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Femtosecond laser cataract surgery: our experience with resident training

Poster Details

First Author: M.Munro CANADA

Co Author(s):    A. Muzychuk   L. Lagrou   R. Mitchell        

Abstract Details



Purpose:

Beginning in November 2013, the Southern Alberta Eye Center began resident teaching in Femtosecond Laser-Assisted (FSL-assisted) Cataract surgery. This new technology has a number of reported advantages over conventional phacoemulsification, including an enhanced safety profile. In addition to being a necessary part of future training in cataract surgery, this may also offer an added level of safety in the early stages of resident cataract surgery training. The purpose of this study is to assess the outcomes of this procedure in training cases and compare these to standard phacoemulsification teaching cases.

Setting:

Mitchell Eye Centre, Southern Alberta Eye Center, Calgary, Alberta, Canada.

Methods:

In this prospective observational case series, the senior resident, at mid-training level in cataract surgery had her full-length procedures reviewed. 17 patients consented for resident performed procedures (7 manual phacoemulsification, 10 FSL-assisted). Procedures were performed predominantly by the resident, with minor aid by the staff in some instances. A comparison of phacoemulsification using standard manual techniques and FSL-assisted cases was performed. A single trained observer graded the cataracts pre-operatively using the standardized Lens Opacities Classification System III (LOC III) scale, evaluating nuclear color (NC), nuclear opalescence (NO), cortical changes (C) and posterior subcapsular changes (PSC). Endothelial cell density (CD) and pachymetry using the Visante OCT (Zeiss) and Noncom ROBO Pachy (Konan Medical) was utilized preoperatively, on postoperative day one (POD1) and at two weeks postoperatively. Macular-OCT (Zeiss) was also performed two weeks postoperatively. The Catalys Precision Laser System (Optimedica) was used to perform the capsulorhexis, limbal relaxing incisions and nuclear fragmentation. It was not used to create wounds. Phacoemulsification was performed using The WHITESTAR Signature Phacoemulsification System (Abbot Medical Optics). Consistent settings for phacoemulsification for study purposes. Surgical parameters recorded include power (AVG%), elliptical motion (EFX), ultrasound time (UST) and total saline (BSS) used. Possible complications of surgery were monitored.

Results:

Surgical time was slightly less for FSL-assisted cases and LOCIII grading revealed slightly more advanced cataracts for FSL-assisted cases. UST, EFX, AVG% and BSS used were all less for the FSL-assisted group in comparison to manual phacoemulsification. Corneal thickness/edema yielded similar values and trends for the two groups, preoperatively and postoperatively, for all imaging modalities. This was also observed with endothelial cell density. Most importantly, increased complications were observed with manual phacoemulsification, as two patients suffered a posterior capsular rupture. One patient required a vitrectomy, performed by the attending surgeon, and one patient had no vitreous loss. Interestingly, no surgical complications occurred with FSL-assisted surgery.

Conclusions:

The benefits of FSL-assisted cataract surgery have been described extensively in the literature worldwide. The improved safety profile may make these cases ideal for resident teaching, particularly during early cataract training when complications are more likely. Based on these early results, compared with standard phacoemulsification teaching cases, FSL-assisted surgery results in reduced resident complication rates and will likely have an increasing role as an adjunct to traditional phacoemulsification teaching cases. This also has the added benefit of exposing trainees to a wider breadth of available technology, in addition to increasing the pool of potential teaching cases. Based on these findings, future studies with a higher power should be pursued. FINANCIAL INTEREST: NONE

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