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Comparison of surgical parameters using different lens fragmentation patterns in eyes undergoing laser-assisted cataract surgery

International Ophthalmology volume 39, pages 2459–2465 (2019)Cite this article

Abstract

Purpose

To compare surgical parameters among eyes undergoing laser-assisted cataract surgery (LACS) using different lens fragmentation patterns (LFP).

Methods

Prospective, randomized, unmasked clinical trial. One-hundred eyes underwent LACS and were randomly assigned to 1 of 3 LFP treatment groups: (1) laser capsulotomy only; no lens fragmentation (NLF) (n = 34); (2) three-plane chop (TPC) (n = 33); and, (3) pie-cut pattern (PCP) fragmentation (n = 33). Prechop phacoemulsification (PHACO) was performed on all eyes using the same femtosecond (FS) laser and active-fluidics PHACO machine. Main outcome measures: FS laser dock time (s), PHACO time (s), PHACO power (%), cumulative dissipated energy (CDE) (%-s), irrigating fluid volume, and operative time.

Results

The 3 treatment groups were comparable in terms of patient age (P = 0.164) and nuclear density (P = 0.669). FS dock time was higher in the PCP group (184.18 ± 25.86) compared to the TPC (145.09 ± 14.15) group (P < 0.001). PHACO time was significantly shorter in the PCP (23.19 ± 17.20 s) compared to TPC (35.27 ± 17.70) and NLF (46.15 ± 23.72) groups (P < 0.001). PHACO power was lower in the PCP (11.81 ± 3.71) compared to the NLF (14.41 ± 1.88) and TPC (14.04 ± 2.46) groups (P < 0.001). CDE was lower in the PCP (2.85 ± 2.32) compared to NLF (6.55 ± 3.32) and TPC (6.55 ± 5.45) groups (P < 0.001). Fluid volumes and operative times were similar.

Conclusion

LFP can influence PHACO surgical parameters. Extensive fragmentation patterns such as PCP appear to lower PHACO time, power, and CDE and may potentially reduce the risk of PHACO related complications.

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References

  1. Kelman CD (1967) Phaco-emulsification and aspiration. A new technique of cataract removal. A preliminary report. Am J Ophthalmol 64:23–35

    CAS  PubMed  Google Scholar 

  2. Fishkind W, Bakewell B, Donnenfeld ED, Rose AD, Watkins LA, Olson RJ (2006) Comparative clinical trial of ultrasound phacoemulsification with and without the WhiteStar system. J Cataract Refract Surg 32:45–49

    PubMed  Google Scholar 

  3. Vasavada AR, Raj SM, Patel U, Vasavada V, Vasavada V (2010) Comparison of torsional and microburst longitudinal phacoemulsification: a prospective, randomized, masked clinical trial. Ophthalmic Surg Lasers Imaging 41:109–114

    PubMed  Google Scholar 

  4. Zeng M, Liu X, Liu Y, Xia Y, Luo L, Yuan Z, Zeng Y, Liu Y (2008) Torsional ultrasound modality for hard nucleus phacoemulsification cataract extraction. Br J Ophthalmol 92:1092–1096

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Georgescu D, Kuo AF, Kinard KI, Olson RJ (2008) A fluidics comparison of Alcon Infiniti, Bausch & Lomb Stellaris, and advanced medical optics signature phacoemulsification machines. Am J Ophthalmol 145:1014–1017

    PubMed  Google Scholar 

  6. Hoffman RS, Fine IH, Packer M (2005) New phacoemulsification technology. Curr Opin Ophthalmol 16:38–43

    PubMed  Google Scholar 

  7. Busic M, Kastelan S (2005) Pseudoexfoliation syndrome and cataract surgery by phacoemulsification. Coll Antropol 29(Suppl 1):163–166

    PubMed  Google Scholar 

  8. Bourne RR, Minassian DC, Dart JK, Rosen P, Kaushal S, Wingate N (2004) Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology 111:679–685

    PubMed  Google Scholar 

  9. Irvine AR, Kratz RP, O’Donnell JJ (1978) Endothelial damage with phacoemulsification and intraocular lens implantation. Arch Ophthalmol 96:1023–1026

    CAS  PubMed  Google Scholar 

  10. Ko YC, Liu CJ, Lau LI, Wu CW, Chou JC, Hsu WM (2008) Factors related to corneal endothelial damage after phacoemulsification in eyes with occludable angles. J Cataract Refract Surg 34:46–51

    PubMed  Google Scholar 

  11. Davison JA (2007) Comparison of ultrasonic energy expenditures and corneal endothelial cell density reductions during modulated and non-modulated phacoemulsification. Ophthalmic Surg Lasers Imaging 38:209–218

