Damian McNamara

May 09, 2016

NEW ORLEANS — Cataract patients with shallow anterior chambers who were treated with femtosecond laser-assisted cataract surgery had less anterior chamber inflammation and less corneal edema the day after surgery than those treated with manual phacoemulsification, according to results from a prospective randomized clinical trial.

This suggests that the newer technique is particularly well suited for more challenging clinical presentations, Shail Vasavada, DO, from the Raghudeep Eye Hospital in Ahmedabad, India, said here at the American Society of Cataract and Refractive Surgery 2016 Symposium.

"In difficult cases, we want patients to be as comfortable and as happy as possible the next day, as they would be for a regular case," he said. The femtosecond laser technique allows most of the manual steps to be completed before going into the eye, "so it definitely helps with a faster and smoother visual recovery," he pointed out.

Dr Vasavada and his colleagues randomized 91 eyes to femtosecond laser-assisted cataract surgery and 91 to traditional phacoemulsification. All 182 eyes had anterior chambers of 2.5 mm or shallower.

"Shallow anterior chambers are known to pose surgical difficulties, including longer surgery time and longer postoperative recovery," Dr Vasavada explained.

Central corneal thickness, a sign of corneal edema, day 1, week 1, and month 1 after the procedure was the primary outcome.

Although central corneal thickness decreased in both groups after surgery, the reduction in the femtosecond group was significant at day 1 (< .03) and week 1 (P < .05). "At 1 month they were equal," Dr Vasavada reported.

Corneal clarity, anterior chamber inflammation, and endothelial density were secondary outcome measures.

"Here again, on day 1, we found that the corneas were significantly clearer in the femtosecond group than in the manual phaco group," Dr Vasavada said. There was no significant difference at week 1 or month 1.

Similarly, anterior chamber inflammation was significantly lower on day 1 in the femtosecond group, but no longer significantly different at week 1 or month 1.

There was no significant difference in endothelial cell density between groups, although there was a trend that suggests less endothelial cell loss in the femtosecond group, Dr Vasavada reported.

"Femtosecond laser-assisted cataract surgery definitely leads to less anterior segment inflammation and less corneal injury during surgery," he said.

In addition to the advantages for patients in the immediate postoperative period, "the femtosecond laser also makes life easier for the surgeon," he added.

"The visual recovery time and the visual acuity were both better," said session panelist Sonia Yoo, MD, from the Bascom Palmer Eye Institute in Miami.

"This study really highlights a particular strength of the femtosecond laser, in that it's clearly advantageous when the anatomy is not typical," she told Medscape Medical News. As more evidence continues to emerge about the use of the femtosecond laser, the technology might show a big advantage for these and other more challenging cases, she added.

Dr Vasavada reports that he and his coworkers receive research grant support from Alcon. Dr Yoo has disclosed no relevant financial relationships.

American Society of Cataract and Refractive Surgery (ASCRS) 2016 Symposium. Presented May 8, 2016.

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