Multi-Platform Outcomes Analysis of Laser-Assisted Cataract Surgery
Purpose
A multi-platform evaluation of the efficacy and safety of femtosecond laser-assisted (FSL) cataract surgery, by comparing the effective phacoemulsification energy / time, reproducibility of capsulotomy creation, and complications rates to that of conventional phacoemulsification.
Methods
A prospective, non-randomized enrollment and retrospective review of 2500 eyes treated with FSL, using the LenSx, Catalys, Victus, and LensAR laser platforms were compared to 5000 eyes undergoing conventional phacoemulsification. The duration of laser encounter (from initiation to release of the patient interface) was recorded, while the ease of docking was graded on a 5-point scale, along with a 11-point subjective pain scale, as was the rates of success with each component of the laser application and ease of surgical manipulation of the corneal incisions. Effective phaco-time, phaco-energy, or total phaco power were measured for respective phacoemulsification systems, along with infusion volumes, and compared to the corresponding conventional arm. Surgical complications were also compared between the FSL and conventional cohorts.
Results
An 80% reduction in the phacometrics was noted with FSL when compared to conventional phacoemulsification, while infusion volumes did not change significantly with a mean LOCS III opalescence of 3.1±1.4 for the FSL group and 3.6±1.9 for the conventional group. Successful completion of the capsulotomy , phaco-fragmentation, arcuate incisions, and clear corneal incisions was achieved in 99% of attempted FSL cases. The subjective pain scale 1.1±0.9, while the ease of opening for the corneal incision was 2.3±1.4. There were 5 cases with anterior capsular defects noted intraoperatively in the FSL group, without posterior capsular involvement with an average intended capsulotomy size of 4.95 mm. The conventional group had 2 cases of radial tears, none of which required vitrectomy.
Conclusion
Combined data across the four FSL cataract surgery platforms show a statistically significant reduction in phaco emulsification time compared to conventional cataract surgery. The data also show a comparable anterior and posterior capsular tear rate to manual surgery.