Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons

Abstract Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

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Comparison of real-world treatment outcomes of femtosecond laser-assisted cataract surgery and phacoemulsification cataract surgery: A retrospective, observational study from an outpatient clinic in France

European Journal of Ophthalmology ◽

10.1177/1120672120925766 ◽

2020 ◽

pp. 112067212092576

Author(s):

Philippe Charles Crozafon ◽

Christine Bouchet ◽

Monia Zignani ◽

Ray Griner ◽

Samuel D Foster ◽

...

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Multiple Comparisons ◽

Posterior Capsule Opacification ◽

Dissipated Energy ◽

Corneal Oedema ◽

Corrected Distance Visual Acuity ◽

Cumulative Dissipated Energy ◽

Phacoemulsification Cataract Surgery

Purpose: This study compared real-world safety and efficacy outcomes of cataract surgery performed with LenSx femtosecond laser-assisted cataract surgery or manual phacoemulsification cataract surgery procedures. Methods: A retrospective observational study used data from anonymised electronic medical records to compare mean cumulative dissipated energy, the proportion of eyes reaching emmetropia, mean change in best-corrected distance visual acuity and the proportion of eyes with post-surgical complications, including corneal oedema and posterior capsule opacification. Results were adjusted for multiple comparisons for primary and secondary objectives. Results: Data from 811 phacoemulsification cataract surgery and 496 femtosecond laser-assisted cataract surgery procedures were analysed. Mean cumulative dissipated energy was significantly lower for femtosecond laser-assisted cataract surgery (6.5 percent-seconds) than for phacoemulsification cataract surgery (14.3 percent-seconds; p < 0.0001) procedures. More femtosecond laser-assisted cataract surgery (81.2%) procedures achieved emmetropia (⩽ 0.5 dioptre) than did phacoemulsification cataract surgery (73.5%) procedures, although this difference was not statistically significant. Mean change in best-corrected distance visual acuity and the proportion of eyes with corneal oedema, posterior capsule opacification or other complications were not significantly different between cohorts when adjusted for multiple comparisons. Conclusions: In this single-centre, single-surgeon retrospective electronic medical record database study using divide and conquer technique, femtosecond laser-assisted cataract surgery was associated with significantly lower cumulative dissipated energy when compared to manual phacoemulsification cataract surgery. This supports the hypothesis that femtosecond laser-assisted cataract surgery involves less mechanical trauma, which might lead to more consistent refractive and safety outcomes than manual phacoemulsification cataract surgery, though such outcomes were found to be comparable in this study.

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Cataract Surgery in Very Old Patients: A Case-Control Study

Journal of Clinical Medicine ◽

10.3390/jcm10204658 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4658

Author(s):

Hanan Nussinovitch ◽

Erez Tsumi ◽

Raimo Tuuminen ◽

Boris Malyugin ◽

Yotam Lior ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Case Control Study ◽

Surgical Techniques ◽

Case Control ◽

Dissipated Energy ◽

Old Patients ◽

Very Old ◽

Very Old Patients ◽

Control Study

Advancements in surgical techniques and increased life expectancy have made cataract surgery more common among very old patients. However, surgical outcomes seem impaired in patients older than 90 years, especially with ocular comorbidities. A retrospective case-control study of 53 eyes of 53 very old patients (mean 92.6 ± 3.0) and 140 eyes of 140 matched patients (mean 75.2 ± 7.6) was undertaken. Groups were matched in terms of gender and systemic and ocular comorbidities. In very old patients, higher phacoemulsification energy (cumulative dissipated energy [CDE], 25.0 ± 22.4 vs. 16.1 ± 10.7, p = 0.01) and rate of intraoperative floppy iris syndrome (IFIS, 9.4% vs. 1.4%, p = 0.02) were observed compared to controls. Uncorrected (UCVA) and best-corrected distance visual acuity (BCVA) gains were significantly poorer among the very old patients than among the control at postoperative day 30 (0.20 ± 0.70 vs. 0.56 ± 0.61 logMAR, p < 0.001 and 0.27 ± 0.64 vs. 0.55 ± 0.62 logMAR, p = 0.006, respectively). Even after including CDE and IFIS as covariates, age remained an independent factor for poor visual gain at 30 days (p < 0.001). Cataract surgery in very old patients may demand more experienced surgeons due to higher nuclear density and the rates of IFIS. Expectations in visual acuity gains should be aligned with the patient’s age.

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Dome-shaped macula: a potential protective factor for visual acuity after cataract surgery in patients with high myopia

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313279 ◽

2019 ◽

Vol 103 (11) ◽

pp. 1566-1570 ◽

Cited By ~ 3

Author(s):

Xiangjia Zhu ◽

Wenwen He ◽

Shaohua Zhang ◽

Xianfang Rong ◽

Qi Fan ◽

...