    PubMed  Google Scholar 

  12. Reepolmaha S, Limtrakarn W, Uthaisang-Tanechpongtamb W, Dechaumphai P (2010) Fluid temperature at the corneal endothelium during phacoemulsification: comparison of an ophthalmic viscosurgical device and balanced salt solution using the finite element method. Ophthalmic Res 43:173–178

    PubMed  Google Scholar 

  13. Binder PS, Sternberg H, Wickman MG, Worthen DM (1976) Corneal endothelial damage associated with phacoemulsification. Am J Ophthalmol 82:48–54

    CAS  PubMed  Google Scholar 

  14. Kim EK, Cristol SM, Geroski DH, McCarey BE, Edelhauser HF (1997) Corneal endothelial damage by air bubbles during phacoemulsification. Arch Ophthalmol 115:81–88

    CAS  PubMed  Google Scholar 

  15. Geffen N, Topaz M, Kredy-Farhan L, Barequet IS, Farzam N, Assia EI, Savion N (2008) Phacoemulsification-induced injury in corneal endothelial cells mediated by apoptosis: in vitro model. J Cataract Refract Surg 34:2146–2152

    PubMed  Google Scholar 

  16. Nemet AY, Assia EI, Meyerstein D, Meyerstein N, Gedanken A, Topaz M (2007) Protective effect of free-radical scavengers on corneal endothelial damage in phacoemulsification. J Cataract Refract Surg 33:310–315

    PubMed  Google Scholar 

  17. Takahashi H (2005) Free radical development in phacoemulsification cataract surgery. J Nippon Med Sch 72:4–12

    CAS  PubMed  Google Scholar 

  18. Dodick JM, Christiansen J (1991) Experimental studies on the development and propagation of shock waves created by the interaction of short Nd:YAG laser pulses with a titanium target. Possible implications for Nd:YAG laser phacolysis of the cataractous human lens. J Cataract Refract Surg 17:794–797

    CAS  PubMed  Google Scholar 

  19. Dodick JM, Lally JM, Sperber LT (1993) Lasers in cataract surgery. Curr Opin Ophthalmol 4:107–109

    CAS  PubMed  Google Scholar 

  20. Kanellopoulos AJ, Dodick JM, Brauweiler P, Alzner E (1999) Dodick photolysis for cataract surgery: early experience with the Q-switched neodymium: YAG laser in 100 consecutive patients. Ophthalmology 106:2197–2202

    CAS  PubMed  Google Scholar 

  21. Kanellopoulos AJ (2001) Laser cataract surgery : a prospective clinical evaluation of 1000 consecutive laser cataract procedures using the Dodick photolysis Nd:YAG system. Ophthalmology 108:649–654

    CAS  PubMed  Google Scholar 

  22. Lin ZD, Feng B, Cheng B, Zou YP (2003) The preliminary study of photolysis for cataract surgery. Zhonghua Yan Ke Za Zhi 39:601–604

    PubMed  Google Scholar 

  23. Hoh H, Fischer E (2000) Pilot study on erbium laser phacoemulsification. Ophthalmology 107:1053–1061

    CAS  PubMed  Google Scholar 

  24. Mian SI, Shtein RM (2007) Femtosecond laser-assisted corneal surgery. Curr Opin Ophthalmol 18:295–299

    PubMed  Google Scholar 

  25. Toropygin SG, Krause M, Riemann I, Seitz B, Mestres P, Ruprecht KW, Konig K (2008) In vitro femtosecond laser-assisted nanosurgery of porcine posterior capsule. J Cataract Refract Surg 34:2128–2132

    PubMed  Google Scholar 

  26. Touboul D, Salin F, Mortemousque B, Courjaud A, Chabassier P, Mottay E, Leger F, Colin J (2005) Tissular and mechanical effects observed with an experimental femtosecond laser microkeratome for corneal refractive surgery. J Fr Ophtalmol 28:274–284

    CAS  PubMed  Google Scholar 

  27. Frey RW, Edwards K, Naranjo Tackman R, Villar Kuri J, Quezada N, Bunch T, Bott S (2010) Changes in CDE with laser lens fragmentation compared with standard phacoemulsification cataract surgery. Investig Ophthalmol Vis Sci 51:5418

    Google Scholar 

  28. Nagy Z, Takacs A, Filkorn T, Sarayba M (2009) Initial clinical evaluation of an intraocular femtosecond laser in cataract surgery. J Refract Surg 25:1053–1060

    PubMed  Google Scholar 

  29. Takacs AI, Kovacs I, Miháltz K, Filkorn T, Knorz MC, Nagy ZZ (2012) Central corneal volume and endothelial cell count following femtosecond laser-assisted refractive cataract surgery compared to conventional phacoemulsification. J Refract Surg 28:387–391

    PubMed  Google Scholar 

  30. Abell RG, Kerr NM, Vote BJ (2013) Femtosecond laser-assisted cataract surgery compared to conventional cataract surgery. Clin Exp Ophthalmol 41(5):455–462

