Bimanual femtosecond laser-assisted cataract surgery compared to standard bimanual phacoemulsification: A case–control study

Abstract

Purpose: To evaluate the efficacy and safety of bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions compared to standard bimanual phacoemulsification (bimanual microincision cataract surgery). Design: Prospective, non-randomized comparative case series. Methods: Bimanual femtosecond laser-assisted cataract surgery with microincisions was performed on 80 eyes (Group A) with the low-energy Ziemer LDV Z8; a matched case–control series of 80 eyes performed with standard bimanual microincision cataract surgery technique was selected for comparison (Group B). All interventions were performed by the same experienced surgeon. Intraoperative parameters were recorded as well as intra- and postoperative complications. Best corrected visual acuity, surgically induced astigmatism, central corneal thickness and endothelial cell count were evaluated before surgery and at 1 and 3 months post intervention. Results: The mean effective phaco times were 3.79 ± 2.19 s (Group A) and 4.49 ± 1.84 s (Group B) (p = 0.041). No major intra- or postoperative complications occurred. An overall significant mean best corrected visual acuity improvement was noted at 3 months, but was not statistically different between the groups. No significant changes were observed for surgically induced astigmatism or corneal pachymetry. A significant loss of endothelial cell count in both groups was detected at 3 months, with Group A reporting a significantly lower endothelial cell count loss compared to Group B (p = 0.009). Conclusion: Bimanual, low-energy femtosecond laser-assisted cataract surgery with 1.4-mm microincisions by an expert surgeon was proven to be safe and effective in this study. This technique has advantages compared with standard bimanual microincision cataract surgery in terms of endothelial preservation.

Long-Term Evaluation of Capsulotomy Shape and Posterior Capsule Opacification after Low-Energy Bimanual Femtosecond Laser-Assisted Cataract Surgery

“…Recently, we published a paper about the safety and effectiveness of the combination of FLACS with bimanual technique [ 11 ]. However, the usefulness of FLACS is still debated since recent meta-analyses showed no statistically significant differences with standard manual cataract surgery in terms of visual and refractive outcomes and general complications [ 2 – 5 ].…”

“…This is likely due to the reduction in phaco energy, which has been shown to harm the endothelium. The positive impact of FLACS on the endothelium has been widely reported in the literature regardless of the femtolaser system used [ 11 , 40 – 45 ] even though recently a few papers reported on no significant differences in endothelial cell loss between the two techniques [ 46 , 47 ]. The present study reports on a longer follow-up period, and the results are obtained from a low-energy femtosecond laser, which is a first report according to our knowledge.…”

“…All interventions were performed using the same phacoemulsifying machine (Faros, Oertli Instruments AG, Berneck, Switzerland). Standard B-MICS and FLACS surgery using the bimanual technique with the LDV Z8 and IOL implantation through a 1.4 mm incision have been previously described [ 11 ].…”

“…Bimanual microincision cataract surgery (B-MICS) is a variant of traditional coaxial phacoemulsification characterized by its incisional microinvasiveness (1.4 mm incisions) [ 7 , 8 ]. The increased stability of the anterior chamber, the separation of the aspiration and the infusion probe together with the small instrument size, and greater visibility of the surgical field make it a safe and effective technique to be used in combination with a femtosecond laser [ 9 – 11 ].…”

Comparison of the selected parameters of the anterior segment of the eye between femtosecond laser-assisted cataract surgery, microincision cataract surgery, and conventional phacoemulsification

“…[46,48] Other authors in their studies also were no noted any differences in CCT between studied groups. [34,40,45,50] On the other hand, the irrigation solution volume used during the entire procedure should be taken into account. In the group B and in the group C we reported a statistically significant higher usage of volume intraoperative irrigation solution compared to FLACS group consumption which may have an impact on increase of hydrodynamic flow and turbulence in the anterior chamber potentially damaging endothelial cells.…”