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Zero phaco: the evolution of femtosecond laser-assisted cataract surgery

Poster Details

First Author: J.Fernández SPAIN

Co Author(s):    M. Rodriguez-Vallejo   J. Martinez                 

Abstract Details


Retrospective non-randomized case series to evaluate the effectiveness of conducting zero-phaco (ZP) in femtosecond laser-assisted cataract sugery (FLACS) with Victus (Baush & Lomb). The influence of crystalline lens opacification, the selected cut pattern (CP) and the incision size (IC) was assessed.


QVision, Ophthalmology Department of Virgen del Mar Hospital (Spain)


29 cataract eyes were stratified in groups ranging from CN0 to CN4 (LOCS III) or nucleus staging from 0 to 3 measured with Pentacam (PNS). ICs were from 2.75 to 1.8 mm. Percentage of eyes on which ZP was performed was calculated for each group. Three CPs were used by combining 4 radial cuts and 4, 6 or 8 circular cuts. Diameters were set at 4 mm and a variation of 4R8C was tested with a radial size of 5.5mm and circles of 3.5 mm (4R8C-B). Effective Phacoemulsification Time (EPT) was recorded in all cases on which ultrasound was used.


Phaco was not needed for eyes with cataracts below CN2 and PNS2 and it was used for grades above from CN2 and PNS2. CN=2 or PNS=2 required phaco in 30.8% and 50% of cases respectively. The need of phaco in PNS2 was influenced by the pattern. In this group, less number of circles needed phaco with more EPT as decreasing this number (4R6C [EPT=1.37] and 4R4C [EPT=2.28]). Furthermore, phaco was not required for 4R8C-B but it was used in 4R8A at 42.9% of cases. ZP was perfectly completed with 4R6C or 4R8C independently of the IC for opacifications below CN2 or PNS2.


The number of circles in the CP and IC have been reduced from the earliest to the latest surgeries. During this period we have found that reducing the number of circle cuts for opacities above CN2 or PNS2 is not a good option for performing ZP. The reduction of the incision size does not seem to be an inconvenient for performing ZP if the CP is properly selected. This is a descriptive analysis based on a case series, therefore research hypotheses are not raised. Prospective randomized studies are required to confirm these findings and for creating an algorithm of treatment.

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