    PubMed  Google Scholar 

  31. Reddy KP, Kandulla J, Auffarth GU (2013) Effectiveness and safety of femtosecond laser-assisted lens fragmentation and anterior capsulotomy versus the manual technique in cataract surgery. J Cataract Refract Surg 39(9):1297–1306

    PubMed  Google Scholar 

  32. Conrad-Hengerer I, Hengerer FH, Schultz T, Dick HB (2012) Effect of femtosecond laser fragmentation on effective phacoemulsification time in cataract surgery. J Refract Surg 28(12):879–883

    PubMed  Google Scholar 

  33. Price FW Jr, Price MO (2008) Femtosecond laser shaped penetrating keratoplasty: one-year results utilizing a top-hat configuration. Am J Ophthalmol 145:210–214

    PubMed  Google Scholar 

  34. Smith RT, Waring GO, Durrie DS, Stahl JE, Thomas P (2009) Corneal endothelial cell density after femtosecond thin-flap LASIK and PRK for myopia: a contralateral eye study. J Refract Surg 25:1098–1102

    PubMed  Google Scholar 

  35. Yang X, Jiang F, Song Y, Peng C, Sheng S, Li X (2010) Accidental macular injury from prolonged viewing of a plasma flash produced by a femtosecond laser. Ophthalmology 117:972–975

    PubMed  Google Scholar 

  36. Cain CP, DiCarlo CD, Rockwell BA, Kennedy PK, Noojin GD, Stolarski DJ, Hammer DX, Toth CA, Roach WP (1996) Retinal damage and laser-induced breakdown produced by ultrashort-pulse lasers. Graefes Arch Clin Exp Ophthalmol 234(Suppl 1):S28–S37

    PubMed  Google Scholar 

  37. Cain CP, Toth CA, Noojin GD, Stolarski DJ, Thomas RJ, Rockwell BA (2002) Thresholds for retinal injury from multiple near-infrared ultrashort laser pulses. Health Phys 82:855–862

    CAS  PubMed  Google Scholar 

  38. Roach WP, Rogers ME, Rockwell BA, Boppart SA, Stein CD, Bramlette CM (1994) Ultrashort laser pulse effects in ocular and related media. Aviat Space Environ Med 65:A100–A107

    CAS  PubMed  Google Scholar 

  39. Thomas RJ, Noojin GD, Stolarski DJ, Hall RT, Cain CP, Toth CA, Rockwell BA (2002) A comparative study of retinal effects from continuous wave and femtosecond mode-locked lasers. Lasers Surg Med 31:9–17

    PubMed  Google Scholar 

  40. Al-Mohtaseb Z, He X, Yesilirmak N, Waren D, Donaldson KE (2017) Comparison of corneal endothelial cell loss between two femtosecond laser platforms and standard phacoemulsification. J Refract Surg 33:708–712

    PubMed  Google Scholar 

  41. Yesilirmak N, Diakonis VF, Sise A, Waren DP, Yoo SH, Donaldson KE (2017) Differences in energy expenditure for conventional and femtosecond-assisted cataract surgery using 2 different phacoemulsification systems. J Cataract Refract Surg 43:16–21

    PubMed  Google Scholar 

  42. Al-Khateeb G, Shajari M, Vunnava K, Petermann K, Kohnen T (2017) Impact of lens densitometry on phacoemulsification parameters and usage of ultrasound energy in femtosecond laser-assisted lens surgery. Can J Ophthalmol 52:331–337

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Peregrine Eye and Laser Institute, 50 Jupiter Street, 1209, Makati City, Philippines

    Harvey S. Uy & Pik Sha Chan

  2. Department of Ophthalmology and Visual Sciences, University of the Philippines, Manila, Philippines

    Harvey S. Uy

  3. Ophthalmic Research Group, Aston University, Birmingham, United Kingdom

    Raquel Gil-Cazorla

  4. Birmingham and Midland Eye Centre, Birmingham, UK

    Sunil Shah

Authors
  1. Harvey S. Uy
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  2. Pik Sha Chan
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  4. Sunil Shah
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Correspondence to Harvey S. Uy.

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Conflict of interest

Drs. Harvey S. Uy and Sunil Shah have received research grants from LENSAR, Inc. Dr. Raquel Gil-Cazorla has no conflict of interest.

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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 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Uy, H.S., Chan, P.S., Gil-Cazorla, R. et al. Comparison of surgical parameters using different lens fragmentation patterns in eyes undergoing laser-assisted cataract surgery. Int Ophthalmol 39, 2459–2465 (2019). https://doi.org/10.1007/s10792-019-01087-8

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  • DOI: https://doi.org/10.1007/s10792-019-01087-8

Keywords

  • Laser-assisted cataract surgery
  • LACS
  • Phacoemulsification
  • Lens fragmentation