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Predictors of intraocular pressure reduction after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a prospective trial

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Abstract

Purpose

To evaluate the association between postoperative intraocular pressure (IOP) reduction and phacoemulsification parameters in patients who underwent both conventional phacoemulsification surgery (CPS) and femtosecond laser-assisted cataract surgery (FLACS).

Methods

This was a prospective multicenter comparative study that enrolled 90 participants who underwent cataract surgery at the University of Maryland Medical System and the Wilmer Eye Institute. Patients underwent FLACS in one eye and CPS in the fellow eye. IOP was measured prior to surgery and monitored through six months postoperatively. Demographic, clinical, biometric, and intraoperative variables including cumulative dissipated energy (CDE), aspiration time, and phacoemulsification time were analyzed for any significant association with postoperative IOP. Postoperative IOP reduction was the primary outcome variable. A secondary goal of the study was to determine differences in postoperative IOP reduction between CPS and FLACS cohorts.

Results

In total, 157 non-glaucomatous eyes were included. Using multivariable analysis, we found preoperative IOP to be consistently associated with postoperative IOP reduction in the entire cohort. At the 6-month follow-up visit, there was a 12.4% reduction in IOP (−2.2 ± 3.4 mm Hg) seen, with no statistically significant difference between FLACS and CPS (12.3% ± 19.4% vs 12.5% ± 19.3%, respectively, p = 0.32). FLACS reduced the CDE required for phacoemulsification (6.6 ± 4.4%-seconds vs 8.6 ± 6.9%-seconds, respectively, p < 0.05). CDE was a predictor of IOP response at 6 months, but subgroup analysis revealed that this trend was driven by seven eyes requiring high CDE, and for the majority of eyes, CDE did not influence the size of the decrease. The seven eyes experiencing highest CDE were less likely to show IOP reduction at 6 months.

Conclusion

Both FLACS and CPS resulted in similar and significant IOP reductions through 6 months after surgery. Preoperative IOP was significantly associated with IOP reduction, and CDE generally did not influence the size of the decrease.

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Abbreviations

IOP:

Intraocular pressure

FLACS:

Femtosecond laser-assisted cataract surgery

CPS:

Conventional phacoemulsification surgery

CDE:

Cumulative dissipated energy

ACD:

Anterior chamber depth

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Acknowledgements

The study is supported by a research grant from ASCRS foundation (ED) and an NIH Career Development Award (OJS, K23EY025014)

Funding

All authors (Eva Devience, Abdelhalim Awidi, Sachin Kalarn, Stephen DeVience, Brendan Bui, MD, Wuqaas M Munir, Mona A Kaleem, Lily Im, Bennie H Jeng, Yassine Daoud, Osamah J Saeedi) have no relevant financial disclosures to report.

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Authors and Affiliations

  1. Kaiser Permanente, Baltimore, MD, USA

    Eva X. Devience

  2. Wilmer Eye Institute at Johns Hopkins University, Baltimore, MD, USA

    Abdelhalim Awidi, Mona A. Kaleem & Yassine Daoud

  3. Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W Redwood St #420, Baltimore, MD, 21201, USA

    Sachin Kalarn, Brendan Bui, Wuqaas M. Munir, Lily Im, Bennie H. Jeng & Osamah J. Saeedi

  4. Scalar Magnetics, Windsor Mill, MD, USA

    Stephen DeVience

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  1. Eva X. Devience
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Corresponding author

Correspondence to Osamah J. Saeedi.

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Conflict of interest

The authors have no financial interest in any of the products mentioned in this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration ad its later amendments or comparable ethical standards.

Human and animal rights

Human subjects were included in this study. The Institutional Review Board of University of Maryland and Wilmer Eye Institute at Johns Hopkins University approved the study. All research adhered to the tenets of the Declaration of Helsinki.

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Patients provided written informed consent to participate in the study.

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Devience, E.X., Awidi, A., Kalarn, S. et al. Predictors of intraocular pressure reduction after femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: a prospective trial. Int Ophthalmol 43, 285–292 (2023). https://doi.org/10.1007/s10792-022-02427-x

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  • DOI: https://doi.org/10.1007/s10792-022-02427-x

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