Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery.

PURPOSE: The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). METHODS: This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3 months of follow-up were the difference between pre-operative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. RESULTS: The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36 ±â€¯0.37 D in the transepithelial group and 0.53 ±â€¯0.42 D in the intrastromal group (p < 0.001). The mean CI was 0.83 ±â€¯0.71 in the transepithelial group and 0.68 ±â€¯0.29 in intrastromal group (p = 0.17). Five eyes (25 %) had an astigmatism overcorrection in the transepithelial group and 1 eye (5%) in the intrastromal group. CONCLUSIONS: Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.

Queratotomía arcuata transepitelial o intraestromal con láser de femtosegundo para corrección de astigmatismo corneal en el momento de la cirugía de cataratas / Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery

Objetivo El objetivo del estudio fue comparar los resultados de las incisiones arcuatas (IA) intraestromales y transepiteliales para tratar el astigmatismo corneal en el momento de la cirugía de catarata asistida con láser de femtosegundo (FLACS). Método Este estudio retrospectivo incluyó 20 pacientes con astigmatismo corneal entre 0,70 y 2,00 dioptrías (D) que se sometieron a FLACS con IA intraestromales en un ojo e IA transepiteliales en el ojo adelfo. Los principales datos evaluados a los 2-3meses de seguimiento fueron la diferencia entre el cilindro corneal queratométrico preoperatorio y postoperatorio (Kcyl), el índice de corrección (IC) y el porcentaje de sobrecorrección. Resultados La diferencia media entre Kcyl preoperatorio y postoperatorio reveló un valor medio de 0,36±0,37D en el grupo transepitelial y 0,53±0,42D en el grupo intraestromal (p<0,001). El IC medio fue de 0,83±0,71 en el grupo transepitelial y de 0,68±0,29 en el grupo intraestromal (p=0,17). Cinco ojos (25%) tuvieron una sobrecorrección del astigmatismo en el grupo transepitelial y un ojo (5%) en el grupo intraestromal. Conclusiones Tanto las IA intraestromales como las IA transepiteliales mostraron potencial para la corrección de astigmatismo leve a moderado y parecen ser un procedimiento seguro. A pesar de que las IA transepiteliales presentaron un IC más alto, los resultados de las IA intraestromales fueron más predecibles (AU)

Purpose The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS). Methods This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2-3months of follow-up were the difference between preoperative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection. Results The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36±0.37D in the transepithelial group and 0.53±0.42D in the intrastromal group (P<.001). The mean CI was 0.83±0.71 in the transepithelial group and 0.68±0.29 in intrastromal group (P=.17). Five eyes (25%) had an astigmatism overcorrection in the transepithelial group and 1eye (5%) in the intrastromal group. Conclusions Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable (AU)

Evaluation of femtosecond laser-assisted cataract surgery after 10 years of clinical application. / Evaluación de la cirugía de la catarata asistida con láser femtosegundo tras 10 años de aplicación clínica.

INTRODUCTION: Femtosecond laser-assisted cataract surgery (FLACS) has been considered a technological advance in modern cataract surgery. After years of experience, it has been observed that clinical outcomes had more complications than expected at the beginning. The aim of this study is to compare the benefits and disadvantages of the FLACS technique with conventional cataract surgery. METHOD: The PubMed and Web of Science platforms were used to search for scientific literature. RESULTS: The FLACS has currently improved the surgical technique in terms of the shorter ultrasound time used and the lower loss of endothelial cells. Likewise, the centration of capsulotomy and the correction of astigmatism with arcuate incisions have also been improved. As disadvantages, are the high cost of the laser, the intraoperative capsular complications, the induction of intraoperative myosis, and the learning curve of the technique. CONCLUSIONS: The FLACS technique is considered beneficial for specific cases, such as patients with scheduled premium surgery, or with low endothelial cell count. However, it is believed that given the technological cost it is not a cost effective technique for most standard cases in our daily clinical practice.

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.

The influence of surgeons and technicians on the learning curve of femtosecond-laser cataract surgery.

