Currently, there is no clear consensus in cataract surgery if low compared to high energy femto-lasers may enable better capsulotomy quality and induce lower inflammatory response. Therefore, the aim of this study was to compare the intra-operative outcomes achieved with high and low pulse energy femtosecond laser systems for cataract surgery. The charts of 200 eyes of 200 patients aged 68.3 ± 10.3 years who had undergone femtosecond laser-assisted cataract surgery using either group 1 high pulse energy: LenSx (Alcon Laboratories) (N = 100) or group 2 low pulse energy: FEMTO LDV Z8 (Ziemer) (N = 100) laser were reviewed retrospectively. Integrity of anterior capsulotomy, classified as (1) complete (free-floating or with minor microadhesions), (2) incomplete and (3) with capsular tears, intraoperative completeness of the clear corneal incisions (CCI, main incision and side port), incidences of intraoperative miosis and incidence of subconjunctival hemorrhage were evaluated and compared between the two groups. The proportion of complete capsulotomies was significantly higher in the group 2 than the group 1 (100% vs 94%; p = 0.03). The incidences of intraoperative miosis (0% vs 19%) and subconjunctival hemorrhage (1% vs 63%) were significantly lower in the group 2 than the group 1 (p < 0.001). Completeness of the main incision was comparable (97% vs 95%; p = 0.721) between the two groups. Although not statistically significant, the completeness of side-port incision was slightly better in the group 2 than the group 1 (91% vs 86%). Low energy laser system performed significantly better in terms of completeness of capsulotomy, intraoperative miosis and sub-conjunctival hemorrhage, compared with high energy laser; the CCI outcomes were comparable.

During toric intraocular lens (IOL) implantation, surgeons must take particular care to ensure that inaccurate preoperative measurement and intraoperative misalignment do not cause unexpected postoperative residual astigmatism. This retrospective, comparative case series study aimed to analyze the rotational deviation, or cyclotorsion, of three corneal marking methods: VERION digital marker (VDM; reference), horizontal slit beam marking (HSBM), and subjective direct visual marking (SDVM) on the table (using a bevel knife tip). Subjects included 81 eyes of 61 patients (mean age: 65.70±13.14 years; range: 32–91 years) undergoing scheduled cataract surgery. A preoperative reference image was taken of each eye. Subsequently, a slit lamp with the light beam turned to the horizontal meridian was used to align the seated patient’s head, and two reference marks were placed at the 3- and 9-o’clock positions of the corneal limbus using a 27-gauge needle and marking pen (HSBM). Upon transfer to the surgical table, the VDM was used to display a real-time dial scale on the patient’s eye, with the entrance of the temporal clear corneal incision (CCI) at 0° (horizontal meridian). Simultaneously, a bevel knife tip was used to create a marker based on the surgeon’s visual determination of the temporal 0° point (SDVM). We used the VDM to quantitatively evaluate the accuracy of axis alignment via deviation from the horizontal reference meridian. Compared with the reference meridian, the SDVM (−3.46°±7.32°, range: −18° to 13°) exhibited greater average relative cyclotorsion versus the HSBM (0.41°±4.92°, range: −10° to 10°). Furthermore, the mean average misalignment was significantly less in the HSBM group versus the SDVM group (t=4.179, P<0.001). The VDM is likely a reliable marking method, similar to the HSBM. In contrast, the SDVM is not entirely reliable. The VDM usage may prevent inaccurate preoperative manual marking during toric IOL implantation.

