Experience in cataract surgery assisted by femtosecond laser at Fundación Hospital Nuestra Señora de la Luz.

OBJECTIVE: To describe the transoperative results of cataract surgeries assisted by femtosecond laser. METHOD: Observational, descriptive, retrospective and cross-sectional study of 420 surgical records made with the LenSx platform from April 2015 to August 2017. The review of records was made through the internal electronic system accessing the preoperative and postoperative note. The information was collected through a database in Excel. The analysis of variables was performed by means of descriptive statistics with measures of central tendency. RESULTS: 86 files met inclusion criteria. The average age was 63 years. There was a general frequency of complications of 27.9% (24 surgeries). The most frequent complications were incomplete or impermeable corneal wound (37.5%), incomplete capsulorhexis (25%) and posterior capsule rupture (16.7%). CONCLUSIONS: The femtosecond laser technology incorporated in cataract surgery can be considered successful because of a low overall frequency of complications.

OBJETIVO: Describir las complicaciones transoperatorias de las cirugías de catarata asistidas por láser de femtosegundo. MÉTODO: Estudio observacional, descriptivo, retrospectivo y transversal de 420 expedientes de cirugías realizadas con la plataforma LenSx de abril de 2015 a agosto de 2017. La revisión de expedientes se realizó a través del sistema electrónico interno accediendo a las notas preoperatoria y posoperatoria. La información se recopiló en una base de datos Excel. Se realizó el análisis de variables por medio de estadística descriptiva con medidas de tendencia central. RESULTADOS: Cumplieron criterios de inclusión 86 expedientes. La edad promedio de los pacientes fue de 63 años. Se presentó una frecuencia general de complicaciones del 27.9% (24 cirugías). Las complicaciones que ocurrieron con mayor frecuencia fueron herida corneal incompleta o impermeable (37.5%), capsulorrexis incompleta (25%) y rotura de cápsula posterior (16.7%). CONCLUSIONES: La tecnología de láser de femtosegundo incorporada en la cirugía de catarata puede considerarse como exitosa al tener una baja frecuencia general de complicaciones.

Comparação entre capsulotomia assistida por laser de femtossegundo e capsulorrexe curvilínea contínua guiada por imagem digital / Comparison between femtosecond laser capsulotomy and manual continuous curvilinear digital image guided capsulorrhexis

Objetivo: Medir e comparar o tamanho e forma de capsulotomias realizadas com laser de femtossegundo com os de capsulorrexes curvilíneas contínuas (CCC) realizadas com auxilio guiado por imagem digital e avaliar o resultado refracional. Métodos: Durante cirurgia de catarata, 40 olhos de 40 pacientes tiveram a capsulotomia realizada com auxílio do laser de femtossegundo e seus resultados foram comparados com os de 40 olhos de 40 outros pacientes que tiveram a capsulorrexe guiada por sistema de imagem digital. Os parâmetros de circularidade, forma e overlap foram medidos usando o Adobe Photoshop (Adobe Systems Inc.) e os resultados refracionais pós-operatórios foram avaliados em ambos os grupos. Resultados: Os diâmetros, tamanho e forma de alta precisão e previsibilidade foram atingidos com laser de femtossegundo e houve diferença estatística entre os grupos. Quando comparado o equivalente esférico entre os grupos, não houve diferença estatística. Conclusão: As capsulotomias realizadas pelo laser de femtossegundo possuem circularidade programada, diâmetro pretendido e valores de desvio padrão médios, indicando resultados reprodutíveis mais elevados. No entanto, CCC realizada por um cirurgião experiente com auxílio guiado de imagem digital, com configurações apropriadas, fornece resultados semelhantes e sugere que diferentes técnicas são igualmente eficazes. .

Purpose: To measure and compare size and shape parameters of femtosecond laser capsulotomy with manually continuous curvilinear digital guided capsulorhexis (CCC) and their refractive outcomes. Methods: Laser capsulotomies in 40 eyes of 40 patients were performed using LenSx femtosecond laser device (Alcon, Forthworth, US) and its results were compared with the CCC digital guided carried out in 40 eyes of 40 patients using the Callisto Eye digital image system (Zeiss, Germany). Capsulorhexis circularity, shape and capsule overlap were measured using Adobe Photoshop (Adobe Systems Inc.) and postoperative refraction outcomes were evaluated in both groups. Results: Highly accurate and predictable capsulotomy diameter, size and shape were achieved with femtosecond laser capsulotomy compared with capsulorhexis and showed statistical difference between groups. Spherical equivalent comparison between groups showed no statistical difference. Conclusions: Femtosecond laser anterior capsulotomy with programed circularity had the intended diameter with average standard deviation values, indicating higher reproducible outcomes. Capsulorhexis performed by an experienced surgeon with auxiliary image guide and appropriate settings provides similar results our results suggest that different techniques are equally effective. .

Efficacy of a lutein-based dye (Phacodyne™) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification.

