Femtosecond Laser Assisted Cataract Surgery With or Without Ophthalmic Viscosurgical Devices
To investigate the impact of the use of ophthalmic viscosurgical devices (OVDS) during femtosecond laser assisted cataract surgery (FLACS) in postoperative visual acuity (VA), endothelial cell count and pachymetry.
All patients undergoing FLACS during a 3 month study period were considered for inclusion in this study. Patients with any ocular pathology that might compromise visual acuity improvement after cataract surgery were excluded. After informed consent was obtained, patients were randomly assigned to undergo surgery with or without OVDS.
In the first group, OVDS were used to remove the anterior capsule and, once the cortex was removed, to fill the capsular bag prior to intraocular lens (IOL) insertion. In the second group, the IOL insertion was done while keeping the anterior chamber and the capsular bag distended with an irrigation handpiece introduced through the 1 mm paracentesis.
All patients underwent an extensive ophthalmic evaluation both prior and after surgery, including best-corrected VA, endothelial cell count and corneal apex pachymetry.
Surgery differences between both groups
GROUP 1: FLACS WITH OVDS.
Anterior capsulorhexis removal with OVDS
LIO injection with OVDS
GROUP 2: FLACS WITHOUT OVDS
Anterior capsulorhexis removal with irrigation handpiece
LIO injection mantaining anterior chamber with irrigation handpiece
Sixty four patients were included in group 1 (FLACS with OVD) and 64 patients in group 2 (FLACS without OVD).
Best corrected visual acuity was very similar in both groups, both before and after surgery.
Slight differences in endothelial cell count before surgery were found between both groups, although they were not statistically significant. Mean percentage of cell loss was the only statistically significant value
• The use of OVDS during FLACS does not seem to have an effect on visual improvement.
• Avoiding the use of OVDs during surgery may decrease endothelial cell loss and may decrease the postoperative IOP
– H. Burkhard Dick, PhD, MD; Ronald D. Gerste, Femtosecond Laser-Assisted Cataract Surgery Without Ophthalmic Viscosurgical Devices. J Refract Surg. 2013;29(11):784-787.
– Hatch KM, Talamo JH.. Laser –assited cataract surgery: benefits and barriers. Curr Opin Ophthalmol. 2014 Jan;25(1):54-61
– Conrad-Hengerer I, Al Juburi M, Schultz T, Hengerer FH, Dick HB. 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 Sep;39(9):1307-13
– Abell RG, Kerr NM, Vote BJ. Femtosecond laser-assisted cataract surgery compared with conventional cataract surgery. Clin Experiment Ophthalmol. 2013 Jul;41(5):455-62. doi: 10.1111/ceo.12025. Epub 2012 Dec 10.
– Therese Krarup, Lars Morten Holm, et al. Endothelial cell loss and refractive predictability in femtosecond laser-assisted cataract surgery compared with conventional cataract surgery. Acta Opht Scan. 2014.