Early results of circularity and centration of capsulotomy prepared by three different methods

AIM: To compare the difference of capsulotomy produced by precision pulse capsulotomy (PPC), manual (M-CCC), and femtosecond laser assisted capsulotomy (FLAC) in relation to intraocular lens (IOL) centration, circularity and its effect on visual outcomes. METHODS: Prospective, non-randomized comparative study conducted at LV Prasad Eye Institute, Hyderabad, India. Sixty eyes of 52 patients were grouped into 3 (FLAC, PPC and M-CCC) based on capsulotomy techniques used. Twenty consecutive eyes with uneventful phacoemulsification and with no comorbidities affecting the capsulotomy or visual outcome were included in each group. The main outcome measure was IOL centration in relation to capsulotomy and pupil. Secondary outcome measures were post-operative visual acuity, manifest refraction and aberration profile between groups. RESULTS: At 5wk the visual, refractive outcomes and endothelial cell density were comparable between the 3 groups. The median circularity index of FLAC was statistically significantly different to M-CCC or PPC (1-10) groups (P<0.01) but PPC (11-20) was comparable to FLAC. Decentration of IOL center in relation to capsulotomy was seen only between the PPC (1-10) group and FLAC group (P=0.02). The IOL was well centered in relation to the pupil in all the groups (P=0.46). The quality of vision parameters like the higher order aberrations, spherical aberration, coma, trefoil, modular transfer function, and Strehl ratio were comparable between the groups. CONCLUSION: Our study shows that despite differences in the morphology of capsulotomy produced by PPC, M-CCC, FLAC a well-centered IOL can be achieved. The measured capsular morphology parameters do not affect visual outcomes.

Comparison between the Characteristics of Femtosecond laser Anterior Capsulotomy Versus Manual Capsulorhexis and their Effects on Intra Ocular Lens Centration, Effectiveness and Safety in Cataract Surgery

Background Cataract is characterized with opacity of the crystalline lens that can markedly limit the routine activities of patients such as reading, writing, walking and in the long run reduce the quality of life. Cataract is the main cause of preventable blindness. Despite some modern advances in the field of cataract impending drug treatments, surgical treatment is still known to be the most actual treatment option(1). Objective To perform a meta-analysis on the characteristics of femtosecond laser anterior capsulotomy and manual capsulorhexis and their effects on intra ocular lens (IOL) centration, effectiveness and safety in cataract surgery. Methods This meta-analysis was conducted from 1/1/2015 to 31/7/2018. Literature search on PubMed was done to identify randomised controlled trials (RCT) and comparative studies MedCalc ver. 18.2 (MedCalc, Ostend, Belgium) was used for data analysis. Results Of the 17 articles included, there were 3 (18%) randomised controlled trials and 14 (82%) comparative study. The meta-analysis was based on a total of 18558 eyes. Of them, 9442 (50.88%) underwent femtosecond laser-assisted cataract surgery (FLACS) and 9116 (49.12%) underwent manual continuous curvilinear capsulorrhexis (CCC). Comparative study between the 2 groups revealed; highly significant increase in better IOL centration; in FLACS group compared to CCC group (p &lt; 0.01), there is non-significant difference as regards capsulotomy diameter (p &gt; 0.05) and non-significant difference as regards corrected distant visual acuity (CDVA) ,un corrected distant visual acuity (UDVA) and mean absolute error (MAE) (p &gt; 0.05). As regards the complications; fixed-effect model showed highly significant increase in complications rate in FLACS group; but random-effects model showed non-significant difference between the 2 groups (p &lt; 0.001, p &gt; 0.05 respectively). Conclusion FLACS is better for IOL centration, but there is non-significant difference between FLACS and manual CCC as regards capsulotomy diameter, CDVA, UDVA, MAE and complication rate.