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Femtosecond laser-assisted cataract surgery (FLACS) for patients with low corneal endothelial density

Poster Details

First Author: D.Ma TAIWAN

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Abstract Details


Cataract patient with low corneal endothelial cell (CEC) count is a challenge to surgeons. In countries where donor corneas are not readily available, measures to reduce intra-operative endothelial damage are advocated. Although FLACS has been reported to reduce CEC damage during surgery, little is known about the result of FLACS for patients with low CEC count. The purpose of this study is to investigate outcome and effect on CEC after FLACS in patients with low CEC density.


Department of Ophthalmology, Chang Gung Memorial Hospital, Taipei, Taiwan.


We retrospectively analyzed FLACS patients operated between 2015 and 2016. In total, 7 eyes from 7 patients (7 females; mean age = 71.6 �Â�± 4.1 years old) were included . These included fellow eye previously received DSAEK for Fuch�â�€�™s dystrophy (N = 3), cornea with guttata (N = 2), one eye with previous ATLK, and one eye with glaucoma S/P LI. Types of IOL implanted, pre- and post-OP BCVA, corneal clarity, pre- and post-OP 3-6 months CEC count were documented.


Except in one eye with previous glaucoma and very low CEC count (472/mm2), all corneas remained clear after LenSx-assisted cataract surgery, and mean CEC count changed from 968 �Â�± 334 /mm2 (579-1445/mm2) pre-operatively to 994 �Â�± 308 /mm2 . (558-1349/mm2) at post-op 3-6 months (p = 0.313). logMAR BCVA improved significantly from 0.9 �Â�± 0.5 (0.4-2.0) pre-operatively to post-op 0.4 �Â�± 0.2 (0.1-0.7) (p = 0.030). Condition in a case with pre-existing mild corneal edema and glaucoma worsened, necessitating DSAEK in the future.


Our experience suggests that FLACS may be considered in cataract patients with low CEC count in the hope to avoid corneal decompensation. Even if corneal edema occurred subsequently, optimal capsulorrehxis opening stabilizes the IOL, facilitating future DSAEK or DMEK procedure.

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