Comparison of Vitreous Loss Rates Between Manual Phacoemulsification Cataract Surgery and Femtosecond Laser–Assisted Cataract Surgery

Saturday, April 18, 2015: 1:16 PM
Room 4 (San Diego Convention Center)
Wendell Scott, MD
Shachar Tauber, MD
Johann Ohly, MD
Rachel Owsiak, MD
Craig Eck, MD
James A. Gessler, MD, MPH

To evaluate and compare the vitreous loss complication rate of the manual phacoemulsification (MP) cataract surgery technique versus the femtosecond laser-assisted cataract surgery (LCS) technique.

A total of 6,984 cataract surgery cases from 2010-2014 performed by four surgeons were audited for rates of vitreous loss.  3,784 cases from 2010-2012 were consecutively performed using MP while 3,200 cases from 2013-2014 were consecutively performed using LCS.  Cases in which vitreous loss occurred were determined by CPT coding, and review of operative summaries and all cases in which a vitrectomy set was opened. Exclusions were made for preoperative planned vitrectomy, traumatic cataract, combination procedures, and cases requiring iris hooks or iris ring devices. A comparison of the group’s MP vs LCS vitreous loss rates was made by statistical analysis.

The group’s rate of vitreous loss cases decreased from 1.16% in the MP cases to 0.72% in the LCS cases.  In absolute terms, the rate decreased for every surgeon in the study. The chi-square test revealed a statistically significant association between date of surgery, and thus technique, and vitrectomy cases (Χ2(1) = 9.77, p<0.01).  Odds ratio analysis indicated that surgeries performed from 2010-2012 using MP were 1.6 times more likely to have vitreous loss than those surgeries performed from 2013-2014 using the femtosecond LCS technique.

Conversion from MP to LCS resulted in a statistically significant decrease in vitreous loss. Since vitreous loss increases the risk of other serious complications of cataract surgery, such as retinal detachment and endophthalmitis, this new finding has important implications for the safety of cataract surgery.