Femtosecond laser-assisted cataract surgery in patients with phakic intraocular lenses and low endothelial cell counts: a case report

Introduction: Endothelial cell loss and complications after cataract surgery may be higher when cataract is complicated by uveitis.Objective: To compare endothelial cell damage and complication rates after phacoemulsification and manual small incision cataract surgery (SICS) in patients with uveitis.Materials and methods: Patients with uveitic cataract were randomly allocated for phacoemulsification (n=75) or manual SICS (n=80) in a double blind prospective study. In the bag implantation of a hydrophobic acrylic intraocular lens was aimed in all cases. Patients with follow up of less than six months were excluded. Main outcome measures were alteration in endothelial cell counts (ECC) and morphology, improvement in vision and complication rates. ECC was measured preoperatively and at 1 week, 3 months and six months, postoperatively.Results: Six patients were lost to follow up and another three due inability to implant IOL. There were no significant difference in endothelial cell counts (P= 0.032), the variance of endothelial cell size (CV) and percentage of hexagonal cells between both the groups at six months (Mann-Whitney test, P=0.283). Endothelial cell density was significantly less in the group in which vitrectomy and/or pupil dilatation procedures were performed (2290±31.5 cells/mm2) versus (2385±50.3 cells/mm2), respectively (t test, P<0.001). Incidence of postoperative complications that were observed like persistent uveitis (P=0.591), macular edema (P=0.671) and PCO (P=0.678) and visual outcome (P=0.974) were comparable between the two groups.Conclusions: Manual SICS and phacoemulsification do not differ significantly in endothelial cell loss and complication rates in uveitic eyes. However, increased anterior chamber manoeuvring due to additional procedures may lead to significantly higher endothelial cell loss.

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Refractive Outcomes After Femtosecond Laser–Assisted Cataract Surgery in Eyes With Anterior Chamber Phakic Intraocular Lenses

Journal of Refractive Surgery ◽

10.3928/1081597x-20180228-01 ◽

2018 ◽

Vol 34 (5) ◽

pp. 338-342 ◽

Cited By ~ 1

Author(s):

Gernot Steinwender ◽

Mehdi Shajari ◽

Thomas Kohnen

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Anterior Chamber ◽

Intraocular Lenses ◽

Refractive Outcomes ◽

Phakic Intraocular Lenses

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Endothelial cell counts in children after unilateral cataract surgery in the Infant Aphakia Treatment Study

Journal of American Association for Pediatric Ophthalmology and Strabismus ◽

10.1016/j.jaapos.2015.07.078 ◽

2015 ◽

Vol 19 (4) ◽

pp. e29

Author(s):

David G. Morrison ◽

Michael J. Lynn ◽

Faruk H. Orge ◽

Scott R. Lambert

Keyword(s):

Endothelial Cell ◽

Cataract Surgery ◽

Cell Counts ◽

Endothelial Cell Counts ◽

Unilateral Cataract

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Short-Term Outcome of Cataract Surgery Using Torsional-Mode Phacoemulsification for Patients with Low Endothelial Cell Counts

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2011.52.4.434 ◽

2011 ◽

Vol 52 (4) ◽

pp. 434 ◽

Cited By ~ 4

Author(s):

Eun Kyoung Lee ◽

Mee Kum Kim ◽

Won Ryang Wee ◽

Jin Hak Lee

Keyword(s):

Endothelial Cell ◽

Cataract Surgery ◽

Short Term ◽

Term Outcome ◽

Torsional Mode ◽

Cell Counts ◽

Short Term Outcome ◽

Endothelial Cell Counts

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Femtosecond laser–assisted cataract surgery in eyes with foldable anterior or posterior chamber phakic intraocular lenses

Journal of Cataract & Refractive Surgery ◽

10.1016/j.jcrs.2017.11.003 ◽

2018 ◽

Vol 44 (2) ◽

pp. 124-128 ◽

Cited By ~ 3

Author(s):

Thomas Kohnen ◽

Gernot Steinwender

Keyword(s):

Femtosecond Laser ◽

Cataract Surgery ◽

Intraocular Lenses ◽

Posterior Chamber ◽

Phakic Intraocular Lenses

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The application of the femtosecond laser in cataract surgery

