Surgical Outcomes and Safety of Femtosecond Laser Cataract Surgery: A Prospective Study of 1500 Consecutive Cases

doi:10.1016/j.ophtha.2012.10.026

Ophthalmology

Volume 120, Issue 2, February 2013, Pages 227-233

https://doi.org/10.1016/j.ophtha.2012.10.026 Get rights and content

Objective

To report the surgical outcomes and safety of femtosecond (FS) laser cataract surgery (LCS) with greater surgeon experience, modified techniques, and improved technology.

Design

Prospective, interventional case series.

Participants

Fifteen hundred consecutive eyes undergoing FS laser cataract and refractive lens exchange surgery in a single group private practice.

Intervention

Femtosecond LCS.

Methods

All eyes undergoing LCS between April 2011 and March 2012 were included in the study. Cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the Alcon/LenSx FS laser (Alcon/LenSx, Aliso Viejo, CA). The procedure was completed by phacoemulsification and insertion of an intraocular lens. The cases were divided into 2 groups: Group 1, initial experience consisting of the first 200 cases; and group 2, the subsequent 1300 cases performed by the same surgeons.

Main Outcome Measures

Intraoperative complication rates and comparison between groups.

Results

Both groups were comparable for baseline demographic parameters. Anterior capsule tears occurred in 4% and 0.31% of eyes, posterior capsule tears in 3.5% and 0.31% of eyes, and posterior lens dislocation in 2% and 0% of eyes in groups 1 group 2, respectively (P<0.001 for all comparisons). Number of docking attempts per case (1.5 vs 1.05), incidence of post-laser pupillary constriction (9.5% vs 1.23%), and anterior capsular tags (10.5% vs 1.61%) were significantly lower in group 2 (P<0.001 for all comparisons).

Conclusions

In the authors' experience, the surgical outcomes and safety of LCS improved significantly with greater surgeon experience, development of modified techniques, and improved technology.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Patients and Methods

This was a single-center, prospective, consecutive cohort study. Ethics approval was obtained from the local human research ethics committee for the evaluation of the safety and success of the LenSx laser system (Alcon, Fort Worth, TX). The study was a part of a prospective, multicenter, nonrandomized, postmarket evaluation undertaken after local regulatory approval was obtained for clinical use of the LenSx system. An in-depth discussion about the risks and benefits of the procedure was

Results

A total of 1500 consecutive cataract/refractive lens exchange surgeries performed with the LenSx FS laser were included in the study. Baseline and demographic parameters were comparable between the 2 groups (Table 2). A comparison of complications between the 2 groups is listed in Table 3. In summary, the incidence of major complications (anterior capsule tears, posterior capsule tears, and posterior lens dislocation) in group 2 was statistically lower compared with the initial group (0.31% vs

Discussion

This prospective, single-center study evaluates safety and surgical outcomes of FS LCS performed after the initial learning curve. We found a significantly lower rate of complications once the surgeons became familiar with the technology. The rate of major capsular complications (anterior and posterior tears) decreased from 7.5% to 0.62% with no cases of dropped nuclei or capsular block syndrome.

Preoperative demographic and clinical parameters were comparable between the 2 groups with no

Acknowledgments

The authors thank Drs. Colin Chan, Simon Chen, Mark Jacobs, Paul Hughes, and David Ng for allowing access to patient data.

References (40)

F.F. Marques et al.
Fate of anterior capsule tears during cataract surgery
J Cataract Refract Surg
(2006)
I.J. Dooley et al.
Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees
J Cataract Refract Surg
(2006)
I. Can et al.
Comparison of Nagahara phaco-chop and stop-and-chop phacoemulsification nucleotomy techniques
J Cataract Refract Surg
(2004)
S. Masket et al.
Astigmatic stabilization of 3.0 mm temporal clear corneal cataract incisions
J Cataract Refract Surg
(1996)
S. Masket et al.
Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility [letter]
J Cataract Refract Surg
(2010)
N.J. Friedman et al.
Femtosecond laser capsulotomy
J Cataract Refract Surg
(2011)
R.F. Steinert
Femto future: sizzle or steak?
Ophthalmology
(2012)
M. Lawless et al.
Femtosecond laser-assisted cataract surgery: an Australian experience
Asia Pac J Ophthalmol
(2012)
W.J. Dupps
Comparative-effectiveness research in cataract and refractive surgery: the CATT call
J Cataract Refract Surg
(2011)
S.J. Bali et al.
Early experience with the femtosecond laser for cataract surgery
Ophthalmology
(2012)

