Clinical Outcomes And Predictive Factors Of Intraoperative Miosis During Femtosecond Laser-Assisted Cataract Surgery: Results From The First 300 Cases

To compare clinical outcomes between patients with and without severe intraoperative miosis during femtosecond laser-assisted cataract surgery (FLACS) and to identify risk factors for severe miosis in the first 300 cases.

Onnuri Smile Eye Clinic, Seoul, South Korea

Patients were divided into two groups based on post-femtosecond laser pupil diameter: the miosis group (<5 mm) and the mydriasis group (≥5 mm). Clinical outcomes at 3 months were compared, and perioperative findings were analyzed to identify factors associated with severe miosis.

The study included 52 eyes in the miosis group and 248 eyes in the mydriasis group. The miosis group had a smaller preoperative pupil diameter (P = 0.002), a narrower capsulotomy-to-pupil margin (P = 0.002), longer vacuum duration (P < 0.001), longer phacoemulsification time (P = 0.005), and more frequent multiple docking attempts (P = 0.009). The first half of cases showed higher rates of multiple docking attempts (P < 0.001) and severe miosis (P < 0.001). However, visual outcomes and specular microscopy parameters at 3 months did not differ significantly between groups.

Small preoperative pupils, a narrow capsulotomy-to-pupil margin, long vacuum time, multiple docking attempts, and less experienced surgeons are risk factors for severe miosis during FLACS. Although severe miosis prolonged phacoemulsification time, it did not significantly impact clinical outcomes.