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Fares Abdulelah Alsaleh, Yassine Jamil Daoud; Comparison of femtosecond-laser assisted cataract surgery to conventional phacoemulsification cataract surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1814. doi: https://doi.org/.
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Clinical benefits from use of femtosecond-laser assisted cataract surgery (FLACS) have not been documented in controlled studies, an important step in substantiating the increase in operative time and expense associated with FLACS. We performed a randomized clinical trial comparing phacoemulsification (PE) and FLACS across relevant clinical outcomes.
Randomized clinical trial comparing FLACS to conventional PE surgery conducted by cornea faculty at a tertiary referral center. 51 Patients were randomized into one eye done with FLACS (cases) and the fellow eye with PE (controls). Criteria included bilateral visually significant cataract, absence of other ocular pathology and previous/concurrent ocular surgery. Subjects underwent ETDRS best-corrected visual acuity (BCVA), applanation tonometry, specular microscopy and ultrasound pachymetry at baseline, 1 week, 1 month and 3 months. Ultrasound, aspiration and surgery times were measured and cumulative dissipated energy (CDE)/fluid usage was recorded intra-operatively for each procedure. Mixed effects regression models were used to estimate follow up outcome scores over time by procedure arm. Two-tailed t-test was used for analysis of intraoperative records.
Aspiration time was significantly reduced in PE (02:13.8 ±00:47) compared to FLACS (03:02.5 ±1:12) (p=0.0002) and overall surgery time showed a reduction in PE (07:33.8 ±05:04) compared to FLACS (09:50.2 ±05:53) (p=0.05). There was no significant difference in CDE (p=0.84) or ultrasound time (p=0.35), but there was a significant decrease in fluid usage in PE (58.50 ±14.90) compared to FLACS (72 ±19.1) (p=0.0005). BCVA and intraocular pressure (IOP) did not show significant differences between PE and FLACS at 1 week (p=0.21, p=0.99), 1 month (p=0.59, p=0.63) and 3 months (p=0.39, p=0.31) postoperatively, respectively. There was a significant reduction in mean pachymetry at 1 month in PE (574.55 ±46.78) compared to FLACS (587.20 ±42.10) (p=0.005) that disappeared at 3 months (p=0.70). Endothelial cell counts (ECC) showed no difference at 1 week (p=0.08), 1 month (p=0.26) and 3 months (p=0.22).
Our results show that conventional PE takes significantly less operative time and uses less intraoperative fluid. There were no differences in BCVA, IOP, pachymetry and ECC at 1 week, 1 month and 3 months postoperatively.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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