Femtosecond laser-assisted cataract surgery: an incision efficacy review
Main Article Content
Abstract
Purpose: This study reviewed the scientific literature on corneal incisions in femtosecond laser-assisted cataract surgeries compared to keratome incisions in conventional phacoemulsification.
Conclusion: There are differences in the results of the studies. Automated incisions are more advantageous in the structure of the cut (reproducible tunnel architecture) and healing time of incisions (epithelial and endothelial gap, endothelial misalignment, Descemet membrane detachment and corneal thickening) compared to manual incisions, in addition to astigmatism correction <1.0 diopter with arcuate incisions. The induction of astigmatism and corneal aberrations is similar between the techniques. Incisions with an angle of entry of 110º in the cornea, triplanar shape, and width of <2.65 mm with the femtosecond laser platforms have presented the best results.
Keywords:
Femtosecond laser-assisted cataract surgery, an incision efficacy review
Article Details
How to Cite
HORTA, Guilherme; HORTA, Rogério; KARA-JUNIOR, Newton.
Femtosecond laser-assisted cataract surgery: an incision efficacy review.
Medical Research Archives, [S.l.], v. 11, n. 12, jan. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4571>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i12.4571.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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6. Nagy ZZ, Takacs AI, Filkorn T, et al. Complications of femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2014;40(1):20-28. doi:10.1016/j.jcrs.2013.08.046.
7. Roberts HW, Ni MZ, O’Brart DPS. Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a “hub and spoke” model for the delivery of high-volume cataract surgery. BMJ Open. 2017;7(3):e013616. doi:10.1136/bmjopen-2016-013616.
8. Popovic M, Campos-Möller X, Schlenker MB, Ahmed II. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: A meta-analysis of 14 567 eyes. Ophthalmology. 2016; 123(10):2113-2126. doi:10.1016/j.ophtha.2016.07.005.
9. Chen X, Yu Y, Song X, Zhu Y, Wang W, Yao K. Clinical outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery for hard nuclear cataracts. J Cataract Refract Surg. 2017; 43(4):486-491. doi:10.1016/j.jcrs.2017.01.010.
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15. Song C, Baharozian CJ, Hatch KM, Talamo JH. Assessment of surgeon experience with femtosecond laser-assisted cataract surgery. Clin Ophthalmol. 2018;12: 1373-1377. doi:10.2147/OPTH.S171743.
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20. Fukuda S, Kawana K, Yasuno Y, Oshika T. Wound architecture of clear corneal incision with or without stromal hydration observed with 3-dimensional optical coherence tomography. Am J Ophthalmol. 2011;151(3): 413-9.e1. doi:10.1016/j.ajo.2010.09.010.
21. Calladine D, Packard R. Clear corneal incision architecture in the immediate postoperative period evaluated using optical coherence tomography. J Cataract Refract Surg. 2007; 33(8):1429-1435. doi:10.1016/j.jcrs.2007.04.011.
22. Singhal D, Sahay P, Goel S, Asif MI, Maharana PK, Sharma N. Descemet membrane detachment. Surv Ophthalmol. 2020;65(3):279-293. doi:10.1016/j.survophthal.2019.12.006.
23. Li SS, Misra SL, Wallace HB, McKelvie J. Effect of phacoemulsification incision size on incision repair and remodeling: optical coherence tomography assessment. J Cataract Refract Surg. 2018; 44(11):1336-1343. doi:10.1016/j.jcrs.2018.07.025.
24. Ventura BV, Moraes HV Jr, Kara-Junior N, Santhiago MR. Role of optical coherence tomography on corneal surface laser ablation. J Ophthalmol. 2012; 2012:676740. doi:10.1155/2012/676740.
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26. Rodrigues R, Santos MSD, Silver RE, Campos M, Gomes RL. Corneal incision architecture: VICTUS femtosecond laser vs manual keratome. Clin Ophthalmol. 2019; 13:147-152. doi:10.2147/OPTH.S181144.
27. Titiyal JS, Kaur M, Ramesh P, et al. Impact of clear corneal incision morphology on incision-site descemet membrane detachment in conventional and femtosecond laser assisted phacoemulsification. Curr Eye Res. 2018; 43(3):293-299. doi:10.1080/02713683.2017.1396616.
28. Mastropasqua L, Toto L, Mastropasqua A, et al. Femtosecond laser versus manual clear corneal incision in cataract surgery. J Refract Surg. 2014;30(1):27-33. doi:10.3928/1081597X-20131217-03.
29. Grewal DS, Basti S. Comparison of morphologic features of clear corneal incisions created with a femtosecond laser or a keratome. J Cataract Refract Surg. 2014;40 (4):521-530. doi:10.1016/j.jcrs.2013.11.028.
