ESCRS FLACS Study

Delving deeper into the ESCRS Femtosecond Laser-Assisted Cataract Surgery (FLACS) Study yields some interesting data concerning visual and refractive outcomes as well as complications related to the procedure, according to Mats Lundström MD, PhD. “Analysis of the data showed that visual and refractive outcomes with FLACS were good overall, and that the cases with a poor outcome seem to be related to the indications for surgery rather than the technique itself. We also found that some surgical complications were related to the technique, but most of these were minor and had no consequence on the visual outcomes,” said Dr Lundström. Designed to evaluate the outcome of FLACS from the patient’s perspective in terms of visual outcome, refractive outcome and complications, the prospective ESCRS FLACS Study drew on the European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) online platform for collecting surgical outcome data, explained Dr Lundström, of Lund University, Sweden. http://www.eurequo.org The main finding from the study, presented at the XXXIII Congress of the ESCRS in Barcelona, Spain, was that FLACS was as good as routine phacoemulsification but did not outperform it. Dr Lundström said that parameters significantly related to the visual outcome included preoperative visual acuity (VA), ocular comorbidity, postoperative complications and surgical difficulties. “These are all aspects familiar to us from phaco studies. Parameters significantly related to a worse visual outcome, defined as two logMAR units or more in 37 cases, were related to postoperative complications, ocular comorbidity, and preoperative VA,” he said. While the overall refractive outcomes were good, detailed analysis of each clinic’s results showed room for improvement in terms of predictability, added Dr Lundström. “Some clinics made their patients more myopic or hyperopic than intended. This is something we need to remember when we plan to use multifocal or trifocal intraocular lenses (IOLs) for such patients,” he said. Surgical complications occurred in 99 cases overall (2.9%), broken down into classical complications such as capsular rupture and vitreous loss in 33 cases (1%) and laser-related complications in 66 (1.9%). The laser-related complications included 27 incision-related complications (0.8%), capsulorhexis-related complications in 18 cases (0.5%), minor anterior capsule complications in 19 (0.5%), and the laser approach had to be abandoned in three cases (0.1%). “It is important to emphasise, however, that some of these complications are not a problem for vision but were identified as part of the study protocol to evaluate this new technique,” he said.

Visual and refractive outcomes with FLACS were good overall

COMPLICATIONS The rate of postoperative complications with a follow-up of two months from time of surgery was 3.3% or 113 cases: persistent corneal oedema in 15 (0.4%); early posterior capsule opacification reducing vision in 26 (0.8%); uveitis with need of treatment in 13 cases (0.4%); high intraocular pressure with need of treatment in four (0.1%); explantation in three (0.1%); and other vision-threatening complications in 58 (1.7%). Overall, patients with worse visual outcome tended to be young (mean age 60), with good preoperative VA and a high percentage of ocular comorbidity, said Dr Lundstrom. Patients with poor refractive outcome were also characterised by young age (mean 62), a high percentage of previous corneal refractive surgery (14.1%), and poorer preoperative VA (median 0.3). Patients with postoperative complications were characterised by over-representation 
of glaucoma, other coexisting eye 
disease, surgical complications and multifocal IOLs. Dr Lundström emphasised that the study was not a clinical trial and was not designed to evaluate the performance of different laser platforms. “This is a registry study of what is happening in the real world. If we want to go into more detail and get more information, we need more randomised clinical trials,” he concluded. Mats Lundström: 
mats.lundstrom@karlskrona.mail.telia.com