Outcome Of Femtosecond Laser-Assisted Cataract Surgery In Eyes With Low Corneal Endothelial Cell Count
Published 2023 - 41st Congress of the ESCRS
Reference: PO0469 | DOI: 10.82333/91s0-y253
Authors: Kathleen Sheng-Chuan Ma* 1 , Altantsetseg Altansukh 2 , David Hui-Kang Ma 2
1Department of Medicine,Catholic University of the Sacred Heart,Rome,Italy, 2Department of Ophthalmology,Chang Gung Memorial Hospital,Taipei,Taiwan, Province of China
Corneal decompensation is a major concern in cataract surgery for patients with low corneal endothelial cell (CEC) count. Recently, femtosecond laser assisted cataract surgery (FLACS) has been proposed to reduce CEC loss in phacoemulsification. This study aims to compare the visual outcome, the CEC loss and central corneal thickness (CCT) change after FLACS in eyes with low CEC count.
This is a single center, retrospective study.
The electronic medical records of patients who received FLACS (Alcon LenSx System) from 2015 to 2022 were reviewed, and those with pre-op CEC below 1500/mm2 were recruited. Following data were retrieved: 1. Pre-op and post-op 6 months CEC count and CCT measured by a NIDEK CEM-530 specular microscope. 2. Pre-op and post-op 6 months BCVA in logMAR. Changes in CEC count, CCT, and BCVA were compared, and the CEC count was also compared with FLACS patients who have normal CEC. Independent two-sample t and Mann-Whitney test were used for data comparison.
21 eyes from 21 patients receiving FLACS (M: F = 2: 19, mean age = 67.1±6.8 y/o) were recruited. Causes for low CEC were Fuch’s dystrophy (n=16), previous corneal transplantation (n=4), and glaucoma (n=1). The mean follow-up period was 12.4±3.4 months. At post-op one year, corneal edema developed in 4 cases with Fuch’s dystrophy (19%). For the other patients, the pre-op and post-op 6 months CEC count was 1015.9±277.9 vs 994.5±250.0 (p=0.829), the CCT was 561.6±74.0 um vs 559.6±79.5 um (p=0.829). The average logMAR BCVA improved significantly at post-op 6 months (1.02±0.70 vs 0.35±0.19, p=0.003) The CEC loss rate percentage at post-op 6 months was 0.5±12.0%, which was lower than that in FLACS patients with normal CEC (n=96, 2.8±1.1%, p=0.4).
Although eventually 20% corneas became edematous after FLACS, data from surviving corneas suggested that FLACS induced only small decrease in CEC count. Our study and previous publications suggested that FLACS may be superior to conventional phacoemulcification in reducing CEC loss in Fuch’s dystrophy and other causes of low CEC patients, which translates to a lower risk of corneal decompensation, especially in eyes with more advanced cataract.