Grid FLACS reduces corneal endothelial cell count loss in dense cataracts
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In patients with dense cataracts, a grid-based femtosecond laser helped reduce corneal endothelial cell count loss during phacoemulsification, according to a study published in the American Journal of Ophthalmology.
Soon-Phaik Chee, MBBS, of the Singapore National Eye Center, and colleagues wrote that previous studies have shown the benefit of femtosecond laser-assisted cataract surgery over manual phacoemulsification (PE). However, they were non-randomized studies and used the “stop and chop” method.
“When dealing with brunescent lenses, the most energy efficient technique for managing the tough nucleus is using a technique which minimizes sculpting,” Chee and colleagues wrote. “Thus, the comparison between FLACS and the manual PE in these studies was perhaps not as well matched as when an in-situ phaco chop technique is used.”
Researchers compared the 600-µm grid femtosecond laser-assisted cataract surgery (FLACSg) with a 16-segment FLACS (FLACS16) and PE in patients with nuclear opacity (NO) of at least 5 (LOCS III). Researchers used the Victus laser platform (Bausch + Lomb) for the procedures and performed the in-situ chop technique in all cases.
Investigators collected data on patient demographics, best corrected visual activity at baseline and at 1 month after operation, endothelial cell count (ECC), effective phacoemulsification time (EPT) and perioperative complications. The outcome measures of the study were loss of ECC at 1 month after surgery and EPT.
Chee and colleagues randomly assigned 93 patients (93.5% Chinese, mean age 74.3 years) to undergo FLACSg (22 patients), FLACS16 (23 patients) or PE (48 patients). In the study population, the most common NO for cataract grading was 5 or 6.
Although they observed a trend, Chee and colleagues found that EPT was not different among the treatment arms. However, EPT was higher for patients with NO greater than 6 compared with NO 6 or less (P < .001). There was also no difference in mean duration of surgery among the treatment groups (PE, 16.38 minutes; FLACS16, 15.26 minutes; FLACSg, 15.29 minutes).
One month after surgery, patients treated with FLACSg had less ECC loss than those treated with PE (P = .018). The difference in ECC loss between the PE and FLACS16 groups was not significant.
Chee told Healio/OSN that initially, their findings may seem surprising.
“However, using a laser to fragment the nucleus into 16 segments and manual PE are not that different in their effect on EPT when a direct phaco chop technique is used,” she said.
“They are similar in essence, as phaco energy is not used to chop through the dense nucleus nor laterally separate the tough fibers that bind the pre-fragmented segments.”