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Preferred femto laser nucleotomy pattern in softer nuclei

Poster Details

First Author: B.Kashyap INDIA

Co Author(s):    B. Kashyap   B. Kashyap   N. Gadkar   N. Prasad           

Abstract Details


While going through the literature no study was available on the effectiveness of Hybrid pattern of Nucleotomy as compared to Grid pattern. So, a randomized control trials was conducted with the aim to compare various Phaco Dynamic parameters in terms of Total Case Time (TCT), U/S Total Time (UST), Cumulative Dissipated Energy (CDE), Estimated Fluid Aspirated (EFA), Total Aspiration Time (TAT) in different patterns of FLACS for softer nuclei (Nuclear sclerosis Gr 1-2 with PSC) and its impact on Corneal Volume and Endothelial Count on day1 and day30 post operatively.


A Randomized Controlled Trial was conducted at Tertiary Eye Hospital, Ranchi, India


A total of 72 patients were randomized into FLACS Grid pattern and FLACS Hybrid pattern. All cases underwent uneventful FLACS surgery and parameters were measured on Total case Time (TST), Effective Ultrasound Time (EUT), Total Aspiration time, Estimated Fluid Aspirated (EFA) and Cumulative Dissipated Energy (CDE). Comparison was done by applying t test for Grid and Hybrid surgery. Post operative Central Corneal Volume and Endothelial Count were measured at 1st day and 30th day. The impact of both surgeries was seen using pair t test for pre operative measurements with post operative measurements on day 1 and day 30 separately.


Independent t test shows mean difference between Grid surgery as compared to Hybrid for Total case time (174.08, p=0.008, 95%CI (46.64-301.53)), Effective Ultra Sound time (11.67, p=0.031, 95%CI (1.07- 22.73), Total Aspiration Time (0.61, p=0.031, 95%CI (0.059-1.15) and Estimated Fluid Aspirated (14.25, p=0.008, 95%CI (3.86-26.64) were statistically significant. Post operative mean difference in Endothelial Count at day-1( -6.66,p=0.914, 95%CI( -118.94,106.77)) and day-30 ( -3.89,p=0.94, 95%CI( -116.56,108.78) for Grid Vs. Hybrid was not significant. However, corneal thickness was significantly more in Grid pattern as compared to Hybrid pattern with mean corneal difference (-2.29,p=0.00, 95% CI(-2.72,-1.87)) on first post operative day


After Phacoemulsifcation of the central lasered emulsified part, adherent nucleo epinucleas bowl is left in the grid pattern group which needs more surgical time, Aspiration time, Estimated Fluid Aspirated and Total Aspiration Time for dislodge and removal as compared to hybrid pattern. As intra operative maneuverability to dislodge Nucleus �â�€�“epinuclear bowl is less and Post operative Central Corneal thickness is better; hybrid pattern emerges as the preferred mode of laser Pre treatment in softer nuclei.

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