Evaluation Of Clear Corneal Incision Following Manual And Femtosecond Laser Assisted Cataract Surgery

To compare the occurrence of incisional Descemet’s detachments (DD) in manual phacoemulsification (PE) versus femtosecond laser assisted cataract surgery (FLACS)

Iladevi Cataract & IOL Research centre, Raghudeep Eye Hospital, Jaipur, India,

Prospective study in 450 eyes undergoing cataract surgeryrandomized to: group I(n=150)PE with a 2.2mm near square limbal incision,group II(n = 150)PE with 2.2mm external entry and internal flare created with the same anterior bevel knife as group I,and group III–FLACS where the laser was used to create a trapezoidal incision with external 2.2mm and internal entry 2.3mm.Outcome measures presence of DD noted clinically at the end of surgery,DD on anterior segment optical coherence tomography(OCT)performed within an hour of surgery,epithelial/endothelial misalignment.Additionally,manual 2.2mm square and femtosecond laser trapezoidal 2.2mm incisions were created in 5 human cadaver eyes each,and incision architecture compared on histomorphology.

Intraoperatively, varying degrees of DD at the incision were seen in 14,13 and 5.3% eyes in groups I,II,III respectively. Postoperatively, DD on OCT in 58, 79 and 30% eyes within an hour. The differences were statistically significant(P <0.05). Histomorphologic evaluation of collagen showed misalignment of the roof and floor of incision in manual group compared to FLACS. There was greater collagen disorganisation around the incision in the manual group.

FLACS incisions had a lower incidence of DD as well as lesser collagen architecture distortion. The femtosecond laser allows creation of precisely sized trapezoidal incisions for more wiggle space at the internal entry causing less trauma.