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Impact of Crystalline Lens Opacification on Effective Phacoemulsification Time in Femtosecond Laser-Assisted Cataract Surgery

2013; Elsevier BV; Volume: 157; Issue: 2 Linguagem: Inglês

10.1016/j.ajo.2013.09.017

1879-1891

Wolfgang J. Mayer, Oliver K. Klaproth, Fritz H. Hengerer, Thomas Kohnen,

Retinal and Macular Surgery

To compare effective phacoemulsification time in cataract surgery performed by manual phacoemulsification vs femtosecond laser-assisted lens fragmentation.Retrospective, consecutive, nonrandomized, comparative case series.The setting was the Department of Ophthalmology, Goethe-University, Frankfurt, Germany. The study population included 150 eyes of 86 patients with senile cataract. In the intervention, 88 eyes (group 1) underwent femtosecond laser-assisted surgery (corneal incisions, capsulotomy, lens fragmentation) using the LenSx platform (Alcon) and residual lens work-up with pulsed ultrasound energy (Infiniti Vision System; Alcon). In 62 eyes (group 2), complete cataract removal was performed with phacoemulsification only, using pulsed ultrasound energy with the same device (Infiniti). Nucleus staging (Pentacam nucleus staging; PNS) was evaluated using Pentacam HR (Oculus); endothelial cell density was measured using specular microscopy (NonCon Robo). The main outcome measures were as follows. Mean preoperative PNS staging was assessed using an automatic ordinal scaling (PNS-O, grades 0-5) and a manually defined density grid derived from Scheimpflug imaging (PNS-P [%]). Effective phacoemulsification time and endothelial cell loss were evaluated in both groups.Preoperative PNS-O and PNS-P showed no significant difference between groups (P = 0.267). Overall mean effective phacoemulsification time was significantly lower in group 1 (1.58 ± 1.02 seconds) compared to 4.17 ± 2.06 seconds in group 2 (P = 0.001). Effective phacoemulsification time was significantly lower in group 1 for all PNS-O stages (P < 0.001). With increasing preoperative PNS-P, effective phacoemulsification time increased in both groups; however, this gain was noticeably, but not significantly, lower in group 2. Endothelial cell loss was significantly lower in group 1 (P = 0.02).Femtosecond laser-assisted cataract surgery allows a significant reduction in effective phacoemulsification time, which correlates positively with the preoperative lens opacity.