30. Wang X, Zhang Z, Li X, et al. Evaluation of femtosecond laser versus manual clear corneal incisions in cataract surgery using spectral-domain optical coherence tomography. J Refract Surg. 2018;34(1):17-22. doi:10.3928/1081597X-20171109-01.
31. Donnenfeld E, Rosenberg E, Boozan H, Davis Z, Nattis A. Randomized prospective evaluation of the wound integrity of primary clear corneal incisions made with a femtosecond laser versus a manual keratome. J Cataract Refract Surg. 2018;44(3):329-335. doi:10.1016/j.jcrs.2017.12.026.
32. Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Prediction of surgically induced astigmatism in manual and femtosecond laser-assisted clear corneal incisions. Eur J Ophthalmol. 2018;28(4):398-405. doi:10.1177/1120672117747017.
33. Kohnen T, Löffler F, Herzog M, Petermann K, Böhm M. Tomographic analysis of anterior and posterior surgically induced astigmatism after 2.2 mm temporal clear corneal incisions in femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2019; 45(11):1602-1611. doi:10.1016/j.jcrs.2019.06.010.
34. Serrao S, Giannini D, Schiano-Lomoriello D, Lombardo G, Lombardo M. New technique for femtosecond laser creation of clear corneal incisions for cataract surgery. J Cataract Refract Surg. 2017; 43(1):80-86. doi:10.1016/j.jcrs.2016.08.038.
35. Nagy ZZ, Dunai A, Kránitz K, et al. Evaluation of femtosecond laser-assisted and manual clear corneal incisions and their effect on surgically induced astigmatism and higher-order aberrations. J Refract Surg. 2014; 30(8):522-525. doi:10.3928/1081597X-20140 711-04.
36. Alió JL, Abdou AA, Soria F, et al. Femtosecond laser cataract incision morphology and corneal higher-order aberration analysis. J Refract Surg. 2013;29(9):590-595. doi:10.3928/1081597X-20130819-01.
37. Wolffsohn JS, PhD, Bhogal G, BSc, Shah SMD. Effect of uncorrected astigmatism on vision. J Cataract Refract Surg. 2011;37 (3):454-460. doi:10.1016/j.jcrs.2010.09.022.
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39. Vickers LA, Gupta PK. Femtosecond laser-assisted keratotomy. Curr Opin Ophthalmol. 2016; 27(4):277-284. doi:10.1097/ICU.0000000000000267.
40. Oshika T, Shimazaki J, Yoshitomi F, et al. Arcuate keratotomy to treat corneal astigmatism after cataract surgery: a prospective evaluation of predictability and effectiveness. Ophthalmology. 1998;105(11): 2012-2016. doi:10.1016/S0161-6420(98)9111 7-4.
41. Price FW, Grene RB, Marks RG, Gonzales JS. Astigmatism reduction clinical trial: a multicenter prospective evaluation of the predictability of arcuate keratotomy. Evaluation of surgical nomogram predictability. ARC-T study group. Arch Ophthalmol. 1995 ;113(3):277-282. doi:10.1001/archopht.1995.01100030031017
42. Zhang F, Li S, Huo D, Li Q. Predictors of femtosecond laser-assisted arcuate keratotomy efficacy for astigmatism correction in cataract surgery. J Refract Surg. 2022;38(8):480-486. doi:10.3928/1081597X-20220609-01.
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2. Kelman CD. Phaco-emulsification and aspiration. A new technique of cataract removal. A preliminary report. Am J Ophthalmol. 1967;64(1):23-35. doi:10.1016/0002-9394(67)93340-5.
3. Market Scope. 2019. Cataract Surgical Equipment Market Report: a Global Analysis for 2018 to 2024. Accessed December 20, 2019. https://www.marketscope.com/pages/reports/101/2019-cataract-surgical-equipmentmarket-report-a-global-analysis-for-2018-to-2024-may-2019#reports
4. Nagy ZZ. New technology update: femtosecond laser in cataract surgery. Clin Ophthalmol. 2014;8:1157-1167. doi:10.2147/OPTH.S36040.
5. He L, Sheehy K, Culbertson W. Femtosecond laser-assisted cataract surgery. Curr Opin Ophthalmol. 2011;22(1):43-52. doi:10.1097/ICU.0b013e3283414f76.
6. Nagy ZZ, Takacs AI, Filkorn T, et al. Complications of femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2014;40(1):20-28. doi:10.1016/j.jcrs.2013.08.046.
