RESUMO
PURPOSE: To compare the safety, effectiveness and changes in endothelial cell density following standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (LOCS III grade 3.0 NO and above). SETTING: Nethradhama Superspeciality Eye Hospital, Bangalore, India. DESIGN: Prospective, randomized, comparative study. METHOD: 100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using pre-defined patterns of nuclear fragmentations. Measured outcomes included intra-operative phaco time, irrigation fluid volume, surgical time and complication rates. Endothelial cell density was evaluated at baseline, 2 weeks and 6 months post-operatively. RESULTS: The CPS group had significantly higher mean total phaco time (TPT, 11.17 ± 6.5 sec vs 8.03 ± 3.77 sec), effective phaco time (EPT, 6.14 ± 3.62 sec vs 4.42 ± 2.07 sec) and total surgical time (8.18 ± 2.36 min vs 7.11 ± 1.55 min) than the FLACS group (p<0.001). Volume of irrigation fluid was comparable between the two groups (CPS, 36.7 ± 12.18 ml, FLACS, 38.64 ± 13.73 ml, (p =0. 45). Mean corneal oedema score and CCT values on POD-1 were significantly higher for the CPS group. At 6 months, % endothelial cell density (ECD) loss was significantly higher in the CPS group (16.08%) versus the FLACS group (12.8%), p <0.001. Three eyes in the CPS group had wound burns of varying severity. CONCLUSION: FLACS with customized nuclear fragmentation patterns resulted in significantly less intra-operative phaco time, surgical time and endothelial cell loss compared to conventional phacoemulsification when treating dense cataracts.
RESUMO
PURPOSE: To compare the dynamic vault range (the difference in the central vault height from scotopic to photopic light condition) after implantation of the ICL/TICL (STAAR Surgical) and Eyecryl phakic/Eyecryl phakic toric intraocular lens (IOL) (Biotech Healthcare). METHODS: This retrospective study included patients with myopia or myopic astigmatism eligible for phakic IOL implantation with either the ICL/TICL or Eyecryl phakic/Eyecryl phakic toric IOL. Vault changes in varying light conditions (scotopic, mesopic, and photopic) were assessed using an anterior segment optical coherence tomography-based tomographer and dynamic vault range (DVR) was compared between the two groups. RESULTS: A total of 60 eyes from 36 patients (30 eyes in each group) with a mean age of 28.63 ± 6.36 years were included. The mean postoperative follow-up at the time of assessment was 9.4 ± 5.3 and 8.9 ± 5.28 months (P = .75) in the ICL and Eyecryl groups, respectively. The mean values of scotopic, mesopic, and photopic vault were 490.56 ± 238.64, 453.56 ± 224.30, and 373.96 ± 200.24 µm in the ICL group and 515.46 ± 174.34, 490.26 ± 184.04, 450.43 ± 173.92 µm in the Eyecryl group (P = .32, .24, and .05, respectively). The DVR was 116.6 ± 59.29 µm in the ICL group versus 65.03 ± 31.78 µm in the Eyecryl group (P < .001). CONCLUSIONS: The Eyecryl phakic IOL showed significantly fewer light-induced changes in the central vault height (DVR) compared to the ICL, which may be attributed to the difference in the material of the two phakic IOL models. This may be clinically significant in eyes with low postoperative vaults with respect to their follow-up and risk assessment of cataractogenesis in the long term. [J Refract Surg. 2023;39(8):546-554.].