Cited by (212)

Application of Femtosecond Laser in Challenging Cataract Cases
2023, Asia-Pacific Journal of Ophthalmology
Femtosecond laser can provide precise and customized incision of ocular tissue with excellent accuracy and predictability. Thus, femtosecond laser–assisted cataract surgery (FLACS) can theoretically enhance the safety and efficacy of cataract surgery by providing reproducible and reliable clear corneal incision, limbal relaxing incision, anterior capsulotomy, and lens fragmentation. However, thus far, the superiority of the anatomical and visual outcomes of FLACS over those of conventional cataract surgery have been unclear. Nevertheless, studies have indicated that FLACS can potentially be helpful in improving the safety of cataract surgery in challenging situations, such as zonular weakness, preexisting capsular tear, white cataract, shallow anterior chamber, and pediatric cataracts, which may contribute to enhanced visual and anatomical outcomes. In this review, we provide a summary of the application of femtosecond laser in general cataract cases. In addition, we introduce the application of FLACS in the abovementioned challenging situations and discuss the results of studies regarding the safety and outcome of FLACS in these challenging cases.
Efficacy of femtosecond laser for anterior capsulotomy in complex white cataracts
2023, Journal Francais d'Ophtalmologie
To determine the advantages and complication rate of capsulotomy performed with femtosecond laser in white complex cataract cases.
Retrospective case series.
Sixteen eyes of 16 patients.
This was a single-center retrospective review of white cataract surgery cases in which the femtosecond laser (LenSx, Alcon Laboratories, Fortworth, Texas, USA) was used between May 2019 and February 2021. Outcome measures included an assessment of the capsulotomy, identification of tags, surgical time, cumulative dispersed energy (CDE) and postoperative management.
Sixteen eyes of 16 patients were included in this study; capsule tags occurred in six patients (37.5%). In 2 patients, the capsule presented small adhesions that were identified and removed. One patient presented a very significant contraction of the anterior capsule with an incomplete cut zone of 2 to 4 hours. In a patient with nystagmus, the capsulotomy was performed without complications under peribulbar anesthesia.
The femtosecond laser permitted capsulotomies of better shape, size and regularity in complex cases of white cataract and in combination with conditions such as nystagmus and prior corneal transplantation. The microadhesions and untreated areas were identified with trypan blue, which is essential to use in these cases to avoid associated complications.
Déterminer les avantages et le taux de complications de la capsulotomie réalisée au laser femtoseconde dans les cas de cataracte complexe blanche.
Série de cas rétrospective.
Seize yeux de 16 patients.
Il s’agissait d’une revue rétrospective monocentrique de cas de chirurgie de la cataracte blanche dans lesquels le laser femtoseconde (LenSx, Alcon Laboratories, Fortworth, Texas, États-Unis) a été utilisé entre mai 2019 et février 2021. Les mesures des résultats comprenaient une évaluation de la capsulotomie, identification des repères, temps opératoire, énergie dispersive cumulative (CDE) et prise en charge postopératoire.
Seize yeux de 16 patients ont été inclus dans cette étude; des étiquettes de capsule sont survenues chez six patients (37,5 %). Chez 2 patients, la capsule présentait de petites adhérences qui ont été identifiées et retirées. Un patient a présenté une contraction très importante de la capsule antérieure avec une zone de coupe incomplète de 2 à 4 heures. Chez le patient atteint de nystagmus, la capsulotomie a été réalisée sans complication sous anesthésie péribulbaire.
Le laser femtoseconde a permis d’obtenir des capsulotomies de forme et de taille d’une plus grande régularité dans les cas complexes de cataracte blanche et d’associations telles que nystagmus et greffe de cornée antérieure. Les micro-adhérences et les zones non traitées ont été identifiées avec du bleu trypan, indispensable à utiliser dans ces cas et pour éviter les complications associées.
Prostaglandin Release After Low-Energy Femtosecond Laser-Assisted Cataract Surgery Without Anti-Inflammatory Drug Premedication
2022, American Journal of Ophthalmology
