A Meta-Analysis Comparing Postoperative Complications and Outcomes of Femtosecond Laser-Assisted Cataract Surgery versus Conventional Phacoemulsification for Cataract

Objective. This meta-analysis aimed to compare the outcomes and postoperative complications between femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification cataract surgery (CPCS). Methods. Bibliographic databases, including PubMed, Embase, and Cochrane library, were systematically searched for references on or before September 2015 regarding the outcomes and complications by FLACS or CPCS. Data on corneal endothelial cell loss, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive outcomes, and postoperative complications were retrieved. Results. A total of 9 trials were included in this analysis. Refractive outcomes (MD = −0.21, 95% CI: −0.39~0.03, P=0.02) were significantly improved after FLACS. Although corneal endothelial cell loss was not significantly reduced after FLACS, there was a trend towards lower corneal endothelial cell loss (mean difference (MD) = 197.82, 95% confidence interval (CI): 2.66~392.97, P=0.05) after FLACS. There was no significant difference in UDVA (MD = −0.01, 95% CI: −0.13~0.10, P=0.80) or CDVA (MD = −0.03, 95% CI: 0.07~0.00, P=0.09) between the two surgeries. Elevated intraocular pressure and macular edema were most commonly developed complications after cataract surgery, and the incidence of these complications associated with the two surgeries was similar. Conclusion. Compared with CPCS, FLACS might achieve higher refractive stability and corneal endothelial cell count. Nevertheless, further study is needed to validate our findings.

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Faculty of 1000 evaluation for Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718043532.793483346 ◽

2013 ◽

Author(s):

George Beiko

Keyword(s):

Endothelial Cell ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Corneal Thickness ◽

Cell Loss ◽

Corneal Endothelial Cell ◽

Endothelial Cell Loss

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Faculty Opinions recommendation of Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser-assisted cataract surgery: three-month follow-up.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718043532.793485567 ◽

2013 ◽

Author(s):

Karl Stonecipher

Keyword(s):

Endothelial Cell ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Corneal Thickness ◽

Cell Loss ◽

Corneal Endothelial Cell ◽

Endothelial Cell Loss

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Corneal endothelial cell loss and corneal thickness in conventional compared with femtosecond laser–assisted cataract surgery: Three-month follow-up

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2013.05.033 ◽

2013 ◽

Vol 39 (9) ◽

pp. 1307-1313 ◽

Cited By ~ 113

Author(s):

Ina Conrad-Hengerer ◽

Mayss Al Juburi ◽

Tim Schultz ◽

Fritz H. Hengerer ◽

Burkhard H. Dick

Keyword(s):

Endothelial Cell ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Corneal Thickness ◽

Cell Loss ◽

Corneal Endothelial Cell ◽

Endothelial Cell Loss

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Comparison of refractive predictability and endothelial cell loss in femtosecond laser-assisted cataract surgery and conventional phaco surgery: prospective randomised trial with 6 months of follow-up

BMJ Open Ophthalmology ◽

10.1136/bmjophth-2018-000233 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000233 ◽

Cited By ~ 9

Author(s):

Therese Krarup ◽

Rasmus Ejstrup ◽

Anouck Mortensen ◽

Morten la Cour ◽

Lars Morten Holm

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Cell Loss ◽

Absolute Difference ◽

Endothelial Cell Loss ◽

Distance Visual Acuity ◽

The Mean

ObjectiveFemtosecond laser-assisted cataract surgery (FLACS) decreases the use of energy and provides a more precise capsulorhexis compared with conventional phaco surgery (CPS). The purpose of this study was to examine if the lower energy use in FLACS caused less endothelial cell loss compared with CPS and if there was a difference in refractive predictability between CPS and FLACS.Methods and analysisThis was a randomised controlled study of 96 patients with a 6-month follow-up comparing one eye surgery by FLACS and the contralateral eye operated by CPS (divide and conquer technique). Both eyes had intraocular aspheric lenses implanted. Uncorrected distance visual acuity, corrected distance visual acuity (CDVA), central corneal endothelial cell count and hexagonality (non-contact endothelial cell microscope) were assessed preoperatively at 40 and at 180 days postoperatively.ResultsThe mean phaco energies were 6.55 (95% CI 5.43 to 7.66) and 9.77 (95% CI 8.55 to 10.95) U/S (p<0.0001) by FLACS and CPS, respectively. At day 40, the mean endothelial cell loss (ECL) was 344 cells/mm2 (95% CI 245 to 443) by FLACS (12.89%) and 497 cells/mm2 (95% CI 380 to 614) by CPS (18.19%) (p=0.027). At day 180, ECL was 362 cells/mm2 (95% CI 275 to 450) in FLACS (13.56%) and 465 cells/mm2 (95% CI 377 to 554) in CPS (17.03%) (p=0.036).The mean absolute difference from the attempted refraction was 0.43 (95% CI 0.36 to 0.51) dioptres (D) at day 40 and 0.46 D (95% CI 0.39 to 0.53) at day 180 by FLACS compared with 0.43 D (95% CI 0.36 to 0.51) at day 40 (p=0.95) and 0.46 D (95% CI 0.37 to 0.52) at day 180 (p=0.91) with CPS.ConclusionECL was significantly lower in FLACS compared with CPS at both day 40 and day 180. ECL was correlated to the energy used. We found no difference in refractive predictability or CDVA between the groups.

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Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-021-05114-2 ◽

2021 ◽

Author(s):

Bishr Agha ◽

Raimund Forster ◽

Thomas Kohnen ◽

Ingo Schmack

Keyword(s):

Visual Acuity ◽

Endothelial Cell ◽

Anterior Segment ◽

Cell Loss ◽

Endothelial Cell Loss ◽

Refractive Outcome ◽

Refractive Outcomes ◽

Scheimpflug Imaging ◽

Fuchs Endothelial Dystrophy ◽

Anterior Segment Parameters

Abstract Purpose To evaluate the potential impact of rebubbling on the anterior segment parameters and refractive outcomes in patients with graft detachment following uneventful DMEK for Fuchs endothelial dystrophy (FED). Methods Retrospective institutional cohort study of comparing 34 eyes of 31 patients with rebubbling for graft detachment following Descemet membrane endothelial keratoplasty (DMEK) to 33 eyes of 28 patients with uneventful DMEK. Main outcome parameters were various corneal parameters obtained by Scheimpflug imaging, refractive outcome, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). Results Anterior and posterior corneal astigmatism, corneal densitometry, central corneal thickness, and anterior chamber depth and volume showed no significant differences. Preoperative distribution of astigmatism axis orientations showed a high proportion of anterior corneal with-the-rule astigmatism (71%) in eyes requiring rebubbling. Mean postoperative cylinder in the rebubbling group (1.21 ± 0.85 D) was significantly higher compared to the controls (p = 0.04), while differences in spherical equivalent (SE) were insignificant (p = 0.24). Postoperative CDVA was 0.11 ± 0.11 in the control group compared to 0.21 ± 0.17 in the rebubbling group (p = 0.03). Eyes with subsequent rebubbling demonstrated a significantly higher endothelial cell loss (56% versus 37%) (p < 0.001). Conclusion Apart from higher cylinder values, refractive outcome and corneal parameters assessed by Scheimpflug imaging were comparable in eyes with rebubbling and controls. However, a reduced visual acuity and an increased endothelial cell loss should be taken into consideration prior to rebubbling especially in eyes with circumscribed graft detachment.

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