Visual outcomes with femtosecond laser-assisted cataract surgery versus conventional cataract surgery in toric IOL insertion.

BACKGROUND: To evaluate the visual outcomes of femtosecond laser-assisted cataract surgery (LCS) compared with phacoemulsification cataract surgery (PCS) in patients undergoing Toric IOL insertion. DESIGN: A non-randomized, single surgeon, prospective, comparative cohort case series PARTICIPANTS: Patients undergoing LCS and PCS between January 2012 and July 2014 at a single center. METHODS: The LCS group underwent femtosecond laser pretreatment for the anterior capsulotomy and lens fragmentation. Otherwise standard phacoemulsification surgery and foldable toric intraocular lens insertion proceeded. MAIN OUTCOME MEASURES: Best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), pre and post operative cylinder and mean absolute refractive error. RESULTS: A total of 418 eyes from 323 patients were included in the study; with 95 eyes in the PCS group and 323 in the LCS group. There were 243 (75.5%) LCS eyes with a pre-operative BCVA of 20/40 or better and 54 (56.8%) in the PCS group (p < 0.001). For post-operative BCVA, 315 (97.5 %) LCS and 81 (85.3%) PCS eyes had a BCVA of 20/40 or better (p = <0.001). However, there was no significant difference for change in BCVA between the groups (mean gain in EDTRS letter 11.0 for LCS and 10.3 for PCS p = 0.64) or in MAE (mean 0.56D PCS vs 0.65D LCS p = 0.18). CONCLUSION: In patients receiving toric intraocular lenses, there is similar improvement in terms of letters gained with LCS and PCS. Overall, there is no additional benefit for patients undergoing LCS in this cohort.

A Comparative Cohort Study of Visual Outcomes in Femtosecond Laser-Assisted versus Phacoemulsification Cataract Surgery.

PURPOSE: To evaluate visual outcomes after femtosecond laser-assisted cataract surgery (LCS) with phacoemulsification cataract surgery (PCS). DESIGN: Prospective, multicenter, comparative case series. PARTICIPANTS: Consecutive patients undergoing femtosecond LCS or PCS with intraocular lens insertion. METHODS: A total of 1876 eyes of 1238 patients (422 male and 772 female) who underwent cataract surgery between January 2012 and June 2014 were included in the study: 1017 eyes from center A and 859 eyes from center B. Cases underwent clinico-socioeconomic selection. Patients with absolute LCS contraindications were assigned to PCS; otherwise, all patients were offered LCS and elected on the basis of their decision to pay (the out-of-pocket cost for LCS). Demographic and postoperative data were collected to determine differences between groups. MAIN OUTCOME MEASURES: Six-month postoperative visual and refractive outcomes. Masked subjective refractions were performed 2 to 6 months postoperatively. RESULTS: There were 988 eyes in the LCS group and 888 eyes in the PCS group. Baseline best-corrected visual acuity (BCVA) was better in LCS compared with PCS (20/44.0 vs. 20/51.5; P < 0.0003). Preoperative surgical refractive aim differed significantly between groups (LCS -0.28 vs. PCS -0.23; P < 0.0001). More patients who received LCS had Toric lenses implanted compared with PCS (47.4% vs. 34.8%; P < 0.0001). Postoperative BCVA was better after LCS (20/24.5 vs. 20/26.4; P = 0.0003) with a greater proportion of LCS cases achieving BCVA >20/30 (LCS 89.7% vs. PCS 84.2%; P = 0.0006) and 20/40 (LCS 96.6% vs. PCS 93.9%; P = 0.0077). However, PCS cases had more letters gained compared with LCS cases (13.5 vs. 12.5 letters; P = 0.0088), reflecting baseline BCVA differences. Mean absolute error was higher in LCS compared with PCS (0.41 diopters [D] vs. 0.35 D; P < 0.0011). The percentage of eyes within 0.5 D of error from preoperative aim refraction was higher in the PCS group (LCS 72.2% vs. PCS 82.6%; P < 0.0001). CONCLUSIONS: Femtosecond LCS did not demonstrate clinically meaningful improvements in visual outcomes over conventional PCS.

Cystoid macular edema after femtosecond laser-assisted versus phacoemulsification cataract surgery.

PURPOSE: To evaluate the incidence of postoperative clinical cystoid macular edema (CME) associated with femtosecond laser-assisted cataract surgery (Catalys laser system) versus phacoemulsification cataract surgery. SETTING: Launceston Eye Institute, Launceston, Tasmania, Australia. DESIGN: Nonrandomized, single-surgeon, prospective, comparative cohort case series. METHODS: Patients who had femtosecond laser-assisted cataract surgery and phacoemulsification cataract surgery between March 2012 and July 2014 were included in the study. The femtosecond laser-assisted cataract surgery group had anterior capsulotomy, lens fragmentation, with or without corneal incisions via femtosecond laser pretreatment. Standard phacoemulsification surgery and foldable acrylic intraocular lens insertion proceeded in all cases. All patients received topical nonsteroidal drops commencing 2 days preoperatively and continuing for 4 weeks postoperatively. The incidence of postoperative clinical CME (confirmed by optical coherence tomography) and comparison between groups were measured. The main outcome measure was the clinical CME rates. RESULTS: Of the eyes, 833 had femtosecond laser-assisted cataract surgery amd 458 had standard phacoemulsification cataract surgery. Both groups had similar baseline parameters. There were 7 cases of postoperative CME (0.8%) in the femtosecond laser-assisted cataract surgery group compared to 1 case (0.2%) in the phacoemulsification cataract surgery group, highlighting a trend toward greater cystoid macular edema in the femtosecond laser-assisted cataract surgery group. This correlated with a change in laser treatment speed (due to a software upgrade), suggesting that retinal safety thresholds need further careful analysis. CONCLUSION: Increased CME might be a subthreshold retinal injury safety signal after femtosecond laser pretreatment and warrants further study. FINANCIAL DISCLOSURE: There are no financial or conflicts of interest for any author.

Leucapheresis for management of retinopathy in chronic myeloid leukaemia.

Chronic myeloid leukaemia is a myeloproliferative neoplasm characterised by granulocytic hyperplasia in the bone marrow and the presence of a specific cytogenetic abnormality known as Philadelphia chromosome with fusion of breakpoint cluster region (BCR) and ableson (ABL) genes. Retinopathy is a rare sight-threatening complication of chronic myeloid leukaemia, which occurs due to leucostasis in retinal blood vessels. We report a case of a patient who presented with visual impairment due to leucostasis, who was successfully managed by leucapheresis along with BCR-ABL tyrosine kinase inhibitor.