OphthaTherapy Therapies in Ophthalmology ◽

10.24292/01.ot.300621.3 ◽

2021 ◽

Vol 8 (2) ◽

pp. 125-130

Author(s):

Piotr Kanclerz ◽

Karolina Pluta

Keyword(s):

Endothelial Cell ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Cost Effective ◽

Cell Loss ◽

Intraocular Lenses ◽

Endothelial Cell Loss ◽

Multifocal Intraocular Lenses ◽

Clinical Benefits ◽

To Receive

Introduction: Since the introduction, femtosecond laser-assisted cataract surgery (FLACS) was believed to revolutionize cataract surgery. However, the judgment of clinical benefits was found to be far more complex than initially might have been thought. The aim of this review was to analyze the benefits and drawbacks of FLACS compared to traditional phacoemulsification cataract surgery. Results: The benefits of FLACS include lower cumulated phacoemulsification time and endothelial cell loss, perfect centration of the capsulotomy, and the possibility to perform precise femtosecond-assisted arcuate keratotomy incisions. The major disadvantages of FLACS are: high cost of the laser and the disposables for surgery, FLACS-specific intraoperative capsular complications, as well as the risk of intraoperative miosis and the learning curve. Conclusions: FLACS seems to be beneficial in some groups of patients i.e., with low baseline endothelial cell count, or those planning to receive multifocal intraocular lenses. Nevertheless, having considered that the advantages of FLACS might not be clear in every routine case, it cannot be considered as cost-effective.

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Effects of intracameral cefuroxime on corneal endothelial cell counts and its morphology after cataract surgery

Interventional Medicine and Applied Science ◽

10.1556/1646.9.2017.13 ◽

2017 ◽

Vol 9 (2) ◽

pp. 100-104

Author(s):

Kourosh Shahraki ◽

Mohammad Naeim Amini Fard ◽

Farkhondeh Shahri ◽

Rama Pourmatin ◽

Tafgeh Mohammadi ◽

...

Keyword(s):

Endothelial Cell ◽

Cataract Surgery ◽

Corneal Endothelial Cell ◽

Cell Counts ◽

Endothelial Cell Counts

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Comparison of Femtosecond Laser-Assisted and Ultrasound-Assisted Cataract Surgery with Focus on Endothelial Analysis

Sensors ◽

10.3390/s21030996 ◽

2021 ◽

Vol 21 (3) ◽

pp. 996

Author(s):

Anna Schroeter ◽

Martina Kropp ◽

Zeljka Cvejic ◽

Gabriele Thumann ◽

Bojan Pajic

Keyword(s):

Endothelial Cell ◽

Femtosecond Laser ◽

Cataract Surgery ◽

Cell Loss ◽

Controlled Study ◽

Endothelial Cell Loss ◽

Cell Counts ◽

Positive Effect ◽

Cell Preservation ◽

Phaco Time

Femtosecond laser-assisted cataract surgery has the potential to make critical steps of cataract surgery easier and safer, and reduce endothelial cell loss, thus, improving postoperative outcomes. This study compared FLACS with the conventional method in terms of endothelial cells behavior, clinical outcomes, and capsulotomy precision. Methods: In a single-center, randomized controlled study, 130 patients with cataracta senilis received FLACS or conventional cataract surgery. Results: A significant endothelial cell loss was observed postoperatively, compared to the preoperative values in both groups. The endothelial cell counts was significantly better in the FLACS group in cataract grade 2 (p = 0.048) patients, compared to conventionally at 4 weeks. The effective phaco time was notably shorter in grade 2 of the FLACS group (p = 0.007) compared to the conventional. However, no statistically significant differences were found for the whole sample, including all cataract grades, due to the overall cataract density in the FLACS group being significantly higher (2.60 ± 0.58, p < 0.001) as compared to conventional methods (2.23 ± 0.42). Conclusions: Low energy FLACS provides a better result compared to endothelial cell loss, size, and shape variations, as well as in effective phaco time within certain cataract grade subgroups. A complete comparison between two groups was not possible because of the higher cataract grade in the FLACS. FLACS displayed a positive effect on endothelial cell preservation and was proven to be much more precise.

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