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Jonathan T. Chao, MD
Timothy P. Page, MD
To analyze the timing of anterior capsule tear outs in intumescent cataracts from the point of contact with a capsulotomy instrument to when the capsulorrhexis extends beyond the pupillary margin and compare it to femtosecond capsulotomy speeds.
This is a retrospective study in which 11 cases of anterior capsule tear outs in intumescent cataracts were selected; 4 of which were from our institution, 4 from published videos in peer reviewed literature, and the remaining 3 from online published videos. Using slow motion videography, we analyzed all recent cases of anterior capsule tear outs in intumescent cataracts at our institution and perused peer-reviewed literature for capsular tear outs in intumescent cataracts. Average time for tear outs were recorded using an embedded timer.
The average tear out time for the 11 cases was 12.95 +/- 10.05 and the average time for tear outs at our institution was 3.88 +/- 2.50 seconds. The fastest recorded tear out occurred within 1.53 seconds, whereas femtosecond laser capsulotomy can be performed in 1.1 seconds
The average time for capsular tear out was not instantaneous and even the fastest observed tear out was slower than the time that it takes to perform a femtosecond laser capsulotomy, which may be considered as an alternative approach to the intumescent cataract
Caroline S. Germano, MD
Renato Antunes S. Germano, MD
Flavio Augusto S. Germano, MD
Pedro C. Carricondo, MD, PhD
Jorge E. Germano, MD
It is a prospective, observational, randomized study that included 79 eyes of 67 patients with cataract. Patients were divided in a control group, which underwent cataract surgery with conventional phacoemulsification, and a study group, with FLACS (performed with LDV Z8 laser). All surgeries were performed by the same surgeon using the Stellaris platform. All patients received topical NSAIDs on the day before surgery. To quantify pupillary size, measurements were performed using a surgical compass: before phacoemulsification and after surgery. In the study group, measurements after laser were added. Total surgical time and ultrasound time were also analyzed.
56 eyes were included in the FLACS group and 23 eyes in the control group. There was no statistically significant difference between pre-femto x pre-phaco pupil (8.71±0.44 mm x 8.62±0.72 mm; p=0.497), as well as pupil size at the end of surgery (7.87 ±1.06mm x 7.75±0.96mm; p=0.644). However, in FLACS group, there was a transient increase in pupillary diameter after laser, from 8.71±0.44 mm to 9.11±0.59mm. There was no statistically significant difference between the mean time of surgery (13.39±1.37 min x13.50±2.04 min; p=0.817) and ultrasound time (33,38 ± 27,36 sec x 35,06 ± 28,80 sec; p=0,749), respectively, between groups.
Although mean pupilary diameter was similar at the end of surgery between the groups, our study showed greater pupil variation in FLACS compared to conventional phaco. Considering this, surgeons must observe the initial pupillary diameter to perform FLACS in order to combine its refractive advantages with lower intra and postop complications.
Hoseok Chung, MD
So Young Park, MD
Jae Hyuck Lee, MD
Su Young Moon, MD
Hun Lee, MD
Jae Yong Kim, MD, PhD
Hungwon Tchah, MD, PhD
To evaluate the changes of intraocular pressure (IOP) following femtosecond laser-assisted cataract surgery (FLACS)
We retrospectively reviewed the medical records of 53 eyes of 47 patients who underwent the FLACS procedure. We examined the nuclear sclerosis grades and noted the femtosecond laser powers for each patient. We measured the IOPs before the femtosecond laser procedure, and then immediately, 30 minutes and 1 hour after the laser procedure.
The mean nuclear sclerosis grade was 3.70±0.95, and the mean laser power was 8.45±1.75J. The mean IOP was 17.15±3.45mmHg before the laser procedure, 29.81±7.14 immediately after the procedure, 17.70±3.88 at 30 minutes after the procedure, and 21.51±5.84 at 1hour after the procedure. There was a significant increase in the mean IOP both immediately and 1 hour after the procedure compared with the pre-laser procedure IOP(p<0.001).But, there was no difference between the IOP 30 minutes after the laser and the IOP with the pre-laser procedure (p=0.247). There was a significant increase in the mean IOP 1 hour after the laser procedure compared with the IOP 30 minutes after the procedure(p<0.001).
IOP changes presented dynamically following the femtosecond laser procedure and was magnified 1 hour after the laser procedure, suggesting that beginning time of cataract surgery after laser procedure should be cautiously selected.
Douglas D. Koch, MD, ABO
Li Wang, MD, PhD
David Dewey, MSc
Joris Vogels, MSc
To assess the accuracy of an iris registration algorithm of a femtosecond laser (CATALYS®, Johnson and Johnson Surgical Vision) for measuring ocular cyclotorsion after the eye has been docked with a liquid optics interface.
In a development data set of 52 eyes, we measured the amount of cyclotorsion from the preoperative measurements obtained with a color LED topographer (Cassini System, Cassini Technologies BV) and the intraoperative position when docked with the femtosecond laser. The development data set was used to refine the automated iris registration algorithm, and a verification data set of 50 eyes will be used to confirm its performance. The amount of cyclotorsion between the preoperative and intraoperative positions was manually compared by 3 image graders. The manually calculated cyclotorsion values were then compared to the automated cyclotorsion calculated by the Iris Registration algorithm.