PurposeTo assess the corneal keratometric values obtained using the VERION image-guided surgery system and other devices.MethodsThis study evaluated the right eyes of 115 cataract patients before intraocular lens (IOL) implantation through consecutive tests using 5 devices: VERION Reference Unit, Placido-based corneal topography (OPD-Scan III), monochromatic light-emitting diodes (LenStar LS900 and AL-Scan), and rotary prism technology (auto kerato-refractometer KR-8800). Analyzed parameters were corneal steep and flat keratometric values (Ks and Kf) and corneal astigmatism and axis. These parameters were evaluated using the one-sample two-tailed t-test and the 95% limits of agreement (95% LOAs) between the devices.ResultsThe mean corneal cylinder value measurements were −0.97±0.63 D, −0.88±0.60 D, −0.90±0.69 D, −0.90±0.67 D, and −0.83±0.60 D with VERION, LenStar, AL-Scan (2.4 mm), OPD III, and KR-8800, respectively. Only KR-8800 showed a significant difference from VERION in the corneal cylinder value (P<0.05). The mean differences in the Kf and Ks of VERION compared to those of OPD III were 0.18±0.45 D and 0.17±0.38 D (P<0.05), respectively. The 95% LOAs of Bland–Altman analysis for the corneal astigmatism axis of the VERION with LenStar, AL-Scan (2.4 mm), OPD III, and KR-8800 were −26.25° to 58.71°, −20.61° to 47.44°, −25.03° to 58.98°, and −27.85° to 65.17°, respectively.ConclusionNone of the VERION parameters were significantly different from those of AL-Scan and LenStar. AL-Scan (2.4 mm zone) was especially similar to VERION. Wide LOAs are potential contributors to axis error in patients with toric IOL implants.

The purpose of the study is to compare the total ultrasound power used between eyes undergoing different lens fragmentation patterns of femtosecond laser-assisted cataract surgery (FLACS) and conventional phacoemulsification surgery (CPS). A total of 506 patient eyes underwent preoperative grading of lens opacity using the Lens Opacity Classification System III (LOCSIII). The eyes were divided into two subgroups: subgroup 1 had a LOCSIII grade of 1–3, and subgroup 2 had a LOCSIII grade of 4–6. The eyes underwent FLACS (LenSx) for clear corneal wound, capsulotomy, and lens fragmentation. Either a grid pattern or radial pattern was used for lens fragmentation. The eyes received one of the following three treatments: (1) CPS without femtosecond laser assistant, (2) FLACS with a grid pattern (FGP) lens fragment, or (3) FLACS with a quadrant pattern (FQP) lens fragment. The mean cumulative dispersed energy (CDE) for each subgroup and treatment was evaluated. The mean CDE was lower in the two FLACS groups (1.21±1.91 in FGP and 1.22±1.92 in FQP) than that in the CPG group (2.67±2.84). In subgroup 1, CDE was higher in the CPG group (1.54±1.18) as compared with the FLACS groups (0.16±0.31 in FGP and 0.74±1.17 in FQP; P<0.001). In subgroup 2, CDE was higher in the CPG (6.47±3.46) as compared with the FLACS groups (2.74±2.21 in FGP and 5.34±2.17 in FQP; P<0.001). CDE was lower in the two FLACS groups than that in the CPS group, and CDE was the lowest with FGP in both subgroups 1 and 2.

Purpose To investigate the feasibility of a new method involving the use of the Verion image-guided system in preventing cyclorotation during femtosecond laser-assisted cataract surgery (FLACS). Patients Our preliminary data included details of 24 consecutive patients. All patients underwent cataract surgery at Universal Eye Center, Zhong-Li, Taiwan, between December 2016 and January 2017. Methods We developed a technique to use the Verion image-guided system in FLACS and evaluated whether this new technique is compatible with Femto LDV Z8. The Verion image-guided system was used to prevent misalignments. The only additional step in this technique is using a marking tool to place ink on the corneal limbus (at 3 and 9 o’clock positions) guided by the Verion digital marker system. Remaining procedures could be performed using the touchscreen of Femto LDV Z8 to calibrate the horizontal reference axis. Results This study included 24 patients who underwent cataract surgery. The technique used could effectively neutralize misalignments at an average of 8.08° and 2.66° in clockwise and counterclockwise directions, respectively. Conclusion This technique combines the advantages of iris fingerprinting technology and mobile features of Femto LDV Z8, has fewer transfer steps, improves centration of the eyes, and, most importantly, can prevent misalignments through cyclotorsion or docking procedures. Furthermore, this method can improve the accuracy of arcuate incisions and toric intraocular lens alignment in astigmatism correction.