7. Roberts HW, Ni MZ, O’Brart DPS. Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a “hub and spoke” model for the delivery of high-volume cataract surgery. BMJ Open. 2017;7(3):e013616. doi:10.1136/bmjopen-2016-013616.
8. Popovic M, Campos-Möller X, Schlenker MB, Ahmed II. Efficacy and safety of femtosecond laser-assisted cataract surgery compared with manual cataract surgery: A meta-analysis of 14 567 eyes. Ophthalmology. 2016; 123(10):2113-2126. doi:10.1016/j.ophtha.2016.07.005.
9. Chen X, Yu Y, Song X, Zhu Y, Wang W, Yao K. Clinical outcomes of femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery for hard nuclear cataracts. J Cataract Refract Surg. 2017; 43(4):486-491. doi:10.1016/j.jcrs.2017.01.010.
10. Horta GA, Horta RC, Steinfeld K, Koch CR, Mello GR, Kara-Junior N. Ultrasound power and irrigation volume in different lens opacity grades: comparison of femtosecond laser-assisted cataract surgery and conventional phacoemulsification. Clinics (Sao Paulo). 2019; 74:e1294. doi:10.6061/clinics/2019/e1294.
11. Chen L, Hu C, Lin X, et al. Clinical outcomes and complications between FLACS and conventional phacoemulsification cataract surgery: a PRISMA-compliant Meta-analysis of 25 randomized controlled trials. Int J Ophthalmol. 2021;14(7):1081-1091.doi:10.18240/ijo.2021.07.18.
12. Friedman NJ, Palanker DV, Schuele G, et al. Femtosecond laser capsulotomy. J Cataract Refract Surg. 2011;37(7):1189-1198. doi:10.1016/j.jcrs.2011.04.022.
13. Roberts HW, Day AC, O’Brart DP. Femtosecond laser-assisted cataract surgery: a review. Eur J Ophthalmol. 2020;30(3):417-429. doi:10.1177/1120672119893291.
14. Zhu S, Qu N, Wang W, et al. Morphologic features and surgically induced astigmatism of femtosecond laser versus manual clear corneal incisions. J Cataract Refract Surg. 2017;43(11):1430-1435. doi:10.1016/j.jcrs.2017.08.011.
15. Song C, Baharozian CJ, Hatch KM, Talamo JH. Assessment of surgeon experience with femtosecond laser-assisted cataract surgery. Clin Ophthalmol. 2018;12: 1373-1377. doi:10.2147/OPTH.S171743.
16. Jin KH, Kim TG. Relationship between early structural changes at cornea incision sites and surgical outcomes after phacoemulsification. Int J Ophthalmol. 2019; 12(7):1139-1145. doi:10.18240/ijo.2019.07.14.
17. Xia Y, Liu X, Luo L, et al. Early changes in clear cornea incision after phacoemulsification: an anterior segment optical coherence tomography study. Acta Ophthalmol. 2009; 87(7): 764-768. doi:10.1111/j.1755-3768.2008.01333.x.
18. Vasavada AR, Praveen MR, Pandita D, et al. Effect of stromal hydration of clear corneal incisions: quantifying ingress of trypan blue into the anterior chamber after phacoemulsification. J Cataract Refract Surg. 2007;33(4):623-627. doi:10.1016/j.jcrs.2007.01.010.
19. Wang L, Dixit L, Weikert MP, Jenkins RB, Koch DD. Healing changes in clear corneal cataract incisions evaluated using Fourier-domain optical coherence tomography. J Cataract Refract Surg. 2012;38(4):660-665. doi:10.1016/j.jcrs.2011.10.030.
20. Fukuda S, Kawana K, Yasuno Y, Oshika T. Wound architecture of clear corneal incision with or without stromal hydration observed with 3-dimensional optical coherence tomography. Am J Ophthalmol. 2011;151(3): 413-9.e1. doi:10.1016/j.ajo.2010.09.010.
21. Calladine D, Packard R. Clear corneal incision architecture in the immediate postoperative period evaluated using optical coherence tomography. J Cataract Refract Surg. 2007; 33(8):1429-1435. doi:10.1016/j.jcrs.2007.04.011.
22. Singhal D, Sahay P, Goel S, Asif MI, Maharana PK, Sharma N. Descemet membrane detachment. Surv Ophthalmol. 2020;65(3):279-293. doi:10.1016/j.survophthal.2019.12.006.
23. Li SS, Misra SL, Wallace HB, McKelvie J. Effect of phacoemulsification incision size on incision repair and remodeling: optical coherence tomography assessment. J Cataract Refract Surg. 2018; 44(11):1336-1343. doi:10.1016/j.jcrs.2018.07.025.