PURPOSE: To demonstrate the influence of the surgeon's and the operating room (OR) technicians' experience upon the outcome of femtosecond laser-assisted cataract surgery (FLACS). MATERIALS AND METHODS: Our study included 250 eyes from 156 patients who had undergone either cataract surgery or clear-crystalline-lens extraction and where capsulorhexis and lens fragmentation had been performed using the CATALYS® Precision System femtosecond platform (Abbott Medical Optics Inc., Santa Ana, CA, USA).The patients were operated either by an experienced surgeon in the use of femtosecond laser or by an inexperienced surgeon in that field and two technicians. The quantitative outcome measures were: Suction loss rate, vacuum time, number of consumables used by the patient and intraoperative complication rate. RESULTS: Both for the experienced and the inexperienced surgeons, suction loss rates as well as vacuum time decreased progressively as time went by and more surgical procedures had been completed by that surgeon. For a given surgeon suction time decreased significantly, going from 137 to 99s, as the assisting technician gradually gained experience. The number of consumables used in each procedure by the experienced surgeon ranged from 1.10 (for the first 50 cases) to 1.02 from those initial cases onwards. Regarding intraoperative complications, they also decreased progressively as the number of procedures completed by the surgeon increased. CONCLUSIONS: The experience of each team member involved in such procedures-be it surgeons or technicians-have an impact, to a greater or lesser extent, upon the surgery's outcome, as quantified by the outcome variables of choice.

Efecto Hipotensor de la Trabeculoplastia Láser / Hypotensive Eff ect of Laser Trabeculoplasty

Objetivo: Reportar el desenlace luego de 12 meses de seguimiento, en pacientes en los que se realizó una queratoplastia lamelar anterior profunda (DALK) asistida con láser de femtosegundo. Metodología: Se realizó un estudio descriptivo, retrospectivo, mediante revisión de historias clínicas de pacientes sometidos a DALK asistida con láser de femtosegundo (Wavelight FS-200 ® Alcon. Forth Worth, Texas), utilizando la configuración de zig-zag. Las indicaciones de DALK incluyeron queratocono, ectasia post LASIK y leucoma como secuela de queratitis infecciosa. Las variables estudiadas fueron agudeza visual mejor corregida, cilindro queratométrico, refracción final y complicaciones intra y post operatoria. Resultados: En total se incluyeron 10 ojos de 10 pacientes, en todos los ojos se llevó a cabo con éxito femto-DALK y no hubo ninguna complicación intra operatoria. En el postoperatorio se presentó un caso de rechazo estromal, un caso de hipertensión ocular secundario a esteroides y un caso de retraso en la cicatrización. El seguimiento promedio fue de 13, 1 meses (R= 12 ­ 15 meses). La Agudeza Visual Mejor Corregida (AVMC) preoperatoria promedio fue LogMAR 0,96 (R= 0,54 ­ 1,60). La AVMC postoperatoria promedio a los 12 meses fue 0,10 (R= 0,00 ­ 0,17). El equivalente esférico preoperatorio medio fue -12,6 Dioptrias (D) (R= -5,0 a -15,0D) y el postoperatorio fue -2,57 D (R= -0,50 a -6,25 D). El astigmatismo queratométrico preoperatorio medio de -11.5D (R= -7.0 a -23D) y el postoperatorio -2,4 D (R= -0,75 a -3,75 D). Conclusión: La femto-DALK en configuración Zig-Zag es un procedimiento confiable, con baja tasa de complicaciones intra y postoperatorias. El resultado refractivo es comparable con la queratoplastia penetrante, y ofrece beneficios sobre factores de estabilidad biomecánica y recuperación del paciente en el primer año postoperatorio.

