Can Aqualase replace phaco?

Removal of soft cataracts with Aqualase (Alcon), theoretically carries less risk to the posterior capsule than phacoemulsification, according to a report published in the February issue of Eye.

Laurence Whitefield and colleagues from Queen Mary's Hospital, Kent, UK, enrolled 33 subjects (mean age 71.4 years) to undergo cataract surgery using Aqualase through a 3.2 mm corneal incision. Grade of nucleus, nuclear removal technique and intraoperative complications were recorded.

The researchers found that Aqualase is capable of removing cataracts up to nuclear sclerosis 2+ fairly easily. Nuclei that were graded 2+ or greater were more technically difficult and conversion to ultrasound phacoemulsification was required in one case. Of the 33 procedures there were just two cases of posterior capsule rupture. One occurred during nucleus removal and the other was unrelated to Aqualase. A total of 96% of the subjects, without preoperative comorbidity, achieved 6/9 or better postoperatively.

The researchers feel that Aqualase does have an advantage over phacoemulsification, as it carries less risk of damage to the posterior capsule. Additionally, the method is similar enough to phacoemulsification to ensure that the learning curve is not too steep. However, they emphasize that Aqualase it is not completely risk free as rupture is possible with the floor pedal in position two.