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Femtosecond laser-assisted cataract surgery for the white cataract
  1. Soon-Phaik Chee1,2,3,4,
  2. Nicole Shu-Wen Chan1,
  3. Younian Yang1,
  4. Seng-Ei Ti1,3,4
  1. 1 Singapore National Eye Centre, Singapore, Singapore
  2. 2 Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  3. 3 Singapore Eye Research Institute, Singapore, Singapore
  4. 4 Duke-NUS Medical School, Singapore, Singapore
  1. Correspondence to Professor Soon-Phaik Chee, Singapore National Eye Centre, Singapore 168751, Singapore; chee.soon.phaik{at}


Aim To report the capsulotomy and lens fragmentation outcomes of white cataracts managed with the femtosecond laser (FL).

Methods Outcomes of a prospective, observational consecutive case series of white cataracts (June 2012–November 2016) that underwent FL-assisted cataract surgery (FLACS) (Victus, Bausch+Lomb, Munich, Germany) at the Singapore National Eye Centre were audited. Data collected: patient demographics, type of white cataract, levelness of docking, anterior capsule position following laser, completeness of capsulotomy and fragmentation, best-corrected visual acuity (BCVA) at 1 month, intraoperative complications. Outcome measures: capsulotomy integrity, fragmentation capability and BCVA at 1 month.

Results 58 eyes of 54 patients underwent FLACS. White cataract types included dry white (24 eyes), intumescent (28 eyes) and Morgagnian (6 eyes). Docking was level in 22 eyes (38.6%). Following FL, the anterior capsule level dropped in 20 eyes (34.5%). Incomplete capsulotomies occurred in 10 eyes (17.2%). Lens fragmentation attempted in 38 eyes was effective or partially effective in 31 eyes (81.6%). No anterior or posterior capsule tears occurred. LogMAR BCVA at 1 month was 0.073 (SD 0.09). Risk factors for incomplete capsulotomy were Morgagnian cataract and lens thickness (multiple logistic regression, p<0.01 and p=0.03, respectively).

Conclusion The main complication of FLACS in white cataracts was incomplete capsulotomy (17.2%), significantly associated with Morgagnian cataracts and increased lens thickness. Lens fragmentation was effected in four-fifths of white cataracts but should be avoided in Morgagnian cataracts due to possible overlap of the lens fragmentation plan and the anterior capsule.

  • treatment lasers
  • treatment surgery
  • white cataract
  • femtosecond laser
  • capsulotomy

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  • Presented at Presented at the XXXV Congress of the European Society of Cataract and Refractive Surgery 2017 in Lisbon, Portugal.

  • Contributors S-PC was involved in the conception and design of the study, drafting of the manuscript and critical revision for important intellectual content. NS-WC was involved in the drafting of the manuscript and critical revision for important intellectual content. YY was involved in the data collection and statistical analysis of the data as well as critical revision for important intellectual content. S-ET was involved in the drafting of the manuscript and critical revision for important intellectual content. All authors have approved the final version published and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests S-PC is a speaker for AbbVie Pte Ltd., Alcon Laboratories, Allergan Inc, Bausch and Lomb Technolas, Carl Zeiss Meditec, Hoya Surgical Optics, Johnson & Johnson Vision, Santen Pharmaceutical Co. Ltd. and Ziemer Ophthalmic Systems. NS-WC and YY have no financial disclosures. S-ET is a speaker for PhysIOL.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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