Objective: The aim was to report the surgical outcomes of twelve months follow-up after femtosecond laser assisted Zig-zag confi guration combined with Deep Anterior Lamellar Keratoplasty (Femto-DALK). Methods: A descriptive, retrospective study, which evaluated and assisted medical records of patients who had undergone deep anterior lamellar keratoplasty (DALK) femtosecond laser assisted. Ten eyes of ten consecutive patients underwent femtosecond (Wavelight FS-200 ® Alcon. Forth Worth, Texas) laser-assisted zig-zag configuration combined with Anwar´s big-bubble technique DALK, from April 2012 to December 2013. The diagnosis of the patients were keratoconus, corneal ectasia and scarring following infectious keratitis. Variables measured were: Best corrected visual acuity, keratometric corneal cylinder, final refraction and intraand postoperative complications were analyzed. Results: The procedure was performed without any complications in all patients. There was only a single case of stromal graft rejection, a case of corticosteroid induced ocular hypertension and a case of delayed corneal epithelial healing. Mean follow-up period was 13.1 months (R= 12­15 months). The mean preoperative BCVA was LogMAR 0,96 (R= 0,54 ­ 1,60). The mean postoperative BCVA at 12th month was 0,054 (R= 0,00 ­0,09). The mean preoperative spherical equivalent (SE) was -12,6 Diopter (D) (R= -5,0 to -24,0D) and postoperative SE was -2,50 D (R=-0,50 to -6,25 D). The measurements of keratometric corneal cylinder preoperative was -11.5D (R= -7.0 a -23D) and postoperative refractive cylinder was -2,4 D (R=-0,75 to -4,00 D). Conclusion: Laser-assisted zig-zag configuration combined with Anwar´s big-bubble technique DALK is a safe procedure. The rate of intra and postoperative complications is low. The refractive outcomes are comparable to penetrating keratoplasty, but better biomechanical stability of the cornea and a faster visual recovery with femtoDALK procedure.

Queratoplastia Lamelar Anterior Profunda asistida con láser de femtosegundo configuración Zig-Zag: Resultados a un año de seguimiento / Deep Anterior Lamellar Keratoplasty in a Zig-Zag Pattern Assisted by Femtosecond Laser: 1 year follow up

Objetivo: Reportar el desenlace luego de 12 meses de seguimiento, en pacientes en los que se realizó una queratoplastia lamelar anterior profunda (DALK) asistida con láser de femtosegundo. Metodología: Se realizó un estudio descriptivo, retrospectivo, mediante revisión de historias clínicas de pacientes sometidos a DALK asistida con láser de femtosegundo (Wavelight FS-200 ® Alcon. Forth Worth, Texas), utilizando la configuración de zig-zag. Las indicaciones de DALK incluyeron queratocono, ectasia post LASIK y leucoma como secuela de queratitis infecciosa. Las variables estudiadas fueron agudeza visual mejor corregida, cilindro queratométrico, refracción final y complicaciones intra y post operatoria. Resultados: En total se incluyeron 10 ojos de 10 pacientes, en todos los ojos se llevó a cabo con éxito femto-DALK y no hubo ninguna complicación intra operatoria. En el postoperatorio se presentó un caso de rechazo estromal, un caso de hipertensión ocular secundario a esteroides y un caso de retraso en la cicatrización. El seguimiento promedio fue de 13, 1 meses (R= 12 ­ 15 meses). La Agudeza Visual Mejor Corregida (AVMC) preoperatoria promedio fue LogMAR 0,96 (R= 0,54 ­ 1,60). La AVMC postoperatoria promedio a los 12 meses fue 0,10 (R= 0,00 ­ 0,17). El equivalente esférico preoperatorio medio fue -12,6 Dioptrias (D) (R= -5,0 a -15,0D) y el postoperatorio fue -2,57 D (R= -0,50 a -6,25 D). El astigmatismo queratométrico preoperatorio medio de -11.5D (R= -7.0 a -23D) y el postoperatorio -2,4 D (R= -0,75 a -3,75 D). Conclusión: La femto-DALK en confi guración Zig-Zag es un procedimiento confiable, con baja tasa de complicaciones intra y postoperatorias. El resultado refractivo es comparable con la queratoplastia penetrante, y ofrece beneficios sobre factores de estabilidad biomecánica y recuperación del paciente en el primer año postoperatorio.

