Exploring Anatomical Variability With Intraoperative Oct: Implications For Femto-Assisted Cataract Surgery Outcomes

Evaluation of interindividual anatomical variability in ocular parameters across diverse patient eyes and its influence in standardized femtosecond-assisted laser cataract surgery (FLACS) with Premium intraocular lens (IOL) implantation. Intraoperative patient's ocular images are acquired via optical coherence tomography (OCT) and matched with preoperative biometric acquisitions.

“Medical Center Clinic “, Ophthalmology Department, Termoli (Cb), Italy.

All eyes that underwent femtosecond laser cataract surgery and between December 2021, and December 2023, within a single-group private practice were included in this investigation. A total of 51 eyes were examined and assessed for eye parameters included in the analysis of anterior chamber depth (ACD), central corneal thickness (CCT) and lens thickness (LT). Furthermore, outcomes related to visual acuity and any complications were assessed. 
The Lensx femtosecond laser (Alcon-LensX, Inc) platform was utilized for “Linear Cross-Sectional Scan” acquisition, for performing anterior capsulotomy and lens fragmentation. Phacoemulsification was followed by insertion of Premium IOLs, including multifocal, toric and/or extended depth-of-focus lenses.

The integrated anterior segment OCT offers real-time scanning ranging from the corneal epithelium to the posterior lens capsule, featuring a high-definition (HD) image output. 
Results of intraoperative ocular measurements, revealed the following mean values with standard deviations: Anterior Chamber Depth (ACD) measured 2.67 ± 0.88 millimeters (mm), Central Corneal Thickness (CCT) recorded 0.56 ± 0.06 mm, Lens Thickness (LT) average 4.49 ± 0.42 mm. The results revealed high concordance in 95% of the standard measurement ranges. Data shows lower agreement in eyes who exhibited unusual biometric characteristics, better characterized with intraoperative OCT scanning.

Utilizing intraoperative “Linear Cross-Sectional Scan” acquisition OCT measurements for examining anterior segment parameters is crucial in standardization and preventing misinterpretation of the anatomical structure (i.e. posterior capsule), thereby intraoperative OCT during FLACS enhance outcomes and appear indispensable in cataract premium surgery. Intraoperative OCT imaging may reveal anatomical variability that can impact surgery, highlighting the essential role of laser-assisted standardization in premium lens implantation.