PURPOSE: To evaluate the efficacy and safety of a novel lutein-based dye for the anterior capsulorhexis during phacoemulsification in cataract surgery in humans. METHODS: Twenty-five eyes from 25 patients were operated by 25 different surgeons who performed continuous circular capsulorhexis (CCC) guided by a lutein-based dye (Phacodyne™) during cataract surgery by phacoemulsification. A questionnaire assessed the surgeon's opinion regarding the efficacy of the dye. Follow-up examinations were performed at 1, 7, and 30 days post-surgery. Eyes were evaluated by full ophthalmic examination, corneal topography/pachymetry, and corneal endothelial cell count. RESULTS: As revealed by the answers to the questionnaire, the dye facilitated the CCC procedure in all eyes. Baseline nuclear cataract classification (according to the Lens Opacities Classification System III; LOCS III) was 3.24 (± 1.12). Preoperative BCVA (logMAR) was 0.89 ± 0.59 and improved to 0.23 ± 0.22 on day 30 after surgery. The intraocular pressure (IOP) remained stable and the inflammatory reaction subsided in all cases within the first 7 days after surgery. The pre-operative values of corneal pachymetry and IOP were similar to those found on follow-up day 30. Loss in endothelial cell number was similar to earlier reports. CONCLUSION: Phacodyne™ was efficient when used for anterior capsulorhexis during cataract surgery by phacoemulsification and

Efficacy of a lutein-based dye (PhacodyneTM) for visualizing anterior capsulorhexis during cataract surgery by phacoemulsification / Eficácia de corante à base de luteína (PhacodyneTM) para observação da capsulorrexis anterior em cirurgia de facoemulsificação

Purpose: To evaluate the efficacy and safety of a novel lutein-based dye for the anterior capsulorhexis during phacoemulsification in cataract surgery in humans. Methods: Twenty-five eyes from 25 patients were operated by 25 different surgeons who performed continuous circular capsulorhexis (CCC) guided by a lutein-based dye (PhacodyneTM) during cataract surgery by phacoemulsification. A questionnaire assessed the surgeon's opinion regarding the efficacy of the dye. Follow-up examinations were performed at 1, 7, and 30 days post-surgery. Eyes were evaluated by full ophthalmic examination, corneal topography/pachymetry, and corneal endothelial cell count. Results: As revealed by the answers to the questionnaire, the dye facilitated the CCC procedure in all eyes. Baseline nuclear cataract classification (according to the Lens Opacities Classification System III; LOCS III) was 3.24 (± 1.12). Preoperative BCVA (logMAR) was 0.89 ± 0.59 and improved to 0.23 ± 0.22 on day 30 after surgery. The intraocular pressure (IOP) remained stable and the inflammatory reaction subsided in all cases within the first 7 days after surgery. The pre-operative values of corneal pachymetry and IOP were similar to those found on follow-up day 30. Loss in endothelial cell number was similar to earlier reports. Conclusion: PhacodyneTM was efficient when used for anterior capsulorhexis during cataract surgery by phacoemulsification and showed no signs of toxicity or side effects during the 30-day follow-up period. .

Objetivos: Avaliar a eficácia e eficiência de um novo corante à base de luteína para coloração da cápsula anterior durante cirurgia de facoemulsificação em humanos. Métodos: Vinte e cinco olhos de 25 pacientes foram operados por 25 cirurgiões diferentes que realizaram capsulorrexis circular contínua e facoemulsificação após coloração da cápsula anterior com corante à base de luteína. Um questionário avaliou a opinião dos cirurgiões sobre a eficácia do corante. Exames pós-operatórios foram realizados nos dias 1, 7 e 30 por meio de exame oftalmológico completo, topografia/ paquimetria e contagem de células endoteliais. Resultados: De acordo com o questionário aplicado, o corante facilitou a cirurgia em todos os olhos. A classificação da catarata de acordo com o LOCS III foi de 3,24 ± 1,12. A acuidade visual pré-operatória com melhor correção foi de 0,89 ± 0,59 (logMAR), passando a 0,23 ± 0,22 no pós-operatório. A pressão intraocular (PIO) permaneceu estável e houve reação de câmara leve que desapareceu em todos os casos durante os primeiros 7 dias de pós-operatório. Não houve significância estatística comparando a paquimetria e PIO pré e pós-operatórios. Conclusão: O novo corante se mostrou eficiente e sem sinais de toxicidade ou efeitos adversos, após 30 dias, quando usado para auxiliar a cirurgia de facoemulsificação. .

How a femtosecond laser increases safety and precision in cataract surgery?

PURPOSE OF REVIEW: To look at the recent applications of femtosecond laser (FSL) technology for capsulotomy and nuclear fragmentation in cataract surgery, the potential advantages, such as more precise and adjustable capsulotomies and the use of less phaco energy with this technology. RECENT FINDINGS: The FSL can create incisions or spaces of different shapes, at a desired depth. This has started the application of the technology in the lens: after a clear image is taken of the lens through a previously dilated pupil, circular capsulotomy is done, with precision in shape and diameter, and in most cases, just needs to be grabbed, or requires very small use of the with the forceps. Then photofragmentation of the nucleus is done, without the risk of damaging the posterior capsule, because it is well visualized, to achieve the aspiration of the nuclear material without applying phaco energy, in the soft or medium-hard nucleus, but eventually in almost all nucleus. SUMMARY: FSL is now used at the level of the lens, with the potentiality for very precise circular and adjustable diameter capsulotomies, and the fragmentation of the nuclear material, allowing the aspiration of the material and less emulsification especially in soft nucleus.