Macular Layers 18-Months After Intra-Individual Femtosecond Laser-Assisted Vs Conventional Cataract Surgery Using An Automated Ai Segmentation

To evaluate retinal thickening 18-months after low-pulse energy femtosecond laser-assisted (LCS) and manual cataract surgery (MCS) using an artificial intelligence (AI)-based automated retinal layer segmentation.

Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria

Design: Prospective, randomized, intraindividual-controlled study

Patient Population: 120 eyes of sixty patients with age-related cataract


Intervention: Bilateral same-day LCS and MCS in a randomized sequence.

Main Outcome Measure: Retinal thickness preoperative, after 1 week, 3 weeks, 6 weeks and 18 months in the central 1mm, 3mm, 6mm. Inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), total retinal thickness (TRT) and photoreceptor (PR) thickness were segmented from Spectralis optical coherence tomography (OCT) using automated AI retinal layer segmentation.

Fifty-six patients completed the follow-up. LCS compared to MCS did not impact any of the investigated retinal layers at any follow-up visit (p>0.05). For the central 1mm, a significant increase in TRT was seen after 1 week followed by an elevated plateau thereafter. For the 3mm and 6mm, TRT increased only after 3 weeks and 6 weeks and decreased again until 18-months. TRT remained significantly increased 18-months postoperatively compared to preoperative thickness (p<0.001). INL and ONL were the main causative layers for the total TRT increase. PR declined 1 week after surgery but regained preoperative values 18 months after surgery.