Conventional phaco vs FLACS
A large randomised clinical study compared the clinical results of conventional phacoemulsification surgery (CPS) with femtosecond laser-assisted cataract surgery (FLACS) in 400 patients. FLACS procedures utilised the LensX laser system. All operations were performed with a gravity-fluidics torsional phacoemulsification machine (Infiniti). With a four-week follow-up period, the study found no significant differences between two treatment modalities, notwithstanding a significant reduction in posterior capsule ruptures in the FLACS group. The study included measures of post-op visual acuity, corneal thickness and endothelial cell loss. Seven patients (3.5%) in the FLACS group were not able to complete the treatment and received CPS. The rate of posterior capsule rupture was 3% in the phaco group and 0% among FLACS patients (p=0.03). The study showed no statistically significant reduction in phacoemulsification energy between the two groups.
HW Roberts, JCRS, “A randomized controlled trial comparing femtosecond laser–assisted cataract surgery versus conventional phacoemulsification surgery”, Vol. 45, No.1, 11-20.
Phaco, FLACS and multifocals
Proponents of FLACS have suggested that its more accurate centration as well as more precisely sized and shaped capsulotomy should improve refractive stability and predictability by reducing the incidence of IOL movement, tilt, and decentration. Korean researchers compared the outcomes of conventional phaco and FLACS followed by multifocal intraocular lens implantation in a retrospective case series analysis. Seventeen patients (23 eyes) had FLACS, of which 14 eyes also had arcuate keratotomy. Another 22 patients (26 eyes) had conventional phaco. Overall, astigmatic change was more predictable in the FLACS group. Internal aberrations such as total RMS, tilt, and RMS HOAs, were lower in the femtosecond group, and patients in that group were more satisfied.
Jin AH Lee, JCRS, “Femtosecond laser-assisted cataract surgery versus conventional phacoemulsification: Refractive and aberrometric outcomes with a diffractive multifocal intraocular lens”, Vol. 45, No.1, 21-27.
Femtosecond laser for residual astigmatism
German researchers evaluated the refractive and visual outcomes of arcuate incisions performed with the femtosecond laser in patients with residual refractive astigmatism after refractive lens exchange (RLE) with trifocal intraocular lenses. The study enrolled 95 eyes of 70 patients, with a mean follow-up of 5.6 months. Patients showed significant improvements in uncorrected vision and in the degree of astigmatism following surgery. No intraoperative or postoperative complications were seen. The investigators conclude that femtosecond laser-assisted corneal arcuate incisions were safe, efficient and feasible to reduce refractive astigmatism after trifocal IOL implantation.
I Ludeke et al., JCRS, “Refractive outcomes of femtosecond laser–assisted secondary arcuate incisions in patients with residual refractive astigmatism after trifocal intraocular lens implantations”, Vol. 45, No.1, 28-34.
