Comparison of ultrasound energy consumption between low-energy femtosecond laser-assisted cataract surgery and conventional phacoemulsification cataract surgery in patients with different cataract densities

Abstract

Purpose Femtosecond laser-assisted cataract surgery (FLACS)'s effect on reducing ultrasound energy, accumulated with cumulative dispersed energy (CDE) units, still remains controversial. This study aims to evaluate the effect of low-energy FLACS on CDE with that of conventional phacoemulsification surgery (CPS) in different cataract densities from multiple surgeons. Methods It was a retrospective case–control study. Total 629 eyes receiving either low-energy FLACS (performed with Ziemer LDV Z8 platform) or CPS were divided into two groups according to preoperative grading of Lens Opacity Classification System III (LOCSIII): milder and harder cataract group. The mean CDE were compared in different cataract densities and surgeons. A linear regression analysis was performed to evaluate the effect of using low-energy FLACS on CDE in harder cataract cases. Results We found overall CDE had no significant difference between two surgeries. However, low-energy FLACS led to a significantly lower CDE in patients with harder cataracts than CPS (18.47 ± 4.32 vs. 12.96 ± 2.34; p < 0.001). Similar results were observed in the three surgeon subgroups and in linear regression analysis and no significant difference of the effect accounting for surgeons. Moreover, low-energy FLACS results in a reduction of energy consumption comparing to CPS and has endothelial sparring effect in patients with harder cataracts. Conclusions The reduced energy consumption was observed by using low-energy FLACS irrespective of surgeons’ experience or the approaches adopted in patients with harder cataracts. Therefore, we can have more confidence to suggest this innovative platform to the patients in such cases.

The use of lens anterior capsule disc for corneal endothelium protection during femtosecond laser-assisted cataract surgery in eyes with low endothelial cell density

“…FLACS results in a reduction of energy consumption with lower cumulative dispersed energy (CDE) comparing to PCS and has endothelial sparring effect especially in patients with harder cataracts. 26 , 27 When compared to conventional PCS, nuclear fragmentation with FLACS also lessens intraoperative ultrasound energy and intraocular manipulations. 28 We believed that the LACD technique offers extra protection in addition to FLACS, which already reduces the risk of damage to the CEC.…”

Update on Femtosecond Laser-Assisted Cataract Surgery: A Review

“…Hard or dense cataracts can be an indication for FLACS, as laser fragmentation of the lens nucleus reduces the total phacoemulsification time, EPT, and CDE, lowering the risk of corneal endothelial loss. 123 …”

“…Hard or dense cataracts can be an indication for FLACS, as laser fragmentation of the lens nucleus reduces the total phacoemulsification time, EPT, and CDE, lowering the risk of corneal endothelial loss. 123 FLACS may be indicated in complex cases with challenging capsulotomies, such as traumatic subluxated cataracts or zonular instability, intumescent cataracts, and pseudoexfoliation syndrome, by reducing the stress on the zonular fibers and posterior capsule, consequently lowering the rate of postoperative complications. Cataract grade can help determining the choice of FLACS over CP, as the lower EPT or CDE associated with FLACS can be beneficial in hard cataracts, translated into a faster visual recovery; 124,125 in the same manner, eyes with particular conditions, such as shallow anterior chambers, can benefit from such approach.…”