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Surgeon’s experience a key factor in femtosecond laser-assisted cataract surgery outcomes
Later surgeries resulted in fewer complications compared to surgeries performed earlier in a surgeon’s experience with the technology.
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Once past the learning curve, surgeons previously inexperienced with femtosecond laser-assisted cataract surgery achieved complication rates similar to those achieved by more experienced surgeons, according to a study.
Surgeons initially involved in a “learning curve” study were assessed in a follow-up study that examined surgical outcomes once the learning period was concluded. Both studies appeared in Ophthalmology.
“In our initial study, we found that those surgeons with refractive surgical experience with a femtosecond laser had significantly fewer complications, such as posterior capsule rupture and dropped nuclei, than those for whom using a ‘patient interface’ and understanding the limitations of femtosecond technology were completely foreign,” study author Gerard Sutton, MBBS, MD, FRANZCO, a professor of corneal and refractive surgery at the Sydney Medical School Foundation, University of Sydney in Australia, told Ocular Surgery News.
The second study found that among later surgeries, posterior capsular rupture rates were lower than those reported in previously published literature, according to Sutton.
Follow-up
The follow-up study included 1,500 consecutive eyes that underwent femtosecond laser and refractive lens exchange surgery. The cases were divided into two groups: the first 200 cases and the subsequent 1,300 cases, all performed by the same surgeons. Surgical techniques used were similar for both groups.
Gerard Sutton
The incidence of major complications in group two was statistically lower than in group one for anterior capsule tears (0.31% vs. 4%), posterior capsule tears (0.31% vs. 3.5%) and posterior lens dislocation (0% vs. 2%).
The number of docking attempts per case (1.05 vs. 1.5), incidence of post-laser pupillary constriction (1.23% vs. 9.5%) and anterior capsular tags (1.61% vs. 10.5%) were also significantly lower for group two.
“Experience in docking, using phenylephrine after the laser to maintain pupillary dilation and progressive improvements in laser delivery through both software and hardware upgrades all contributed to improved safety,” Sutton said.
Modifications to the platform continue and, when coupled with the newest patient interface, have increased the free-floating capsule rate to greater than 95%, according to Sutton.
“As a consequence, issues associated with anterior capsular tags and tears have virtually disappeared. It has also meant that less energy is required to achieve the same level of nuclear fracture and that the procedure is even quicker,” he said.
Sutton said that if the study was conducted today with the latest patient interface and the incremental improvements in technology, the differences would be even starker.
Pearls for transitioning
When transitioning to the femtosecond laser for cataract surgery, Sutton emphasized the importance of becoming familiar with the patient interface and docking technique, and remembering that the femtosecond laser is not perfect, at times producing incomplete capsulotomies, nuclear fractures and wounds.
However, “there is no doubt that this technology is at least the equivalent of current standard techniques, with the promise and some early signs that it may prove safer and more predictable,” Sutton said. “The learning curve is now not that steep, and it is a delightful addition to an already wonderful surgical procedure.”
In light of the study results, Sutton said femtosecond laser technology may end up having the greatest impact not with experienced surgeons, but rather with beginning surgeons who might otherwise struggle with capsulotomies and nuclear fractures in dense cataracts. – by Bob Kronemyer