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      • Record: found
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      Comparison of refractive predictability and endothelial cell loss in femtosecond laser-assisted cataract surgery and conventional phaco surgery: prospective randomised trial with 6 months of follow-up

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          Abstract

          Objective

          Femtosecond laser-assisted cataract surgery (FLACS) decreases the use of energy and provides a more precise capsulorhexis compared with conventional phaco surgery (CPS). The purpose of this study was to examine if the lower energy use in FLACS caused less endothelial cell loss compared with CPS and if there was a difference in refractive predictability between CPS and FLACS.

          Methods and analysis

          This was a randomised controlled study of 96 patients with a 6-month follow-up comparing one eye surgery by FLACS and the contralateral eye operated by CPS (divide and conquer technique). Both eyes had intraocular aspheric lenses implanted. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), central corneal endothelial cell count and hexagonality (non-contact endothelial cell microscope) were assessed preoperatively at 40 and at 180 days postoperatively.

          Results

          The mean phaco energies were 6.55 (95% CI 5.43 to 7.66) and 9.77 (95% CI 8.55 to 10.95) U/S (p<0.0001) by FLACS and CPS, respectively. At day 40, the mean endothelial cell loss (ECL) was 344 cells/mm 2 (95% CI 245 to 443) by FLACS (12.89%) and 497 cells/mm 2 (95% CI 380 to 614) by CPS (18.19%) (p=0.027). At day 180, ECL was 362 cells/mm 2 (95% CI 275 to 450) in FLACS (13.56%) and 465 cells/mm 2 (95% CI 377 to 554) in CPS (17.03%) (p=0.036).

          The mean absolute difference from the attempted refraction was 0.43 (95% CI 0.36 to 0.51) dioptres (D) at day 40 and 0.46 D (95% CI 0.39 to 0.53) at day 180 by FLACS compared with 0.43 D (95% CI 0.36 to 0.51) at day 40 (p=0.95) and 0.46 D (95% CI 0.37 to 0.52) at day 180 (p=0.91) with CPS.

          Conclusion

          ECL was significantly lower in FLACS compared with CPS at both day 40 and day 180. ECL was correlated to the energy used. We found no difference in refractive predictability or CDVA between the groups.

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          Sources of error in intraocular lens power calculation.

          N E Sverker Norrby (2008)
          To identify and quantify sources of error in the refractive outcome of cataract surgery. AMO Groningen BV, Groningen, The Netherlands. Means and standard deviations (SDs) of parameters that influence refractive outcomes were taken or derived from the published literature to the extent available. To evaluate their influence on refraction, thick-lens ray tracing that allowed for asphericity was used. The numerical partial derivative of each parameter with respect to spectacle refraction was calculated. The product of the partial derivative and the SD for a parameter equates to its SD, expressed as spectacle diopters, which squared is the variance. The error contribution of a parameter is its variance relative to the sum of the variances of all parameters. Preoperative estimation of postoperative intraocular lens (IOL) position, postoperative refraction determination, and preoperative axial length (AL) measurement were the largest contributors of error (35%, 27%, and 17%, respectively), with a mean absolute error (MAE) of 0.6 diopter (D) for an eye of average dimensions. Pupil size variation in the population accounted for 8% of the error, and variability in IOL power, 1%. Improvement in refractive outcome requires better methods for predicting the postoperative IOL position. Measuring AL by partial coherence interferometry may be of benefit. Autorefraction increases precision in outcome measurement. Reducing these 3 major error sources with means available today reduces the MAE to 0.4 D. Using IOLs that compensate for the spherical aberration of the cornea would eliminate the influence of pupil size. Further improvement would require measuring the asphericity of the anterior surface and radius of the posterior surface of the cornea.
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            Comparison of intraocular lens decentration parameters after femtosecond and manual capsulotomies.

