Comparison of Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification on Endothelial Cell Density When Using Torsional Modality

Abstract

Purpose

To compare the effects of femtosecond laser assisted cataract surgery (FLACS) and manual phacoemulsification on cumulative dissipated energy (CDE), torsional amplitude, and endothelial cell density (ECD).

Patients and Methods

This prospective, randomized study was conducted at Oka Eye Clinic (Fukuoka, Japan). Surgeries were performed using FLACS (with LenSx) or conventional technique in adults ≥20 years with grade 2–4 cataracts. Visits included preoperative, surgery day, and 5 postoperative visits (days 1, 4–10, 20–40, 60–120, and 150–210). Primary endpoint was CDE. Secondary endpoints included ECD percent change at day 150–210 versus preoperative visit and average torsional amplitude on surgery day. Exploratory endpoints included central corneal thickness and corrected distance visual acuity (CDVA). Superiority of FLACS to conventional technique was evaluated using t-tests based on a mixed model for repeated measures.

Results

Full analysis set included 53 eyes per group. Mean cataract grade was 2.92±0.58 in FLACS and 2.94±0.57 in conventional group. FLACS versus conventional method had significantly lower mean CDE (0.213±0.334 versus 1.718±0.898%-seconds, respectively; P<0.0001), demonstrating superiority of FLACS. Low endothelial cell loss (ECL) was achieved with both FLACS and conventional methods (1.5±5.6% and 2.7±5.2%; P=0.260). Torsional amplitude was significantly lower for FLACS versus conventional method (19.6±16.0% versus 31.1±6.6%; P<0.0001). Central corneal thickness was comparable for both methods at all visits except day 1; CDVA was comparable for both methods at all postoperative visits.

Conclusion

FLACS achieved significantly lower CDE compared with the conventional surgical method (P<0.0001). Low ECL was achieved with both FLACS (1.5%) and conventional (2.7%) methods.

Graphical Abstract

Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use:

https://youtu.be/xzalrupRtlw

Keywords:

• cumulative dissipated energy
• endothelial cell loss
• LenSx
• torsional phaco

Data Sharing Statement

Study data not reported in this publication are confidential.

Acknowledgments

This study was funded by Alcon Vision LLC. Medical writing assistance was provided by Natalia Zhukovskaya, PhD, of ICON (North Wales, PA), and was funded by Alcon.

Disclosure

VP Injev and N Sasaki are Alcon employees. Y Oka received grant support from Alcon Japan Ltd. The authors report no other conflicts of interest in this work.

Additional information

Funding

Research funding was provided by Alcon Japan Ltd.