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Elaine Williams, Blake Williams, Douglas Williams; Early clinical experience with femtosecond laser-assisted cataract surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):655.
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© ARVO (1962-2015); The Authors (2016-present)
Femtosecond laser technology was first used clinically for cataract surgery in 2008, and there is considerable interest in the ophthalmology community in expanding the use of this technology. However, there have been concerns about the learning curve associated with adopting this new technology after Bali et al. reported four dropped nuclei (requiring posterior vitrectomies) in their first 200 cases, along with other minor complications. We performed a retrospective, observational clinical study to assess the safety and visual outcomes of our first 500 cases of laser-assisted cataract surgery, when compared to surgery without the laser.
We collected data on pre- and post-op best-corrected visual acuity (VA), post-op uncorrected VA, and post-op refractive astigmatism in patients receiving cataract surgery with the LenSx femtosecond laser at an outpatient ophthalmic ambulatory surgery center. Three surgeons performed the surgeries between 1/1/13 and 10/29/14. Results were compared to a randomly selected group of 500 non-laser cataract surgeries by the same surgeons over the same time period. All cases were reviewed for intraoperative complications. Patients with pre-existing pathology that prevented best-corrected VA of 20/40 or better were excluded from VA analysis. Pearson’s chi-squared test was used for statistical analysis.
In each study group, 2/500 surgeries resulted in a torn posterior capsule with vitreous prolapse requiring anterior vitrectomy. No nuclei or fragments were lost into the posterior vitreous, and no return trips to the OR were required. Patients receiving laser surgery were more likely than the non-laser group to have a post-op uncorrected VA of 20/40 or better (318/363 [87.6%] vs 254/392 [64.8%]; p<0.0001). Patients receiving laser surgery were also more likely than the non-laser group to have ≤ +/- 0.75 diopters of post-op astigmatism: 369/488 (75.6%) vs 276/453 (60.9%), p<0.001.
Femtosecond laser cataract surgery was associated with improved visual outcomes as defined by post-op uncorrected vision of 20/40 or better, as well as less post-op astigmatism, without any measurable increase in adverse events during the initial 500 cases at this surgery center. This study suggests that the femtosecond laser is an effective tool for providing more predictable refractive outcomes with a comparable safety profile to traditional cataract surgery.
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