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Etienne Benard-Seguin, Raphaëlle Fadous, Antoine Sylvestre-Bouchard, Hasitha De Alwis, Mylaine Beaudry, Leila Mejdoub, Paul Harasymowycz, Isabelle Brunette; Cataract Surgery Wound Architecture with Manual vs. Femtosecond Laser Assisted Catalys Procedures.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4340. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Femtosecond laser-assisted cataract surgery (FLACS) offers several advantages for wound construction, including high precision, repeatability and a variety of corneal wound profiles. The aim of this study was to evaluate a series of wound profiles to determine the incision architecture which minimizes wound leakage and maximizes restitution of a normal corneal anatomy. The FLACS 3-plane wound profile was compared to that of the standard keratome manual incision.
This Phase IV ambispective case study involved all consecutive cases of cataract surgery performed between January 2013 and April 2017 by a single surgeon (PH) at the Clinique d'ophtalmologie Bellevue, Montreal, Canada, using either a FLACS or a manual technique. Randomized selection was used to select 1 eye per patient. The primary outcome was the presence of wound leakage at the end of the surgery inferred by the placement of a 10-0 Nylon. Corneal wound anatomy was assessed qualitatively by OCT Cirrus (Zeiss). A subgroup analysis was conducted to determine the impact of combined cataract and microinvasive glaucoma surgery on the incidence of wound leakage.
This study involved a total of 1863 eyes from 1100 patients (498 male, 602 females, mean (± SD) age 67.9 ± 10.2) for whom only one eye was randomly selected. FLACS was performed in 805 eyes (73.2%) and manual cataract surgery in 295 eyes (26.8%). Wound Leakage occurred in 156 eyes that underwent FLACS (19.4 %) and in 25 eyes that underwent manual surgery (8.5%). FLACS was associated with an increase in wound leakage (RR 2.29; CI [1.53, 3.41]; p=0.0001). Combined surgery was not associated with an increase in wound leakage (RR 0.93; CI [0.7, 1.22]; p=0.58). FLACS corneal incision profiles with anterior side cut angles (ASCA) of 120 deg, 110 deg and 100 deg as well as posterior side cut angles (PSCA) of 70 deg and 45 deg were evaluated. A reduction in wound leakage was observed by increasing the ASCA from 110 deg to 120 deg (RR 1.76, CI [1.16,2.67]; p=0.01). There was no difference between PSCA of 45 deg and 70 deg (RR 0.93; CI [0.7,1.25]; 0.637).
FLACS is associated with an increase in wound leakage, however, the incidence of wound leakage can be influenced by corneal wound profile, a highly adaptable parameter with FLACS. Combined glaucoma surgery does not increase wound leakage. Optimized FLACS wound profiles are being designed.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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