            I Takacs, Michael C Knorz, Illés Kovács … (2011)
            To evaluate a laser technique and manual technique to perform capsulorrhexis in cataract eyes. Anterior capsulotomy was performed with an intraocular femtosecond laser (LenSx Lasers Inc) in 54 eyes (FS group) and manual continuous curvilinear capsulorrhexis was performed in 57 eyes (CCC group). Circularity and area of capsulotomy and IOL decentration were measured using Photoshop CS4 Extended (Adobe Systems Inc) 1 week after surgery. Average keratometry, axial length, and preoperative anterior chamber depth were examined with the Lenstar LS 900 (Haag-Streit AG). No statistically significant differences were noted between groups in axial length, preoperative refractive state, and in the area of capsulotomy. Circularity values were significantly better in the FS group (P=.032). We found incomplete overlap of capsulotomies in 28% of eyes in the CCC group and 11% in the FS group (P=.033). Significant correlations were noted between axial length and area of capsulotomy, and between average keratometry and area of the capsulotomy in the CCC group (R=0.278, P=.036; and R=-0.29, P=.033, respectively), but both did not correlate in the FS group (P>.05). In the CCC group, the pupillary area correlated significantly with the area of the capsulotomy (R=0.27, P=.039). Significant correlation was noted between IOL decentration and axial length in the CCC group (R=0.30, P=.026), but there was no correlation in the FS group (P>.05). Femtosecond laser capsulorrhexis was more regularly shaped, showed better centration, and showed a better intraocular lens/capsule overlap than manual capsulorrhexis. Copyright 2011, SLACK Incorporated.
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              A new intraocular lens design to reduce spherical aberration of pseudophakic eyes.

              Jack Holladay, Patricia A Piers, Gabor Koranyi … (2015)
              The aim of this study was to design and evaluate in the laboratory a new intraocular lens (IOL) intended to provide superior ocular optical quality by reducing spherical aberration. Corneal topography measurements were performed on 71 cataract patients using an Orbscan I. The measured corneal surface shapes were used to determine the wavefront aberration of each cornea. A model cornea was then designed to reproduce the measured average spherical aberration. This model cornea was used to design IOLs having a fixed amount of negative spherical aberration that partially compensates for the average positive spherical aberration of the cornea. Theoretical and physical eye models were used to assess the expected improvement in optical quality of an eye implanted with this lens. Measurements of optical quality provided evidence that if this modified prolate IOL was centered within 0.4 mm and tilted less than 7 degrees, it would exceed the optical performance of a conventional spherical IOL. This improvement occurred without an apparent loss in depth of focus. A new IOL with a prolate anterior surface, designed to partially compensate for the average spherical aberration of the cornea, is intended to improve the ocular optical quality of pseudophakic patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open Ophthalmol
                Journal ID (iso-abbrev): BMJ Open Ophthalmol
                Journal ID (hwp): bmjophth
                Journal ID (publisher-id): bmjophth
                Title: BMJ Open Ophthalmology
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2397-3269
                Publication date Collection: 2019
                Publication date (Electronic): 1 March 2019
                Volume: 4
                Issue: 1
                Electronic Location Identifier: e000233
                Affiliations
                [1] departmentDepartment of Ophthalmology , Rigshospitalet Glostrup , Glostrup, Denmark
                Author notes
                [Correspondence to ] Dr Therese Krarup; theresekrarup@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-8543-2843
                Article
                Publisher ID: bmjophth-2018-000233
                DOI: 10.1136/bmjophth-2018-000233
                PMC ID: 6440690
                PubMed ID: 30997403
                SO-VID: e4fb2498-b7fa-42ea-856d-573b9583a953
                Copyright © © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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                Subject: Original Article
                Subject: 1506
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                Keywords: cataract surgery,femtosecond-assisted cataract surgery,lensar,corneal endothelial cell loss
                Data availability:
                Keywords: cataract surgery, femtosecond-assisted cataract surgery, lensar, corneal endothelial cell loss

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