Review of Initial Experience With Femtosecond Laser–Assisted Cataract Surgery by Novice Surgeons
Purpose
Novice surgeons are known to have a higher complication rate than experienced surgeons when performing traditional manual cataract surgery with phacoemulsification. The purpose of this study is to report the outcomes and complications of the first 150 cataract procedures performed by novice surgeons using the femtosecond laser at Wills Eye Hospital.
Methods
Retrospective nonrandomized chart review of all femtosecond laser-assisted cataract surgeries performed by residents at Wills Eye Hospital from December 2012 until present. The occurrence of intraoperative complications (anterior capsule tears, posterior capsule ruptures, dropped nucleus, and retained lens material) and postoperative complications (intraocular pressure above 24 mmHg in the early postoperative period, persistent postoperative inflammation requiring continued treatment after the one-month postoperative visit) were compared to age-matched controls who had undergone manual cataract surgery by residents during the same time period. Exclusion criteria included severe retinal disease, advanced glaucoma, and uveitis. We aim to include 150 cases in our review.
Results
With regard to demographics, there was not a statistically significant difference in the gender, eye, or age between the two groups. The rate of anterior capsule tears and posterior capsule ruptures were equivalent. There was a slightly higher rate of retained cortex in the femtosecond laser assisted cataract surgery arm, but it was not statistically significant (P value 0.42). With regard to postoperative complications, the incidence of macular edema and elevated intraocular pressure was equivalent. There was a higher rate of persistent postoperative inflammation in the manual cataract surgery group that trended toward statistical significance (P value 0.08)
Conclusion
Incorporation of femtosecond laser-assisted cataract surgery (FLACS) into resident training does not negatively impact patient complication rates. In resident hands, FLACS cases are equivalent to the current standard of care for manual phacoemulsification cataract surgery.