In the development data set, the arithmetic mean of cyclotorsion calculated by the automated system was -0.2° for right eyes and +3.1° for left eyes, with a range of +15° to -11°. The average standard deviation between the 3 manually graded cyclotorsion values for each eye was 0.57° degrees. The mean difference in cyclotorsion between automated calculation and the manual calculation was 0.71°; this difference was 2° or less for 98% of the eyes.
In our development data set, we found high agreement between the amount of cyclotorsion measured with manual and automated methods. We will report outcomes in a validation data set of 50 eyes.
Dr.Bibhuti Kashyap, MD, DNB
Nidhi Gadkar, MS, DNB
Bharti Kashyap, MS
To compare Cumulative Dissipated Energy (CDE) in dense cataracts, early post operative Corneal Volume (CCV) and Endothelial Count (EC) among 3 groups i.e. FLACS Grid (Gr 1) and Hybrid (Gr 2) with Micro Incision Cataract Surgery (MICS) (Gr 3).
Each group comprised of 40 patients and respective CDE values were noted. Pre and post-operative EC, CCV and Pentacam Nucleus Grading were measured
Tukey Post Hoc Analysis showed significance among the groups for CDE values (p=0.000). 1st day post-op CCV was lesser in Gr 1 (63.13±3.57) as compared to Gr 2 (63.42±10.2) & Gr 3 (67.97±4.38); p=0.036 and 30th day Post-op CCV were 61.61±3.45: 62.29±4.27 and 62.5±4.03 respectively (p=0.130). Post-op EC were lower in MICS group at 1st & 30th day but not significant (p=0.31)
FLACS Grid and Hybrid pre treatment allowed for a significant reduction in CDE compared to MICS for denser lens nuclei resulting in less endothelial cell trauma and less central corneal swelling.
Andrea C. Arteaga, MD
Jennifer Park, MD
Rawan Rupnow, MS
Joelle A Hallak, MS, PhD
Jose de la Cruz, MD, MSc, ABO
To evaluate relationship between intraoperative lens thickness, estimated postoperative refractive outcomes and changes in target refraction in patients undergoing femtosecond laser-assisted cataract surgery (FLACS)
Retrospective chart review of patients that underwent FLACS. Surgery was performed by residents and fellows at the Illinois Eye and Ear Infirmary. Estimated target refraction was based on biometry calculation. Lens measurements including anteroposterior distance and lens tilting are taken in consideration. Eyes with preoperative ocular pathology, keratoconus, history of refractive surgery and toric IOL were excluded.
86 eyes were included. Average axial length was 24.3mm (21.4 - 28.7mm). Mean lens thickness 5201 microns (3709 - 6363 microns). Mean target refraction was -0.2D (-2.66 to +0.23D) and mean difference from target refraction at POM#1 was 0.44D (0 to 1.64D). Twenty percent of the eyes had more than 0.50D of difference from target refraction and of these eyes, 75% had a lens thickness higher than 5000 microns. There was a correlation of 0.26 (p 0.02) between lens thickness and greater difference from target refraction.
Eyes with thicker lenses are less likely to achieve the target refraction after cataract surgery. Lens thickness may impact the accuracy of the measure of the intraocular lens and could potentially impact the final position of the IOL. All these variables should be considered to predict the refractive outcome of these patients.
Eric S. Tam, MD, FRCSC
Sohel Somani, MD, FRCSC
Hannah H. Chiu, MD, FRCSC
To assess the vasoconstrictive effect of Brimonidine 0.15% on reducing subconjunctival hemorrhage after suction ring application during Femtosecond laser assisted cataract surgery (FLACS).
This was a masked prospective randomized controlled study. Inclusion criteria included all FLACS cases between June and August 2019. Exclusion criteria included anticoagulation therapy, prior conjunctival surgery, intraop complications, Analyzed Area <25mm2 or >10% difference between postop vs. preop values. All subjects in Control and Study groups underwent baseline images with the Oculus Keratograph M5. Bulbar Redness Score and Analyzed Area were recorded. All operated eyes then received the usual preop eye drops. Subjects in the Study group received an additional drop of Brimonidine 0.15%. All subjects then underwent FLACS. Comparison images were repeated 15 minutes postop in both groups.
Preop Bulbar Redness Score (BRS) (Study=1.62±0.52; Control=1.40±0.34; P=0.07) and Analyzed Area (AA) (Study=28.86±2.86; Control=26.04±2.93; P=0.28) were not statistically significant between Study and Control groups. Postop BRS (Study=1.42±0.44; Control=1.46±0.43; P=0.70) and AA (Study=26.96±2.82; Control=26.40±2.98; P=0.46) were also not statistically significant between the two groups. However, the change in BRS between preop and postop was statistically significantly greater in the control group (0.06±0.43) compared to the study group (-0.12±0.56) (P=0.03). The change in AA in the postop vs. preop (Study=0.40%±3.60%; Control=1.40%±4.30%; P=0.33) was not statistically significant.
Preoperative application of Brimonidine 0.15 % can significantly decrease the severity of subconjunctival hemorrhage in eyes undergoing FLACS.