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Study: Femtosecond laser side cuts self-seal better than manual incisions
Laser and manual incisions yielded similar visual acuity, but wound leakage was more common with the manual incision.
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Femtosecond laser and manual corneal incisions yielded similar visual outcomes, but laser incisions sealed more effectively against potential leakage, according to a study presented at the American Society of Cataract and Refractive Surgery meeting in New Orleans.
“The focus of our study was on the quality of the incisions and their ability to self-seal,” study author Eric D. Donnenfeld, MD, told Ocular Surgery News.
Types of incisions
The randomized study included 45 eyes of 45 patients. Patients underwent a femtosecond laser 110° three-plane reverse side cut (group A, 15 patients), a femtosecond laser 70° three-plane forward side cut (group B, 15 patients), or a manual three-plane incision (group C, 15 patients).
The Catalys femtosecond laser (Abbott Medical Optics) was used to make all laser incisions.
“The 110° reverse side cut creates a tongue-in-groove type incision,” Donnenfeld, an OSN Cornea/External Disease Board Member, said. “All three incisions were the same width, 2.65 mm, and we aimed for a 1.2 mm length.”
Uncorrected and best corrected visual acuities were assessed preoperatively and at 1 day, 1 week and 1 month postoperatively.
“We did not look at topographies or higher-order aberrations, which is an area certainly worth looking at,” Donnenfeld said.
Incision stability and leakage were evaluated at the time of surgery without mechanical pressure. Seidel testing with and without pressure was performed at 1 day, 1 week and 1 month postoperatively.
“We didn’t do a pressure check in the operating room. We just did the pressure at which the wound started to leak. That was done in the operating room at the conclusion of the surgery,” Donnenfeld said.
Visual acuity
At 1 day after surgery, UCVA was 20/20 or better in 0% of eyes in group A, 13% of eyes in group B and 7% of eyes in group C. UCVA was 20/25 or better in 40% of eyes in group A, 27% of eyes in group B and 13% of eyes in group C. UCVA was 20/40 or better in 93% of eyes in group A, 80% of eyes in group B and 100% of eyes in group C.
BCVA was 20/25 or better in 100% of eyes in all three groups at 30 days.
“We saw no major differences between the laser cut and the manual incisions,” Donnenfeld said.
Wound leakage
At the conclusion of surgery, 10 patients in group A, four patients in group B and five patients in group C had no leakage without pressure.
Leakage was mild in five eyes in groups A and B and in one eye in group C. Leakage was moderate in five eyes in group B and in six eyes in group C. Leakage was severe in one eye in group B and in two eyes in group C.
Leakage occurred without pressure at a mean of 28.2 mm Hg in group A, 15.1 mm Hg in group B and 9.9 mm Hg in group C on the day of surgery. Differences between groups A and B and between groups A and C were statistically significant (P = .003 and P < .001, respectively).
No incisions in any group leaked without pressure 1 day after surgery, and no eyes in group A leaked with pressure 1 day after surgery.
“That is a significant advantage. As we know, wound leaks are the most common cause of endophthalmitis, and a better wound creates a safer incision with cataract surgery,” Donnenfeld said.
Eight eyes in group B and 13 eyes in group C leaked with pressure 1 day after surgery. Differences were significant between groups A and B (P = .003), groups A and C (P < .001), and groups B and C (P = .009).
Also at 1 day, leakage was mild in six eyes in group B and in five eyes in group C. Leakage was moderate in two eyes in group B and in seven eyes in group C. Leakage was severe in one eye in group C.
One day after surgery, leakage occurred without pressure at a mean of 21.8 mm Hg in group A and 21.7 mm Hg in groups B and C.
No eyes leaked with or without pressure at 14 days or 30 days. – by Matt Hasson
- References:
- Donnenfeld ED. Evaluating self-sealing efficacy and safety in primary corneal incisions created manually compared with a femtosecond laser in patients undergoing cataract surgery. Presented at: American Society of Cataract and Refractive Surgery meeting; May 6-10, 2016; New Orleans.
- VIDEO: Reverse side cuts with femtosecond laser enable better self-sealing of primary incision during cataract surgery. http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B99a580ba-2795-4339-ae41-75fb73e0e866%7D/video-reverse-side-cuts-with-femtosecond-laser-enable-better-self-sealing-of-primary-incision-during-cataract-surgery.
- For more information:
- Eric D. Donnenfeld, MD, can be reached at Ophthalmic Consultants of Long Island, 2000 North Village Avenue, Rockville Centre, NY 11570; email: ericdonnenfeld@gmail.com.
Disclosure: Donnenfeld reports he is a consultant for Abbott Medical Optics, Alcon and Bausch + Lomb.