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Axial Length ◽

High Myopia ◽

Protective Factor ◽

Choroidal Neovascularisation ◽

Postoperative Visual Acuity ◽

Younger Age ◽

Male Sex ◽

Central Fovea

PurposeTo evaluate whether the presence of dome-shaped macula (DSM) is a protective factor for visual acuity after cataract surgery in patients with high myopia.MethodsIncluded were 891 highly myopic cataract eyes (600 patients) that were examined by optical coherence tomography (OCT) through the central fovea and underwent cataract surgery in our hospital. DSM was defined as an inward bulge >50 µm in horizontal or vertical OCT sections. The incidences of various maculopathies were compared between eyes with and those without DSM. The influences of age, sex, eye laterality, axial length and DSM on postoperative visual acuity were evaluated by multivariate linear regression.ResultsOf the 891 eyes, 123 (13.8%) had DSM. There was a greater association of DSM with extrafoveal retinoschisis (RS) than with other vision-threatening complications such as foveal RS and choroidal neovascularisation. In addition to axial length and age, sex was associated with the presence of DSM (p=0.016). In bilateral high myopia, the incidence of DSM increased with the degree of anisometropia and was more common in the longer eye of patients with anisometropia. Younger age, male sex, shorter axial length and the presence of DSM were associated with better postoperative visual acuity in highly myopic cataract eyes (β=0.124, p=0.002; β=0.142, p<0.001; β=0.275, p<0.001 and β=−0.088, p=0.038, respectively).ConclusionAssociated with fewer visual threatening macular complications, presence of DSM may be a protective factor for visual function after cataract surgery in highly myopic eyes.

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Cataract Surgery With Toric Intraocular Lenses Can Optimize Uncorrected Postoperative Visual Acuity in Patients With Marked Corneal Astigmatism

Cornea ◽

10.1097/ico.0b013e31802be5cc ◽

2007 ◽

Vol 26 (2) ◽

pp. 133-135 ◽

Cited By ~ 24

Author(s):

James P Kersey ◽

Annie OʼDonnell ◽

Christopher D Illingworth

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Corneal Astigmatism ◽

Intraocular Lenses ◽

Postoperative Visual Acuity

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Comparative Analysis of Double and Trifocal IOL Implantation in Femtosecond Laser-Assisted Cataract Surgery

Ophthalmology in Russia ◽

10.18008/1816-5095-2019-1s-68-73 ◽

2019 ◽

Vol 16 (1S) ◽

pp. 68-73 ◽

Cited By ~ 1

Author(s):

O. I. Orenburkina

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Average Distance ◽

Clinical Results ◽

Main Group ◽

Intraocular Lenses ◽

Control Group ◽

Lighting Conditions ◽

Near Visual Acuity

Purpose: to compare the clinical results of implantations of bi-and trifocal intraocular lenses (IOL) in femtosecond laser-assisted cataract surgery. Patients and methods. The article presents the results of the Acrysof IQ Panoptix trifocal lens implantations in 84 patients (112 eyes) — the main group and Acrysof IQ Restor bifocal IOL implantations in 52 patients (98 eyes) — the control group. All patients underwent femtosecond laser-assisted cataract surgery (FLACS). The following data were evaluated: uncorrected distance visual acuity (UCDVA) , uncorrected near visual acuity (30–45 cm) and at an average distance (50–70 cm) at discharge, after 14 days, 1 and 3 months after the surgery under photopic and mesopic lighting conditions. Postoperative refractometry data; the defocusing curve was performed in patients with a high UCDVA (0.9–1.0) monocularly under photopic conditions using standard optotypes 14 days after surgery; aberrometry indicators. Results. It was shown that both lenses provided high uncorrected distance and near visual acuity in photopic lighting conditions. At the same time, the Acrysof IQ Panoptix lens provided significantly better visual acuity at an intermediate distance and was more resistant to defocusing conditions. Refraction data: after 1 month, emmetropia was observed in 87 % of patients in the main group and in 85 % of control group, after 6 months — 92 and 89 % respectively. There were no significant differences in high order aberrations and total aberrations between patients of the compared groups. Conclusion. The use of the PanOptix trifocal lens made it possible to obtain maximum visual acuity at different distances, regardless of the level of illumination.

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Changes in Retinal Vasculature and Thickness After Femtosecond Laser-assisted Cataract Surgery and Conventional Cataract Surgery Using Optical Coherence Tomography Angiography

10.21203/rs.3.rs-1212191/v1 ◽

2022 ◽

Author(s):

Hong Zhang ◽

Liangzhang Tan ◽

Fang Tian ◽

Xue Gong ◽

Lu Chen ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Optical Coherence Tomography Angiography ◽

