Shift to laser refines cataract surgery

Nov 01, 2012

Femtosecond laser appears to provide improved safety profile, more predictable outcomes

Comparison of outcomes achieved after cataract surgery indicates that the use of a femtosecond laser-assisted technique offers opportunity for improving both safety and efficacy, according to data presented by Dr Michael Lawless, at the annual meeting of the American Society of Cataract and Refractive Surgery.

He presented findings from analyses of intraoperative events occurring in his series of eyes and comparing the refractive and uncorrected visual acuity (UCVA) outcomes achieved in cohorts with a toric IOL implanted using a femtosecond laserassisted or manual surgical technique. The results consistently favoured the femtosecond laserassisted procedure.

In his analysis of intraoperative safety, Dr Lawless said that the problems he has encountered in the femtosecond laser procedures have been trivial. They included three cases of suction break (0.7%), six eyes that developed pupillary constriction (1.5%), and five eyes (1.2%) with anterior capsular tags or slight irregularity. There were no cases of anterior or posterior capsular tears or any posterior lens dislocations.

Comparative analyses

The absolute difference between the attempted and achieved SE was 0.28 ± 0.26 D in the laser group and 0.39 ± 0.30 D in the manual group and the difference between groups showed a trend toward statistical significance (p = 0.07). Corresponding with these results, his analysis of the correlation between attempted versus achieved SE showed a tighter fit for the laser group compared with the eyes that underwent manual operation (R2 = 0.9881 versus 0.9574) and the percentage of eyes within 0.5 D of intended SE was 84% for the laser group versus 75% in eyes operated on with a manual technique.

Rates of distance UCVA of 6/6 or better were similar in the laser and manual groups (46.7% and 45.5%, respectively), but the percentage of eyes achieving 6/7.5 or better distance UCVA was higher in eyes operated on with the femtosecond laser compared with the controls (71.1% versus 63.6%, respectively).

Dr Lawless also compared his outcomes with the femtosecond laser against the best, most recent published results for the toric IOL and found that the percentage of eyes achieving distance UCVA of 6/6 or better was higher in his series than for the published reports except for one where the outcome was similar to his own.