Objective: The aim was to report the surgical outcomes of twelve months follow-up aft er femtosecond laser assisted Zig-zag configuration combined with Deep Anterior Lamellar Keratoplasty (Femto-DALK). Methods: A descriptive, retrospective study, which evaluated and assisted medical records of patients who had undergone deep anterior lamellar keratoplasty (DALK) femtosecond laser assisted. Ten eyes of ten consecutive patients underwent femtosecond (Wavelight FS-200 ® Alcon. Forth Worth, Texas) laser-assisted zig-zag configuration combined with Anwar´s big-bubble technique DALK, from April 2012 to December 2013. The diagnosis of the patients were keratoconus, corneal ectasia and scarring following infectious keratitis. Variables measured were: Best corrected visual acuity, keratometric corneal cylinder, final refraction and intraand postoperative complications were analyzed. Results: The procedure was performed without any complications in all patients. There was only a single case of stromal graft rejection, a case of corticosteroidinduced ocular hypertension and a case of delayed corneal epithelial healing. Mean follow-up period was 13.1 months (R= 12­15 months). The mean preoperative BCVA was LogMAR 0,96 (R= 0,54 ­ 1,60). Th e mean postoperative BCVA at 12th month was 0,054 (R= 0,00 ­0,09). The mean preoperative spherical equivalent (SE) was -12,6 Diopter (D)(R= -5,0 to -24,0D) and postoperative SE was -2,50 D (R=-0,50 to -6,25 D). The measurements of keratometric corneal cylinder preoperative was -11.5D (R= -7.0 a -23D) and postoperative refractive cylinder was -2,4 D (R=-0,75 to -4,00 D). Conclusion: Laser-assisted zig-zag configuration combined with Anwar´s big-bubble technique DALK is a safe procedure. The rate of intra and postoperative complications is low. The refractive outcomes are comparable to penetrating keratoplasty, but better biomechanical stability of the cornea and a faster visual recovery with femtoDALK procedure.

Femtophacovitrectomy. Case series and description of the technique. / Femtofacovitrectomía. Serie de casos y descripción de la técnica.

OBJECTIVE: The aim of this study was to assess the safety and surgical results of combined pars plana vitrectomy and femtosecond laser-assisted cataract surgery (femtophacovitrectomy). MATERIAL AND METHODS: A prospective, non-comparative case series was conducted by selecting patients with cataract and vitreoretinal pathology who underwent femtophacovitrectomy by a single surgeon at the Hospital Central Militar between June 2013 and February 2014. An evaluation was made of the preoperative characteristics, surgical indications, results, and postoperative complications, with a minimum follow-up of 3 months. RESULTS: The study included 35 eyes of 35 patients, of whom 20 (57.1%) were male. The mean age was 60.76±4.2 years. Diagnoses included vitreous haemorrhage (19 cases), macular hole (6 cases), epiretinal membrane (7), and tractional detachment (5 cases). The mean best corrected visual acuity was 1.3 LogMAR before surgery, and 0.5 LogMAR at 3-months follow-up (P<.05). No patient had visual loss. The intra-operative complication was miosis in 14.28%. In the early postoperative period (<1 month), all had subconjunctival haemorrhage, with moderate corneal oedema in 20% of cases, and only 2.85% (one case) ocular hypertension associated with use of intraocular gas. There were no cases of endophthalmitis. The mean follow-up was 13.3 months (10-16 months). CONCLUSIONS: The use of femtosecond laser in phacovitrectomy is a safe and effective alternative, with similar risk of complications in cases of macular pathology, tractional retinal detachment, and/or vitreous haemorrhage.

[Malyugin ring for intraoperative miosis in femtosecond laser phacovitrectomy]. / Anillo de Malyugin para miosis intraoperatoria en femtofacovitrectomía.

OBJECTIVE: To evaluate the usefulness of the Malyugin ring in poor pupil dilation during phacoemulsification assisted with femtosecond laser with 23 gauge pars plana vitrectomy. METHOD: A 57-year-old female with cataract and vitreous hemorrhage, and poor pupil dilation (5.5mm). The phacoemulsification assisted with femtosecond laser, using Malyugin ring after capsulorrhexis, followed by pars plana vitrectomy, and removing at the end without complications. RESULTS: A successfull intraoperative pupil dilation was achieved without complications, with a final BCVA of 20/40. CONCLUSIONS: The Malyugin ring is an effective alternative in cases with poor pupil dilation in femtophacovitrectomy, preserving the anatomical and functional integrity.