Arcuate keratotomy infiltration following uneventful femtosecond laser assisted cataract surgery

An 84-year-old gentleman underwent uneventful femtolaser-assisted cataract surgery (FLACS) with an arcuate keratotomy (AK) in the left eye. On the 18th post-operative day, a corneal infiltrate developed involving the AK. Staphylococcus epidermidis was the organism isolated on culture. The infiltrate resolved with topical fortified vancomycin and amikacin eyedrops, and the patient regained a visual acuity of 6/6 after 12 weeks. This is the first case from south-east Asia reported in the literature of an infective infiltrate along a femtosecond laser AK. We propose strict peri-operative recommendations to be followed to prevent and treat such infections.

Ultrasound power and irrigation volume in different lens opacity grades: comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification

OBJECTIVES: To compare the amount of ultrasound energy and irrigation volume in conventional phacoemulsification cataract surgery versus femtosecond laser-assisted phacoemulsification at different nuclear-cortical cataract grades. METHOD: This was a prospective, consecutive, investigator-masked nonrandomized parallel cohort study. Patients were divided into 4 groups (Phaco1, Phaco2, Femto1 and Femto2) according to the surgical technique (conventional phacoemulsification [Group Phaco] or femtosecond laser-assisted cataract surgery [Group Femto]) and the Lens Opacity Classification System III (LOCS) grade (LOCS<11 [group 1] or LOCS≥11 [group 2]). The measured outcomes were effective phacoemulsification time (EPT), indicating the ultrasound energy, and balanced salt solution (BSS) use, indicating the irrigation volume, to indirectly estimate the damage to the corneal endothelium caused by the cataract surgery. RESULTS: A total of 160 eyes from 109 patients were included: 87 eyes in Group Phaco, 73 eyes in Group Femto, 76 eyes in group 1 and 84 eyes in group 2. The EPT mean in Femto1 was 53% less (2.73±1.88, 0.1 to 8.65) than that in Phaco1 (5.80±2.86) (p=0.00) and in Femto2 (8.38±9.32) was 33% less than that in Phaco2 (12.55±8.38) (p=0.00). No significant differences in mean LOCS grades between the Phaco1 (8.21±1.44) and Femto1 (7.90±1.90) groups (p=0.73) or between the Phaco2 (13.15±2.55) and Femto2 (12.72±2.18) groups (p=0.95) were found. There were no significant differences in the mean BSS use between the Phaco1 (55.73±12.45) and Femto1 (59.37±10.93) groups (p=0.48) or between the Phaco2 (64.34±21.00) and Femto2 (65.71±17.60) groups (p=0.47). CONCLUSIONS: Compared to conventional phacoemulsification at different nuclear-cortical cataract grades, femtosecond laser-assisted cataract surgery provides an EPT reduction but does not influence the BSS use.

Comparación entre facoemulsificación asistida con femtoláser y facoemulsificación convencional: resultados visuales y complicaciones / Comparison between femtosecond laser-assisted phacoemulsification and conventional emulsification: visual results and complications

La aplicación del femtoláser en la cirugía de catarata podría ser una de las grandes revoluciones contemporáneas ocurridas en el campo del tratamiento de la catarata. Si el uso de esta tecnología provocara una eficacia y seguridad muy superiores sobre la facoemulsificación convencional, justificaría el alto costo que genera para la cirugía de catarata en la actualidad. En revisiones de estudios comparativos no se han encontrado diferencias significativas entre los resultados visuales de ambos procedimientos al final del período de seguimiento posoperatorio. Una mejor circularidad de la capsulorrexis, unido a disminución en la emisión de energía ultrasónica y del tiempo efectivo de faco, son atribuidos como las grandes ventajas del uso del femtoláser en la facoemulsificación. Sin embargo, en cuanto a la pérdida de células endoteliales, el edema corneal posoperatorio y el edema macular posquirúrgico no se han registrado grandes diferencias entre ambas técnicas quirúrgicas, mientras que el costo de la cirugía se incrementa considerablemente con la utilización del femtoláser. Por tanto, se necesitan estudios de gran tamaño de muestra bien diseñados que proporcionen evidencias más fiables respecto al uso del femtoláser en la cirugía de catarata actual(AU)

The application of femtoláser in cataract surgery could be one of the great contemporary revolutions occurred in the field of treatment of cataract. If the use of this technology would cause a very superior efficacy and safety over conventional phacoemulsification, it justifies the high cost it generates for cataract surgery today. In reviews of comparative studies we have not found significant differences between the visual results of both procedures at the end of the period of postoperative follow-up. Better circularity of the capsulorhexis, coupled with decrease in the emission of ultrasonic energy and effective phacoemulsification time, are attributed as the major advantages of using femtoláser in phacoemulsification. However in terms of endothelial cell loss, postoperative corneal edema and macular edema after surgery they have not been recorded big differences between the two surgical techniques, while the cost of surgery is considerably increased with the use of femtoláser. Therefore studies of large sample size, well-designed to provide more reliable evidence regarding the use of femtoláser in current cataract surgery are needed(AU)

Cirugía de catarata asistida con láser de femtosegundo / Femtosecond laser-assisted cataract surgery

Se realizó una búsqueda en la plataforma Infomed, específicamente en la Biblioteca Virtual de Salud, con el objetivo de conocer las técnicas más avanzadas en la cirugía de córnea y de catarata. La última incorporación de estas tecnologías es el láser de femtosegundo. La aplicación del femtoláser en la cirugía de catarata podría ser una de las más grandes revoluciones ocurridas en el campo del tratamiento quirúrgico ocular en los últimos años. Actualmente se dispone en el mercado de varias plataformas de láseres de femtosegundos aprobadas para cirugía de córnea y de catarata. Hoy en día se espera una agudeza visual posquirúrgica perfecta después de la cirugía de catarata con una excelente calidad visual, e independencia de los espejuelos respecto a la visión cercana y de lejos(AU)

A search was made in Infomed platform, particularly in the Virtual Library of Health, to find out the most advanced techniques in cornea and cataract surgery. The most recent one is the femtosecond laser that may become one of the greatest revolutions in the field of ocular surgical treatment in the last few years. Several femtosecond laser platforms are now available at the market, all of them approved to be used in cornea and cataract surgery. It is expected to attain a perfect visual acuity after the cataract surgery with excellent visual quality and to free the patient from using glasses regarding the near-sight and far-sight vision(AU)