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Femtosecond laser cataract surgery carries lower risk of CME, study shows
A significant difference in the thickness of the inner macular region was found by OCT in femtosecond laser-treated eyes.
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Femtosecond laser-assisted cataract surgery might offer a reduced risk for postoperative cystoid macular edema compared to standard ultrasound phacoemulsification, according to a study.
Cystoid macular edema (CME) consists of fluid-filled cyst-like areas within the macula that lead to retinal thickening and vision loss. Modern cataract surgery techniques and low-ultrasound technology have reduced the incidence of CME as a postoperative complication.
Benefits of femtosecond laser
However, a certain amount of surgical trauma and inflammation are inherent in phaco and sometimes cause subclinical forms of CME, Zoltan Z. Nagy, MD, professor at Budapest University, Hungary, said at the winter meeting of the European Society of Cataract and Refractive Surgeons in Istanbul.
Femtosecond laser-assisted cataract surgery, on the other hand, minimizes inflammation, trauma and ultrasound use. Another advantage of this approach is its potential to reduce the incidence of CME.
“In a prospective, case-control study, we compared two groups of eyes — one treated with femtosecond laser (LenSx, Alcon), the other one with conventional phacoemulsification — to evaluate the potentially different impact of these two approaches on the macula,” Dr. Nagy said.
Study results
Twenty eyes of 20 patients were included in each group. Macular volume and macular thickness in three regions (central, inner macular ring and outer macular ring) were evaluated by optical coherence tomography before surgery and at 1 and 4 weeks postoperatively. All operations were performed under topical anesthesia.
“After adjustment for age and preoperative thickness values, we found no significant difference in two of the three macular regions. In the inner macular ring, a difference was found in favor of the femtosecond laser group at both the 1-week and 4-week time points. Phacoemulsification, in other words, had produced more thickening of the inner macular layer than femto,” Dr. Nagy said.
Mean thickness of the inner macular ring at baseline in the conventional phaco group was 275 µm, rising to 285 µm at 1 week and 295 µm at 1 month. In the femtosecond laser group, a slight decrease to 170 µm was seen at 1 week, followed by an increase to 280 µm at 1 month.
“Our results suggest that both methods are equally safe in terms of the effects on the macula. However, femtosecond cataract surgery may carry a reduced risk over standard phacoemulsification for postop CME,” he said.
The potentially decreased risk of developing postoperative CME could be particularly advantageous for patients with ocular comorbidities such as uveitis and diabetic retinopathy, Dr. Nagy noted. – by Michela Cimberle
- Zoltan Z. Nagy, MD, can be reached at the Semmelweis University Department of Ophthalmology, Maria u. 39, H-1085 Budapest, Hungary; +36-20-815-8468; email: zoltan.nagy100@gmail.com.
- Disclosure: Dr. Nagy is a consultant for Alcon.