Comparison Of Cumulative Dissipated Energy ( C D E ) Between Femtosecond Laser-Assisted Cataract Surgery (F L A C S ) Using A New Maneuver To Separate Femto-Cataract Cuts Versus Standard Phacoemulsification.

The purpose of this study is to compare two different cataract techniques, Femto second laser-assisted cataract surgery (FLACS) using four cuts and a new maneuver to separate femto-cataract cuts very easy,versus standard phacoemuilsification.We have compared the Cumulative Dissipated Energy (CDE) of the Phaco machine, we also have compared which  had less endothelial cells lost and Hexagonality Index, between the two surgical thechniques.We have classified the lens hardness : 0 refractive surgery clear lens, 1 subcapsular cataract with clear nucleous, 2 mild hardness, according with Mandelblum (SPONCS) classification in order to compare the two groups.

This study was conducted at The Cornea and Anterior Segment Service of The Clinica de Ojos Ruiz-Montenegro & Eurolaser Ocular S.C. in Wagner 50, La Loma.

Morelia,Michoacán Mexico.

Retrospective study,40 eyes of 28 patients.Two groups of 20 eyes each one,with 3 subgroups according of hardness of the lens,Mandelblum cataract clasification was used.Same surgeon.First group Z8 Ziemer Femtolaser,separated the four lens pieces with the Montenegro´s maneuver using viscoelastic,then Centurion Alcon Machine to aspirate the cataract,measuring of Cumulative Dissipated Energy(CDE)in each patient,Second group standart phaco Centurion Alcon Machine.All patients were checked pre and post operatory for Specular Microscopy to compare endotelial cells density loss and hexagonality ,we also compared de CDE in both groups.Alcon foldable intraocular lenses were placed with the ultrasert  automatic system in all groups.

We have found that in group 1 (femto-phaco) the average CDE was 4.57 (range from 1.84 to 7.58)

The decrease average of endothelial cell density was 3.92% and the decrease average of hexagonality was 3.85%.

Whereas, in group 2 (standard-phaco) the average CDE was10.53 (range from 6.52 to 11.58)

The decrease average of endothelial cell density was 5.25% and the decrease average of hexagonality was 5.16%

No surgical complications were found in any group.

In conclusion, we have determinated that when we compared the two different cataract techniques, Femto second laser-assisted cataract surgery (FLACS) versus Standard Phacoemuilsification, the only statistically significant difference was the CDE , which was a lot lower in the Femto group (p<0.05)

In our study,the decrease average of endothelial cell density and the decrease average of hexagonality was also less in the femto group. However, the difference was not statistically significant.Furthermore,we recomend the Montenegro's maneuver to facilitate the separation of the fragments which were already divided by the Femtosecond laser.