To compare prostaglandin E2 (PGE-2) levels in the aqueous and pupil diameter in patients undergoing low-pulse energy femtosecond laser-assisted cataract surgery (LCS) without non-steroidal anti-inflammatory (NSAID) pretreatment with either fragmentation or capsulotomy performed first.
Prospective, randomized, fellow-eye controlled comparison.
This study was undertaken at the Department of Ophthalmology, Medical University of Vienna. The population consisted of 140 eyes of 70 patients with bilateral age-related cataract. Bilateral same-day LCS with either anterior capsulotomy before lens fragmentation (Caps-First) in one eye or vice versa (Frag-First) in a random sequence were performed. Aqueous was tapped 5 minutes after LCS and PGE-2 concentration was analyzed. Pupil diameters were recorded immediately before and after femtosecond laser pretreatment. The main outcome measure was PGE-2 concentrations in picograms/milliliter and pupil diameter in millimeters.
Mean PGE-2 concentrations were 42.0 ± 63.7 pg/mL in the Caps-First group versus 71.8 ± 160.7 pg/mL with the Frag-First group (P = .186). Mean pupil diameters before and after pretreatment were 7.6 ± 0.8 mm and 7.6 ± 0.8 mm, respectively (P = .871). Mean PGE-2 concentrations and pupil diameters did not show any significant difference between time points or groups.
Low-energy femtosecond laser pretreatment did not increase PGE-2 levels in the absence of NSAID pretreatment. This was independent of whether capsulotomy or fragmentation was performed first. Moreover, no pupillary miosis was observed.
Photo-responsive intraocular lens with on demand drug release for posterior capsule opacification prevention and improved biosafety
2022, Chemical Engineering Journal
Posterior capsular opacification (PCO) is the most common complication after cataract surgery, which is caused by the adhesion, proliferation, migration and epithelial-mesenchymal transformation of the residual lens epithelial cells (LECs) in lens capsule. The drug eluting coating modification provides a powerful way to inhibit PCO incidence after IOL implantation. However, the uncontrolled proliferative drug brings intraocular biosafety issues when application. Therefore, developing new strategies with controlled drug release for PCO prevention is of great significance. In this investigation, a hydrophilic photo-responsive drug release coating was successfully constructed on IOL surface, which was verified through ¹H•NMR, UV–Vis, FTIR and XPS. In vitro assay indicated that the IOL coating exhibited excellent anti-adhesion and anti-proliferation effects on LECs under irradiation. The photo-controlled drug release in vitro can be achieved by simply adjusting the intensity and time of irradiation. Finally, the surface-modified IOL was implanted in rabbit eyes and in vivo evaluation was carried out. In vivo assay demonstrated that the implantation of the modified IOL into eyes can significantly reduce the occurrence of PCO. Moreover, the modified IOL exhibited good biocompatibility and biosafety. We believe that this work will provide a synergistic strategy for effective prevention of PCO through a photo-controllable drug release coating on IOL surface.
Surgical time and efficacy of illuminated chopper-assisted cataract surgery involving miosis after femtosecond laser pretreatment
2024, European Journal of Ophthalmology
Preventing the Argentinian flag sign and managing anterior capsular tears: A review
2024, Indian Journal of Ophthalmology

View all citing articles on Scopus

: Manuscript no. 2012-851.

: Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

: Michael Lawless is a member of the Medical Advisory Board of Alcon LenSx, USA.

View full text

Original articleSurgical Outcomes and Safety of Femtosecond Laser Cataract Surgery: A Prospective Study of 1500 Consecutive Cases

Objective

Design

Participants

Intervention

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Patients and Methods

Results

Discussion

Acknowledgments

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Ophthalmology

Asia Pac J Ophthalmol

J Cataract Refract Surg

Ophthalmology

J Cataract Refract Surg

Ophthalmology

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

J Cataract Refract Surg

Ophthalmology

Ophthalmology

J Cataract Refract Surg

Original article
Surgical Outcomes and Safety of Femtosecond Laser Cataract Surgery: A Prospective Study of 1500 Consecutive Cases