Advances in cataract surgery

Abstract

Newly emerging cataract surgical techniques cause comparable ECL to that of conventional phacoemulsification. Femtosecond laser-assistance may reduce ECL, but likely only in the early postoperative period. Further studies are needed to better elucidate short and long-term effects of FLACS on the corneal endothelium. Viscous dispersives may offer equal or increased protection of the corneal endothelium during surgery compared with viscoelastic devices currently in wide use, but further studies are required to support these results.

Comparing the Curative Effects between Femtosecond Laser-Assisted Cataract Surgery and Conventional Phacoemulsification Surgery: A Meta-Analysis

“…In addition, there is limited regenerative capacity of the corneal endothelium, a process that involves the self-repair of the endothelium through cell enlargement and migration. [ 12 ] That is, once the self-repair capacity of endothelium has been exceeded, long-term injury not only impacts the function of the endothelium but also its ability to withstand further injury. Therefore, when observing the different results at different time-points, it can be deduced that the reduction in EPT and phacoemulsification power not only contributes to reduced endothelial cell loss but also to the preservation of endothelial function and resistance to injury.…”

“…The corneal endothelium is responsible for maintaining corneal transparency and normal thickness. [ 12 ] Central corneal thickening always accompanies endothelial cell loss. When endothelial cell density significantly decreases, corneal edema may develop.…”

“…When endothelial cell density significantly decreases, corneal edema may develop. [ 12 ] The central cornea in the CPS group was thicker than in the FLACS group at one day, one month, and three to six months postoperatively, suggesting that endothelial pump function was impaired, leading to corneal swelling. In addition, reduced corneal edema leads to faster visual recovery after IOL implantation.…”

“…Previous studies have shown that the pre-treatment of cataracts with lasers using FLACS leads to a reduced IOL tilt and improved biometry predictability. [ 7 , 10 , 11 ] The corneal endothelium plays an important role in maintaining corneal transparency and normal thickness [ 12 ], and phacoemulsification time and energy are known to directly cause endothelial cell loss. [ 13 – 15 ] Many recent studies have found that FLACS helps to reduce effective phacoemulsification time (EPT) and the required phacoemulsification energy, thereby diminishing corneal endothelial injury.…”

Standard manual capsulorhexis / Ultrasound phacoemulsification compared to femtosecond laser-assisted capsulorhexis and lens fragmentation in clear cornea small incision cataract surgery

“…The results in our study indicate that in the femtosecond laser group-B the mean ultrasound energy required for phacoemulsification was reduced by 65 % and the phacoemulsification time by 52 % (both p < .001). The reduced phacoemulsification time and dissipated energy (CDE) may correlate to reduced effect to the endothelial cells [ 39 ]. The reports in the peer-review literature are, however, inconclusive: some studies report adverse effect to the corneal endothelial cells by femto-second laser incisions [ 40 ], while other studies demonstrate a rather comparable endothelial cell loss between manual ultrasound phacoemulsification and femto-second assisted cataract surgery [ 41 ].…”