density and variation were recorded before and after operation, the preoperative and postoperative ratio of hexagonal cells were compared between the two groups subsequently. and ·RESULTS: At 1d postoperatively, uncorrected visual acuity >0.5 of the observation group was no significant difference with that of the control group; the ratio was 74% at 6mo after surgery, which was significantly higher than that of the control group(53%),there was statistical significance (P < 0. 05). The diameter of the anterior capsulotomy,the size of the capsule,the grade Ⅱ nuclear CDE, and the grade Ⅲ nuclear CDE of the observation group were sharply different from those of the control group, there was statistical significance (P<0.05). The differences of corneal endothelial cell density and variation, proportion of hexagonal cells before and after surgery of the two groups were significant, and the difference after 6mo between the two groups was huge, there was statistical meaning (P<0.05). · CONCLUSION: Femtosecond laser assisted cataract surgery can reduce the effect of ultrasound energy on cornea,and can sharply decrease the damage to corneal endothelial cell morphology and function.