Macular Thickness ◽

Retinal Vasculature ◽

Optical Coherence ◽

Age Related

Abstract Purpose To assess the changes in retinal vasculature and thickness after femtosecond laser-assisted cataract surgery (FLACS) using optical coherence tomography angiography (OCTA).Methods Fifty-six eyes of 56 patients with age-related cataract were enrolled in this study. Patients were divided into FLACS or conventional phacoemulsification surgery (CPS) due to the choice of operation. Vessel density (VD) and thickness at the macular area and optic nerve head (ONH) were checked by OCTA at baseline and at 1 day, 1 month and 3 months after cataract surgery.Results In the FLACS group: The radial peripapillary capillary (RPC) density displayed a significant reduction during the follow-up (P < 0.05), even when the retinal nerve fiber layer (RNFL) thickness was not significantly changed. There was a significant negative correlation between the changes in RPC density and femtosecond laser-assisted pre-treatment time (FLAPT) at 1 day and 1 month after cataract surgery respectively (both P < 0.05). At 3 months postoperatively, the macular thickness had a significant increase in all regions (all P < 0.05). In the CPS group, the retinal VD and thickness did not show statistically significant changes in all regions during the follow-up (all P > 0.05). However, the best corrected visual acuity (BCVA) was significantly improved in both groups postoperatively (both P < 0.001).Conclusions OCTA provided a promising analysis of retinal vascular alterations, demonstrating the reduction of RPC density and the increase of macular thickness after FLACS. However, these changes had no effect on the improvement of visual acuity after cataract surgery.

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Femtosecond Laser in Cataract Surgery: What Makes it Worth it? or not?

Journal of Ophthalmic Science ◽

10.14302/issn.2470-0436.jos-18-2494 ◽

2019 ◽

Vol 2 (1) ◽

pp. 16-23

Author(s):

Karl Stonecipher ◽

Joseph Parrish ◽

Megan Stonecipher ◽

Jamison Maxwell ◽

Donald P. Maxwell

Keyword(s):

Visual Acuity ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Postoperative Outcomes ◽

Prospective Evaluation ◽

Visual Outcomes ◽

Lens Opacification

This review is designed to look at a prospective evaluation of the use of the femtosecond laser and manual incision standard cataract surgery in one center with one surgeon focusing on visual outcomes and complications. Multiple studies support both benefits, risks, alternatives, and differences between manual capsulotomy combined with standard manual incision cataract surgery and cataract surgery employing the femtosecond laser in conjunction with routine phacoemulsification. The purpose of this study was to evaluate early postoperative outcomes using a prospective evaluation of cases from one surgeon over the course of two years from 2015-2017. The first group of cases involves 2134 eyes comparing phacoemulsification time in seconds (PT), ultrasound time in seconds (UT), and cumulative delivered energy (CDE). The second group of cases involves 1913 eyes that were Lens Opacification Classification III similar and without other ocular or lenticular abnormalities. Finally, a subgroup from the latter group (n=150) were evaluated over the course of two days and postoperative 3-hour examinations (visual acuity) were compared.

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Using the postoperative visual acuity to monitor the quality of cataract surgery: Does the day one visual acuity following cataract surgery correlate with the final visual acuity?

Middle East African Journal of Ophthalmology ◽

10.4103/meajo.meajo_279_16 ◽

2017 ◽

Vol 24 (2) ◽

pp. 91

Author(s):

Colin Cook ◽

Halimatu Aliyu ◽

Hamzah Mustak

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Final Visual Acuity ◽

Postoperative Visual Acuity

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The Impact of Cataract Surgery on Contrast Visual Acuity and Retinal Sensitivity in Patients with Retinitis Pigmentosa

Journal of Ophthalmology ◽

10.1155/2021/2281834 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Gen Miura ◽

Takayuki Baba ◽

Tomoaki Tatsumi ◽

Hirotaka Yokouchi ◽

Shuichi Yamamoto

Keyword(s):

Visual Acuity ◽

Retinitis Pigmentosa ◽

Cataract Surgery ◽

Contrast Sensitivity ◽

Retinal Sensitivity ◽

Zone Length ◽

Ellipsoid Zone ◽

Postoperative Visual Acuity ◽

Before And After ◽

The Impact

Purpose. To determine the effects of cataract surgery on contrast visual acuity and retinal sensitivity in patients with retinitis pigmentosa. Methods. Retinal sensitivity and contrast visual acuity were determined by microperimetry (MAIA) and contrast sensitivity acuity tester (CAT-CP), respectively, before and after cataract surgery. The significance of the correlations between visual acuity, retinal sensitivity, contrast visual acuity, improvements after surgery, and macular structure before and after cataract surgery was determined. Results. Retinal sensitivity and contrast visual acuity were significantly improved after cataract surgery. The correlations among postoperative visual acuity, postoperative retinal sensitivities, and preoperative ellipsoid zone length were significant. The postoperative retinal sensitivity of the central 10° and the ellipsoid zone length was particularly significantly correlated. Preoperative contrast visual acuity and the amount of improvement and preoperative retinal sensitivity and the amount of improvement were significantly negatively correlated. The contrast visual acuity under both the 100% and 10% photopic and mesopic conditions improved significantly after cataract surgery. Conclusions. Cataract surgery in retinitis pigmentosa patients with preserved ellipsoid zones significantly improved retinal sensitivity and contrast visual acuity. Cataract surgery can be expected to improve retinal sensitivity and contrast visual acuity under various conditions, even if preoperative visual parameters are low, as long as the ellipsoid zone is preserved.

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