January 2019

RESIDENTS

A randomized controlled trial comparing femtosecond laser assisted cataract surgery vs. conventional phacoemulsification surgery


by H.W. Roberts, MSc, V.K. Wagh, MD, D.L. Sullivan, MSc, P. Hidzheva, MCOptom, D.I. Detesan, B.S. Heemraz, J.M. Sparrow, DPhil, D.P.S. O’Brart, MD

J Cataract Refract Surg. 2018;45(1):11–20.

Purpose: To compare the clinical results of conventional phacoemulsification surgery (CPS) to femtosecond laser (FL) assisted cataract surgery (FLACS).
Setting: Guy’s & St Thomas’ NHS Foundation Trust, London, U.K.
Design: Single-center prospective randomized interventional case-controlled trial
Methods: 400 eyes of 400 patients undergoing cataract surgery were randomized to receive either CPS or FLACS. FLACS was performed with a LenSx (Alcon, Fort Worth, Texas), and all operations were performed with an Infiniti machine (Alcon). Visual acuity (VA), refraction, central corneal thickness (CCT), central foveal thickness (CFT), endothelial cell loss (ECL), and rates of intraoperative and postoperative complications were recorded. Quality of life outcomes were measured with EuroQOL’s EQ-5D and patient reported quality of vision with Cat-PROM5.
Results: 400 eyes of 400 patients were randomized to receive CPS (n=200) or FLACS (n=200). 3.5% of FLACS patients were not able to complete FL treatment and received CPS. Unaided VA (logMAR) after CPS was 0.15 ± 0.21 and 0.15 ± 0.19 after FLACS (p=1), and pinhole corrected VA was 0.04 ± 0.12 and 0.04 ± 0.12, respectively (p=1). Increase in CCT was 13 μm ± 19 after CPS and 15 μm ± 25 after FLACS (p=0.5). ECC loss was –9.7% ± 13.7 after CPS and –10.2% ± 13.7 after FLACS (p=0.76). Refractive mean spherical equivalent error was –0.14 ± 0.60 D after CPS and –0.12 ± 0.60 D for FLACS (p=0.74). Change in CFT was 9 μm ± 35 after CPS and 6 μm ± 35 after FLACS (p=0.55). Rate of posterior capsular rupture (PCR) was 3% and 0%, respectively (p=0.03).
Conclusions: This study confirms, in the majority, the non-significant differences between these two treatment modalities notwithstanding a significant reduction in PCRs in the FLACS group.

A randomized controlled trial comparing femtosecond laser assisted cataract surgery vs. conventional phacoemulsification surgery A randomized controlled trial comparing femtosecond laser assisted cataract surgery vs. conventional
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2018-12-31T11:20:47Z
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