Surgical and Visual Outcomes of Femtosecond Laser–Assisted Cataract Surgery
To report the surgical outcomes of 1105 consecutive cases of femtosecond laser-assisted cataract surgery (FLACS) performed at the Singapore National Eye Centre, and to compare the visual outcomes with manual controls.
Retrospective case control study based on clinical audit data. The femtosecond laser (Victus, Bausch + Lomb Technolas) was used to create a capsulotomy and fragment the nucleus. The unaided and best corrected visual acuities (UAVA, BCVA), refractive outcomes and intraoperative complications of consecutive cases of FLACS from May 2012 to December 2013 were studied at 6 weeks postoperatively. Data was analyzed for eyes normal except for cataract and UAVA for eyes targeting <±0.5D. Visual outcomes, refractive accuracy (mean absolute error [MAE] and manifest refraction spherical equivalent [MRSE]) of experienced surgeons were compared with a random sample of their manual cases.
All 1105 eyes were successfully docked by 18 surgeons. Complications included subconjunctival hemorrhage (289, 26.24%), suction loss (6, 0.57%) iris hemorrhage (1, 0.09%), anterior capsule rip (2, 0.18%) and posterior capsule rupture (3, 0.27%). Random sample comprised 520 eyes. Rate of achieving UAVA ≥20/25 was higher among FLACS eyes (68.2%) than controls (54.5%)(Fisher’s Exact Test, P<0.001). Mean LogMAR UAVA was better in FLACS eyes (N=666, 0.12±0.12) than controls (N=382, 0.15±0.13) (t test, p=0.0001). MAE and MRSE was better in FLACS eyes (0.31±0.26D & -0.08±0.38D respectively) than controls (0.35±0.28D & -0.16±0.44 respectively) (Mann-Whitney U test, p=0.023 & p=0.007 respectively).
FLACS was safely performed in all cases. The FLACS eyes achieved marginally better UAVA compared to manual cases. In addition, refractive predictability appeared superior.