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Study finds no significant differences in conventional, femtosecond phaco
Researchers who compared outcomes of conventional phacoemulsification with femtosecond laser-assisted cataract surgery found nonsignificant differences in clinical and patient-reported outcomes.
In this single-center, prospective, interventional, case-controlled trial, cataract surgery patients were randomized to receive one of the two procedures. The study involved 400 eyes of 400 patients; seven in the femtosecond laser group were unable to complete treatment and received conventional phaco; nine did not return for follow-up.
Researchers evaluated visual acuity, corneal topography, spectral domain OCT, endothelial cell count, central foveal thickness and quality of life outcomes preoperatively, the day of surgery and 4 weeks after surgery.
The study results “overwhelmingly” indicated “an absence of clinical differences” between the two procedures, the authors said, but they noted a significant reduction in posterior capsule ruptures in the femtosecond group.
Previous studies reported increases in visual acuity 1 week or 6 months after femtosecond laser-assisted surgery, but not in the 1- to 3-month time points, the authors said.
“In the current study, we chose to evaluate patients at 4 weeks, when the majority of postoperative edema and inflammation has settled,” they said.
The researchers also stated that they did not find the femtosecond procedures to result in more predictable refractive outcomes, contrary to other studies.
“Our overall median absolute error (0.32 D for femtosecond laser–assisted surgery and 0.29 D for conventional phaco) and proportions within ±0.5 D and ±1.0 D were similar between both
groups and in keeping with other studies in the literature,” they said. “However, in a subgroup analysis of this same study, we have shown better outcomes with femtosecond laser astigmatic keratotomies compared with manual limbal relaxing incisions.” – by Nancy Hemphill, ELS, FAAO
Disclosures: Roberts reported no relevant financial disclosures. Please see the full study for all other authors’ disclosures.
Perspective
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In our clinics, we recognize that both types of surgery are safe and effective. Careful preoperative evaluation and counseling are paramount in helping the patient make the best decision between the two. Patient refractive goals, existing ocular surface disease, macular pathology and lens anatomy all influence our recommendations for undergoing laser-assisted surgery. In our clinic the femtosecond laser has reduced retreatment rates and is especially useful when combined with presbyopia-correcting IOLs — a point that Roberts and colleagues did not investigate. While it is far from completely replacing traditional cataract extraction, laser-assisted surgery certainly deserves its place in the surgeon’s toolbox.