24. Ventura BV, Moraes HV Jr, Kara-Junior N, Santhiago MR. Role of optical coherence tomography on corneal surface laser ablation. J Ophthalmol. 2012; 2012:676740. doi:10.1155/2012/676740.
25. Chaves MAPD, de Medeiros AL, Vilar CMC, et al. Architecture evaluation of the main clear corneal incisions in femtosecond laser-assisted cataract surgery by optical coherence tomography imaging. Clin Ophthalmol. 2019; 13:365-372. doi:10.2147/OPTH.S184024.
26. Rodrigues R, Santos MSD, Silver RE, Campos M, Gomes RL. Corneal incision architecture: VICTUS femtosecond laser vs manual keratome. Clin Ophthalmol. 2019; 13:147-152. doi:10.2147/OPTH.S181144.
27. Titiyal JS, Kaur M, Ramesh P, et al. Impact of clear corneal incision morphology on incision-site descemet membrane detachment in conventional and femtosecond laser assisted phacoemulsification. Curr Eye Res. 2018; 43(3):293-299. doi:10.1080/02713683.2017.1396616.
28. Mastropasqua L, Toto L, Mastropasqua A, et al. Femtosecond laser versus manual clear corneal incision in cataract surgery. J Refract Surg. 2014;30(1):27-33. doi:10.3928/1081597X-20131217-03.
29. Grewal DS, Basti S. Comparison of morphologic features of clear corneal incisions created with a femtosecond laser or a keratome. J Cataract Refract Surg. 2014;40 (4):521-530. doi:10.1016/j.jcrs.2013.11.028.
30. Wang X, Zhang Z, Li X, et al. Evaluation of femtosecond laser versus manual clear corneal incisions in cataract surgery using spectral-domain optical coherence tomography. J Refract Surg. 2018;34(1):17-22. doi:10.3928/1081597X-20171109-01.
31. Donnenfeld E, Rosenberg E, Boozan H, Davis Z, Nattis A. Randomized prospective evaluation of the wound integrity of primary clear corneal incisions made with a femtosecond laser versus a manual keratome. J Cataract Refract Surg. 2018;44(3):329-335. doi:10.1016/j.jcrs.2017.12.026.
32. Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Prediction of surgically induced astigmatism in manual and femtosecond laser-assisted clear corneal incisions. Eur J Ophthalmol. 2018;28(4):398-405. doi:10.1177/1120672117747017.
33. Kohnen T, Löffler F, Herzog M, Petermann K, Böhm M. Tomographic analysis of anterior and posterior surgically induced astigmatism after 2.2 mm temporal clear corneal incisions in femtosecond laser-assisted cataract surgery. J Cataract Refract Surg. 2019; 45(11):1602-1611. doi:10.1016/j.jcrs.2019.06.010.
34. Serrao S, Giannini D, Schiano-Lomoriello D, Lombardo G, Lombardo M. New technique for femtosecond laser creation of clear corneal incisions for cataract surgery. J Cataract Refract Surg. 2017; 43(1):80-86. doi:10.1016/j.jcrs.2016.08.038.
35. Nagy ZZ, Dunai A, Kránitz K, et al. Evaluation of femtosecond laser-assisted and manual clear corneal incisions and their effect on surgically induced astigmatism and higher-order aberrations. J Refract Surg. 2014; 30(8):522-525. doi:10.3928/1081597X-20140 711-04.
36. Alió JL, Abdou AA, Soria F, et al. Femtosecond laser cataract incision morphology and corneal higher-order aberration analysis. J Refract Surg. 2013;29(9):590-595. doi:10.3928/1081597X-20130819-01.
37. Wolffsohn JS, PhD, Bhogal G, BSc, Shah SMD. Effect of uncorrected astigmatism on vision. J Cataract Refract Surg. 2011;37 (3):454-460. doi:10.1016/j.jcrs.2010.09.022.
38. Schallhorn SC, MD, Hettinger KA, MS, Pelouskova M, MSc, et al. Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients. J Cataract Refract Surg. 2021;47(8):991-998. doi:10.1097/j.jcrs.0000000000000560.
39. Vickers LA, Gupta PK. Femtosecond laser-assisted keratotomy. Curr Opin Ophthalmol. 2016; 27(4):277-284. doi:10.1097/ICU.0000000000000267.
40. Oshika T, Shimazaki J, Yoshitomi F, et al. Arcuate keratotomy to treat corneal astigmatism after cataract surgery: a prospective evaluation of predictability and effectiveness. Ophthalmology. 1998;105(11): 2012-2016. doi:10.1016/S0161-6420(98)9111 7-4.
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