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Femtosecond laser pretreatment lowers ultrasound use in phaco
In a group of 400 eyes pretreated with a femtosecond laser, 99% were treated without ultrasound.
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NEW ORLEANS — Femtosecond laser pretreatment enabled surgeons to perform cataract surgery without ultrasound in a significant majority of patients with mild to moderate cataracts, according to a study presented here.
Changes to phacoemulsification settings, phaco tips and surgical technique also contributed to decreasing use of ultrasound in successive study phases.
“We are very close to our final goal to treat all patients without ultrasound,” Tim Schultz, MD, said at the American Academy of Ophthalmology meeting. “Analysis offers many new possibilities with new techniques. We will see in following trials what the effects to the eye are.”
Schultz presented for H. Burkhard Dick, MD, and spoke during an original paper session and at an AAO media briefing.
Tim Schultz
“Phaco energy is one of the risk factors for endothelial cell loss during cataract surgery,” Schultz said. “The aim of the study was to investigate if it is possible to reduce effective phaco time with use of a femtosecond laser.”
Patients and study design
The prospective clinical trial included eyes that underwent femtosecond laser pretreatment and were compared with eyes that underwent standard cataract surgery.
Inclusion criteria were cataracts graded 1 to 4 on the Lens Opacities Classification System III (LOCS III) scale, pupil size larger than 6 mm and age older than 22 years.
All surgeries were performed by one surgeon at one center. Capsulotomy, lens fragmentation and partial corneal incisions were performed with the Catalys femtosecond laser (Abbott Medical Optics). The Stellaris phacoemulsification machine (Bausch + Lomb) was used to perform lens aspiration.
The first stage of the study included 650 laser cases and 650 standard cases.
Phacoemulsification settings, instrumentation and manual technique were altered between the first and second stages.
The second stage included 1,000 eyes that underwent laser pretreatment compared with 1,000 manual cases.
The third stage included 400 eyes that underwent laser pretreatment.
Results by cataract grade
In the first group of 650 laser cases, surgery was performed without ultrasound in 90% of eyes with grade 2 cataracts, 66% of eyes with grade 3 cataracts and 63% of eyes with grade 4 cataracts, Overall, 70% of eyes in this group were treated without ultrasound.
“In between, we conducted many changes in the setup, including changes in the settings of the phaco machine,” Schultz said. “We changed the phaco tip, and the laser was updated. Furthermore, the technique in the eye, the manual technique, was changed.”
In the group of 1,000 eyes that underwent laser pretreatment, surgery was performed without ultrasound in 100% of eyes with grade 2 cataracts, 98% of eyes with grade 3 cataracts and 87% of eyes with grade 4 cataracts. Overall, ultrasound was not used in 95% of eyes in this group.
In the group of 400 eyes pretreated with the femtosecond laser, 397 (99%) were treated without ultrasound. Three eyes had grade 4 cataracts and required ultrasound.
“At the moment, we are at 99% [without ultrasound], so we are very close to totally eliminating ultrasound from cataract surgery,” Schultz said. – by Matt Hasson