To compare functional and morphological outcomes of femtosecond laser clear corneal incision (CCI) versus manual CCI during cataract surgery.
Sixty eyes of 60 patients who underwent CCI during cataract surgery were randomized into two groups: femtosecond laser CCI (30 eyes) and manual CCI (30 eyes).
There were no significant between-group differences in uncorrected distance visual acuity, corrected distance visual acuity, surgically induced astigmatism, and corneal aberrations. Keratometric astigmatism was significantly lower in the femtosecond laser CCI group compared to the manual CCI group at 30 and 180 days (P < .05). Central endothelial cell count was significantly higher in the femtosecond laser CCI group compared to the manual CCI group at 7 and 30 days postoperatively (P < .05). A lower increase of corneal thickness at the incision site was observed at 30 and 180 days postoperatively in the femtosecond laser CCI group compared to the manual CCI group (P < .05). In addition, femtosecond laser CCI showed a better morphology (lower percentage of endothelial and epithelial gaping and endothelial misalignment) compared to manual CCI at different time points. Total phacoemulsification time was significantly lower in the femtosecond laser CCI group (P < .05).
The femtosecond laser procedure was safe, efficient, and less damaging, as evidenced by lower central endothelial cell loss, lower increase of corneal thickness at the incision site, and better tunnel morphology compared to the manual technique.
[J Refract Surg. 2014;30(1):27–33.]
- 1.Calladine D, Ward M, Packard R. Adherent ocular bandage for clear corneal incisions used in cataract surgery. J Cataract Refract Surg. 2010; 36:1839–1848.
10.1016/j.jcrs.2010.06.058> Crossref MedlineGoogle Scholar
- 2.Xia Y, Liu X, Luo L, Early changes in clear cornea incision after phacoemulsification: an anterior segment optical coherence tomography study. Acta Ophthalmol. 2009; 87:764–768.
10.1111/j.1755-3768.2008.01333.x> Crossref MedlineGoogle Scholar
- 3.Ursea R, Feng M, Urs R, RoyChoudhury A, Silverman RH. Comparison of Artemis 2 ultrasound and Visante optical coherence tomography corneal thickness profiles. J Refract Surg. 2013; 29:36–41.
10.3928/1081597X-20121126-01> LinkGoogle Scholar
- 4.Mohamed S, Lee GK, Rao SK, Repeatability and reproducibility of pachymetric mapping with Visante anterior segment-optical coherence tomography. Ophthalmol Vis Sci. 2007; 48:5499–5504.
10.1167/iovs.07-0591> Crossref MedlineGoogle Scholar
- 5.Prospero Ponce CM, Rocha KM, Smith SD, Krueger RR. Central and peripheral corneal thickness measured with optical coherence tomography, Scheimpflug imaging, and ultrasound pachymetry in normal, keratoconus-suspect, and post-laser in situ keratomileusis eyes. J Cataract Refract Surg. 2009; 35:1055–1062.
10.1016/j.jcrs.2009.01.022> Crossref MedlineGoogle Scholar
- 6.He L, Sheehy K, Culbertson W. Femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2011; 22:43–52. > Crossref MedlineGoogle Scholar
- 7.Feizi S. Femtosecond laser cataract surgery. J Ophthalmic Vis Res. 2011; 6:151. > MedlineGoogle Scholar
- 8.Masket S, Sarayba M, Ignacio T, Fram N. Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility. J Cataract Refract Surg. 2010; 36:1848–1849.
10.1016/j.jcrs.2010.03.027> CrossrefGoogle Scholar
- 9.Mastropasqua L, Nubile M, Lanzini M, Carpineto P, Toto L, Ciancaglini M. Corneal and conjunctival manifestations in Fabry disease: in vivo confocal microscopy study. Am J Ophthalmol. 2006; 141:709–718.
10.1016/j.ajo.2005.11.053> Crossref MedlineGoogle Scholar
- 10.Thibos LN, Horner D. Power vector analysis of the optical outcome of refractive surgery. J Cataract Refract Surg. 2001; 27:80–85.
10.1016/S0886-3350(00)00797-5> Crossref MedlineGoogle Scholar
- 11.Alpins NA. Vector analysis of astigmatism changes by flattening, steepening, and torque. J Cataract Refract Surg. 1997; 23:1503–1514.
10.1016/S0886-3350(97)80021-1> Crossref MedlineGoogle Scholar
- 12.Alpins NA, Goggin M. Practical astigmatism analysis for refractive outcomes in cataract and refractive surgery. Surv Ophthalmol. 2004; 49:109–122.
10.1016/j.survophthal.2003.10.010> Crossref MedlineGoogle Scholar
- 13.Berdahl JP, DeStafeno JJ, Kim T. Corneal wound architecture and integrity after phacoemulsification evaluation of coaxial, microincision coaxial, and microincision bimanual techniques. J Cataract Refract Surg. 2007; 33:510–515.
10.1016/j.jcrs.2006.11.012> Crossref MedlineGoogle Scholar
- 14.Vasavada V, Vasavada AR, Vasavada VA, Srivastava S, Gajjar DU, Mehta S. Incision integrity and postoperative outcomes after microcoaxial phacoemulsification performed using 2 incision-dependent systems. J Cataract Refract Surg. 2013; 39:563–571.
10.1016/j.jcrs.2012.11.018> Crossref MedlineGoogle Scholar
- 15.Bradley MJ, Olson RJ. A survey about phacoemulsification incision thermal contraction incidence and causal relationships. Am J Ophthalmol. 2006; 141:222–224.
10.1016/j.ajo.2005.08.018> Crossref MedlineGoogle Scholar
- 16.Abell RG, Kerr NM, Vote BJ. Toward zero effective phacoemulsification time using femtosecond laser pretreatment. Ophthalmology. 2013; 25:1165–1167. > Google Scholar
- 17.Conrad-Hengerer I, Hengerer FH, Schultz T, Dick HB. Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery. J Refract Surg. 2012; 28:879–883.
10.3928/1081597X-20121116-02> LinkGoogle Scholar
- 18.Takács AI, Kovács I, Miháltz K, Filkorn T, Knorz MC, Nagy ZZ. Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification. J Refract Surg. 2012; 28:387–391.
10.3928/1081597X-20120508-02> LinkGoogle Scholar