August 2020 Volume 46 Issue 8
JCRS August 2020
Previous studies comparing femtosecond laser-assisted cataract surgery (FLACS) with conventional cataract surgery (CSS) have provided contradictory results. A new comprehensive meta-analysis was conducted to try and provide answers to unanswered questions about the relative merits of the two approaches. Researchers included 73 studies (25 randomised controlled, 48 observational), with a total of 12,769 eyes treated with FLACS and 12,274 eyes treated with CCS. The studies involved five different laser platforms. The study was not powered to compare the different platforms. Both procedures were similarly safe and effective with few complications. No significant differences among groups were found in visual acuity at one week and after six months. However, in most of the studies, FLACS provided slightly better visual acuity in the medium-term. FLACS required lower ultrasound energy, which was associated with less injury to corneal tissues. Moreover, FLACS appears beneficial in the short-term for patients with low endothelial cell density and dense cataract. Ten years after the introduction of FLACS, questions of cost efficacy remain.
CM Kolb et al. “Comparison of femtosecond laser–assisted cataract surgery and conventional cataract surgery: a meta-analysis and systematic review”, Vol 46, #8, p 1075-1085.
Reducing FLACS inflammation
A single dose of topical NSAID 30 minutes before FLACS surgery appears sufficient to minimise inflammation in the aqueous humour, a new study suggests. Researchers investigated interleukin (IL)-1β, IL-6 and total prostaglandin (PG) levels in the anterior chamber in 40 patients undergoing immediate sequential cataract surgery. One eye underwent low pulse energy FLACS, with the second eye undergoing conventional phaco surgery. No difference was noted in levels of IL-1β and IL-6 between the groups. There was a small but statistically significant increase of PG levels in the femto group. No statistically significant correlations were noted between levels of 1β, IL-6, or total PG and suction time or lens density.
L Schwarzenbacher et al., “Intraindividual comparison of cytokine and prostaglandin levels with and without low-energy, high-frequency femtosecond laser cataract pre-treatment after single-dose topical NSAID application”, Vol 46, #8, p 1086-1091.
Toric IOLs in children
Toric IOL implantation can produce excellent results in paediatric eyes undergoing non-traumatic cataract surgery, a long-term study concludes. The study included 76 eyes of 51 children, with a mean age of 7.41 ± 2.82 years and mean preoperative keratometric astigmatism of 1.56 ± 2.13D. The mean corrected distance visual acuity improved significantly from 0.59 logMAR preoperatively to 0.23 at 36 months. Mean postoperative uncorrected distance visual acuity was 0.32. Mean refractive astigmatism at final follow-up was -0.55 ± 0.40 D, with 74% patients having a UDVA of at least 20/40. Five per cent of eyes needed treatment for visual axis obscuration. None developed glaucoma. No eye required repositioning of the toric IOL until final follow-up.
V Vasavada et al., “Visual outcomes after toric intraocular lens implantation in paediatric eyes undergoing cataract surgery”, Vol 46, #8, p 1102-1107.