Analysis of Operating Room Times While Transitioning to Femtosecond Laser Cataract Surgery and Comparison With Phacoemulsification

Saturday, April 18, 2015: 1:41 PM
Room 4 (San Diego Convention Center)
Ritika Dalal, MBBS, DNB
Dilraj S. Grewal, MD
Jonathan Chou, MD
Surendra Basti, MD
Scott Jun

To analyze the impact of the learning curve on operating room (OR) times during transition to femtosecond laser assisted cataract surgery (FLACS) for an experienced surgeon at an academic medical center and comparison with OR times for conventional phacoemulsification.

Records of all patients operated by one surgeon using FLACS between November 2012 and June 2014 were reviewed. Complex cataract procedures and eyes where laser was used for select surgical steps were excluded. Total OR time, time for the laser portion of the surgery and time required for laser and non-laser steps combined were analyzed. The cohort was divided into five sequential groups (n=33 for groups I-IV, n=34 for group V). Temporal change in surgical time was compared between groups. For controls, 50 consecutive patients who underwent phacoemulsification concurrently were reviewed. Statistical validity was evaluated using unpaired t test.

Of 190 eyes that underwent FLACS, 166 eyes met inclusion criteria. Time for the laser portion of surgery showed a statistically significant decline through the first three groups (group I 4.37 min, group III 3.37 min) but plateaued thereafter (mean 3.39 min for groups IV and V). Total OR time for FLACS showed a significant decline through the sequential groups (group I=44 minutes, group V= 34 mins). Time for both surgical steps combined reduced from 33 mins for group I to 23 mins for group V. However, the latter was significantly longer than surgical time for conventional phacoemulsification (14 minutes)

Despite significant reduction in OR times with increasing surgeon experience, FLACS takes significantly longer compared to phacoemulsification (2.3 x longer initially {group 1} and 1.6 x longer while approaching 200 cases). Surgeons and institutions should budget for this increased time and associated potential costs during the transition to FLACS.