Femtosecond Laser–Assisted Lens Fragmentation: Effects on Effective Phaco Time and Postoperative Corneal Edema
To evaluate effective phaco time (EPT) and postoperative corneal edema associated with use of laser-assisted lens fragmentation with the Victus femtosecond laser (Bausch + Lomb) during cataract surgeries performed using the Stellaris phacoemulsification machine (Bausch + Lomb).
This was a prospective, randomized, single-site study. 48 patients underwent phacoemulsification randomized to use one of the following ultrasound power settings: standard pulse mode with fixed 50% duty cycle, multiburst mode with waveform linear 1-75% duty cycle, or multiburst mode with femtosecond laser-assisted fragmentation. The primary outcome measures were EPT and corneal edema on postoperative day 1. Corneal edema was measured on a scale of 0 to 3+. Pre operative lens density was documented for all groups.
Mean EPT was 4.2 sec for phaco performed using the standard pulse mode, 2.5 sec for phaco using the multiburst mode, and 0.6 sec for phaco performed using the multiburst mode with femtosecond laser-assisted fragmentation. Corneal edema on postoperative day 1 was reduced after phaco performed using the multiburst mode with femtosecond laser-assisted fragmentation compared with phaco performed using the standard mode or the multiburst mode without femtosecond laser-assisted fragmentation. All three groups had similar cataract desities. A masked observer was used to determine corneal edema post op day #1.
Use of the multiburst power setting on the Stellaris machine increases the efficiency of phacoemulsification compared with the standard mode. Use of the femtosecond laser for lens fragmentation further reduces energy usage and EPT and also results in reduced postoperative corneal edema.